Nursing Pharmacology Lecture Notes

Introduction

• Focus: Nursing pharmacology questions for the NCLEX exam.
• Presenter: Nurse Sarah.

Case Study 1: Serotonin Syndrome

• Patient Details: 36-year-old, symptoms include diaphoresis, shivering, muscle rigidity, irritability, tachycardia (HR 140 bpm), hyperthermia (Temp: 102.6°F).
• Medical History: Depression, diabetes, atrial fibrillation, hypertension.
• Current Medications: Sertraline (SSRI).
• Key Concern: Serotonin syndrome due to combination of sertraline with dextromethorphan (cough suppressant affecting serotonin).
  • Symptoms of Serotonin Syndrome: Sweating, shivering, muscle rigidity, irritability.

Case Study 2: Statin-Induced Muscle Damage

• Patient Details: Taking simvastatin, reports muscle soreness and weakness.
• Key Concern: Statin can cause rhabdomyolysis.
  • Lab Test to Monitor: Increased creatine kinase (CK) levels indicate muscle damage.
• Other Findings: Increased HDL is not alarming; desired high HDL level.

Case Study 3: Heparin Adverse Reactions

• Medication: Continuous IV heparin drip.
• Key Monitoring: Partial Thromboplastin Time (PTT).
• Adverse Reactions:
  • Hematuria: Blood in urine indicates bleeding.
  • Decreasing platelets: Heparin-induced thrombocytopenia.
  • Low hemoglobin and hematocrit: Indicates potential bleeding.
  • Positive stool guaiac test: Occult blood in stool.
  • Non-Issue: Increased glucose is not related to heparin.

Case Study 4: Gentamicin Peak Levels

• Medication: Gentamicin (aminoglycoside antibiotic).
• Key Monitoring: Nephrotoxicity and ototoxicity.
• Peak Level Timing: Draw 30 minutes after a 30-minute IV infusion for peak concentration.

Case Study 5: Diltiazem and Heart Blocks

• Medication: Diltiazem (calcium channel blocker).
• Key Monitoring:
  • Do not administer with third-degree AV block.
  • Hold if heart rate is 46 bpm.
• Non-Concerns: High BP, atrial fibrillation indication.

Case Study 6: Captopril and ECG Changes

• Medication: Captopril (ACE inhibitor).
• Key Issues: Hyperkalemia indicated by tall, peaked T-waves on ECG.
• Non-Issues: Dry cough is a common side effect; normal urinary output.

Case Study 7: Ethylene Glycol Poisoning

• Antidote: Fomepizole inhibits toxic metabolite formation.
• Non-Antidotes: Acetylcysteine (Tylenol), Naloxone (opioids), Deferoxamine (iron).

Case Study 8: Digoxin Toxicity Risk

• Medications: Digoxin and furosemide (Lasix).
• Key Monitoring: Hypokalemia (K+ = 3 mEq/L) increases digoxin toxicity risk.

Case Study 9: Warfarin and High INR

• Medication: Warfarin (Coumadin), INR level 6.
• Nursing Action: Hold dose and notify healthcare provider. Avoid administering or doubling dose.

Case Study 10: Cefazolin Allergy Concern

• Medication: Cefazolin (cephalosporin antibiotic).
• Key Concern: Cross-sensitivity with penicillin allergies.

Conclusion

• Further video resources available for more pharmacology questions.