Comprehensive Nursing Pharmacology: Disease Cautions,
Insulin, Cardiac Drugs, Antibiotics, Psych Meds, and Emergency
Reversals Exam #1 Questions with Correct Answers
Kidney disease / AKI / CKD - ✔✔Be extra careful with digoxin, gentamicin,
vancomycin, enoxaparin, DOACs, metformin, NSAIDs, potassium supplements,
lithium-like psych meds if present, many antibiotics. Monitor BUN, creatinine,
eGFR/CrCl, I&O.
Liver disease - ✔✔Be careful with amiodarone, acetaminophen-containing
products (Tylenol) , warfarin, statins if present, many psych meds, valproate if
present, metronidazole. Monitor AST/ALT, bilirubin, jaundice.
Asthma/COPD - ✔✔Nonselective beta blockers can worsen bronchospasm. Use
caution with carvedilol; metoprolol is beta-1 selective but still caution.
Aspirin/NSAIDs may trigger bronchospasm in aspirin-sensitive asthma.
GI bleed / peptic ulcer disease - ✔✔Avoid/caution with aspirin, NSAIDs,
anticoagulants, antiplatelets, corticosteroids. Teach black tarry stools, coffee-
ground emesis, unusual bleeding.
Pregnancy - ✔✔Avoid ACE inhibitors/ARBs, warfarin,
tetracyclines/fluoroquinolones usually, many anticonvulsants unless provider
determines benefit. Aspirin: avoid late pregnancy unless specifically ordered.
Heart block / bradycardia - ✔✔Hold/caution with digoxin, diltiazem, beta
blockers, clonidine, amiodarone. Check apical pulse and ECG parameters.
,Heart failure - ✔✔Avoid/caution with non-DHP calcium channel blockers like
diltiazem in decompensated HF. NSAIDs can worsen fluid retention. Watch beta
blockers during acute exacerbation.
Hyperkalemia - ✔✔Avoid/caution with ACE inhibitors, ARBs, spironolactone,
potassium supplements. Monitor K+.
Hypokalemia - ✔✔Raises digoxin toxicity risk and can worsen dysrhythmias.
Loop/thiazide diuretics can lower K+.
Seizure disorder - ✔✔Bupropion/tramadol if present lower threshold. Watch drug
interactions that lower anticonvulsant levels; abrupt withdrawal of
anticonvulsants can trigger seizures.
Myasthenia gravis - ✔✔Fluoroquinolones such as levofloxacin can worsen muscle
weakness. Aminoglycosides can worsen neuromuscular blockade.
Gallbladder disease - ✔✔Estrogens/ceftriaxone can be associated with biliary
sludge; opioids can worsen biliary colic by sphincter spasm. Monitor RUQ
pain/jaundice if relevant.
Rapid Insulin - ✔✔Examples: Novolog/aspart, Humalog/lispro; Onset: 10-30 min;
Peak: 0.5-3 hr; Duration: 3-5 hr. Give with meal in front of patient; hypoglycemia
risk fast.
Short Insulin - ✔✔Examples: Regular/Novolin R; Onset: 30-60 min; Peak: 2-4 hr;
Duration: 5-8 hr. Only insulin commonly given IV. Clear.
,Intermediate Insulin - ✔✔Examples: NPH/Novolin N; Onset: 1-2 hr; Peak: 4-12 hr;
Duration: 12-18 hr. Cloudy. Can mix with regular/rapid; draw clear before cloudy.
Long Insulin - ✔✔Examples: Lantus/glargine; Onset: 1-2 hr; Peak: No pronounced
peak; Duration: Up to 24 hr. Basal coverage; do not use for DKA rescue.
Mixture Insulin - ✔✔Examples: Novolog 70/30; Onset: 10-20 min; Peak: 1-4 hr;
Duration: Up to 24 hr. Contains rapid + intermediate; must eat soon.
Hypoglycemia signs - ✔✔Sweating, shakiness, tachycardia, hunger, headache,
confusion, irritability, seizures. Treat conscious patient with 15 g fast carbs and
recheck in 15 minutes per policy.
Digoxin (Lanoxin) - ✔✔Class: Cardiac glycoside; positive inotrope; slows AV
conduction. Used for: Heart failure, atrial fibrillation rate control.
Amiodarone - ✔✔Class: Class III antiarrhythmic. Used for: Life-threatening
ventricular dysrhythmias; AF rhythm/rate control.
Diltiazem (Cardizem) - ✔✔Class: Calcium channel blocker, non-DHP. Used for:
HTN, angina, SVT, AF/Aflutter rate control.
Nifedipine - ✔✔Class: Calcium channel blocker, dihydropyridine. Used for:
Hypertension, angina.
, Clonidine - ✔✔Class: Central alpha-2 agonist. Used for: Hypertension; withdrawal
symptoms; ADHD formulation exists.
Captopril - ✔✔Class: ACE inhibitor; Used for: Hypertension, HF, diabetic
nephropathy, post-MI
Captopril - DO NOT GIVE / USE CAUTION WITH - ✔✔Pregnancy, history of
angioedema, bilateral renal artery stenosis, hyperkalemia; caution AKI/CKD
Captopril - Labs/vitals to monitor - ✔✔BP, K+, BUN/Cr, urine protein if renal
disease
Captopril - Major side effects/toxicity - ✔✔Dry cough, hyperkalemia, hypotension,
renal dysfunction, angioedema
Captopril - Patient teaching - ✔✔Report face/lip/tongue swelling; avoid salt
substitutes; rise slowly; pregnancy warning
Captopril - Nursing implications/interventions - ✔✔Monitor first-dose
hypotension; hold/notify for angioedema; monitor K+/Cr after start
Captopril - Exam trap - ✔✔ACE = cough and angioedema; raises potassium.
Lisinopril - ✔✔Class: ACE inhibitor; Used for: Hypertension, HF, renal protection in
diabetes, post-MI
Insulin, Cardiac Drugs, Antibiotics, Psych Meds, and Emergency
Reversals Exam #1 Questions with Correct Answers
Kidney disease / AKI / CKD - ✔✔Be extra careful with digoxin, gentamicin,
vancomycin, enoxaparin, DOACs, metformin, NSAIDs, potassium supplements,
lithium-like psych meds if present, many antibiotics. Monitor BUN, creatinine,
eGFR/CrCl, I&O.
Liver disease - ✔✔Be careful with amiodarone, acetaminophen-containing
products (Tylenol) , warfarin, statins if present, many psych meds, valproate if
present, metronidazole. Monitor AST/ALT, bilirubin, jaundice.
Asthma/COPD - ✔✔Nonselective beta blockers can worsen bronchospasm. Use
caution with carvedilol; metoprolol is beta-1 selective but still caution.
Aspirin/NSAIDs may trigger bronchospasm in aspirin-sensitive asthma.
GI bleed / peptic ulcer disease - ✔✔Avoid/caution with aspirin, NSAIDs,
anticoagulants, antiplatelets, corticosteroids. Teach black tarry stools, coffee-
ground emesis, unusual bleeding.
Pregnancy - ✔✔Avoid ACE inhibitors/ARBs, warfarin,
tetracyclines/fluoroquinolones usually, many anticonvulsants unless provider
determines benefit. Aspirin: avoid late pregnancy unless specifically ordered.
Heart block / bradycardia - ✔✔Hold/caution with digoxin, diltiazem, beta
blockers, clonidine, amiodarone. Check apical pulse and ECG parameters.
,Heart failure - ✔✔Avoid/caution with non-DHP calcium channel blockers like
diltiazem in decompensated HF. NSAIDs can worsen fluid retention. Watch beta
blockers during acute exacerbation.
Hyperkalemia - ✔✔Avoid/caution with ACE inhibitors, ARBs, spironolactone,
potassium supplements. Monitor K+.
Hypokalemia - ✔✔Raises digoxin toxicity risk and can worsen dysrhythmias.
Loop/thiazide diuretics can lower K+.
Seizure disorder - ✔✔Bupropion/tramadol if present lower threshold. Watch drug
interactions that lower anticonvulsant levels; abrupt withdrawal of
anticonvulsants can trigger seizures.
Myasthenia gravis - ✔✔Fluoroquinolones such as levofloxacin can worsen muscle
weakness. Aminoglycosides can worsen neuromuscular blockade.
Gallbladder disease - ✔✔Estrogens/ceftriaxone can be associated with biliary
sludge; opioids can worsen biliary colic by sphincter spasm. Monitor RUQ
pain/jaundice if relevant.
Rapid Insulin - ✔✔Examples: Novolog/aspart, Humalog/lispro; Onset: 10-30 min;
Peak: 0.5-3 hr; Duration: 3-5 hr. Give with meal in front of patient; hypoglycemia
risk fast.
Short Insulin - ✔✔Examples: Regular/Novolin R; Onset: 30-60 min; Peak: 2-4 hr;
Duration: 5-8 hr. Only insulin commonly given IV. Clear.
,Intermediate Insulin - ✔✔Examples: NPH/Novolin N; Onset: 1-2 hr; Peak: 4-12 hr;
Duration: 12-18 hr. Cloudy. Can mix with regular/rapid; draw clear before cloudy.
Long Insulin - ✔✔Examples: Lantus/glargine; Onset: 1-2 hr; Peak: No pronounced
peak; Duration: Up to 24 hr. Basal coverage; do not use for DKA rescue.
Mixture Insulin - ✔✔Examples: Novolog 70/30; Onset: 10-20 min; Peak: 1-4 hr;
Duration: Up to 24 hr. Contains rapid + intermediate; must eat soon.
Hypoglycemia signs - ✔✔Sweating, shakiness, tachycardia, hunger, headache,
confusion, irritability, seizures. Treat conscious patient with 15 g fast carbs and
recheck in 15 minutes per policy.
Digoxin (Lanoxin) - ✔✔Class: Cardiac glycoside; positive inotrope; slows AV
conduction. Used for: Heart failure, atrial fibrillation rate control.
Amiodarone - ✔✔Class: Class III antiarrhythmic. Used for: Life-threatening
ventricular dysrhythmias; AF rhythm/rate control.
Diltiazem (Cardizem) - ✔✔Class: Calcium channel blocker, non-DHP. Used for:
HTN, angina, SVT, AF/Aflutter rate control.
Nifedipine - ✔✔Class: Calcium channel blocker, dihydropyridine. Used for:
Hypertension, angina.
, Clonidine - ✔✔Class: Central alpha-2 agonist. Used for: Hypertension; withdrawal
symptoms; ADHD formulation exists.
Captopril - ✔✔Class: ACE inhibitor; Used for: Hypertension, HF, diabetic
nephropathy, post-MI
Captopril - DO NOT GIVE / USE CAUTION WITH - ✔✔Pregnancy, history of
angioedema, bilateral renal artery stenosis, hyperkalemia; caution AKI/CKD
Captopril - Labs/vitals to monitor - ✔✔BP, K+, BUN/Cr, urine protein if renal
disease
Captopril - Major side effects/toxicity - ✔✔Dry cough, hyperkalemia, hypotension,
renal dysfunction, angioedema
Captopril - Patient teaching - ✔✔Report face/lip/tongue swelling; avoid salt
substitutes; rise slowly; pregnancy warning
Captopril - Nursing implications/interventions - ✔✔Monitor first-dose
hypotension; hold/notify for angioedema; monitor K+/Cr after start
Captopril - Exam trap - ✔✔ACE = cough and angioedema; raises potassium.
Lisinopril - ✔✔Class: ACE inhibitor; Used for: Hypertension, HF, renal protection in
diabetes, post-MI
