Overview
Concise notes from a pharmacology NCLEX review video covering key drugs, test-taking strategies, and clinical judgment about labs, potency, adverse effects, and indication matching.
Lithium: Indication, Labs, and Electrolyte Interaction
- Lithium is the drug of choice for bipolar disorder; it is an electrolyte and a metal.
- Lithium levels are influenced by sodium; electrolytes interact and affect clinical status.
- As sodium increases, lithium decreases; patient more prone to mania.
- As sodium decreases, lithium increases; patient more prone to toxicity.
- Prioritize reporting lithium-related concerns over unrelated normals in lab sets.
Potency Concept and Opioid Comparison
- Potency means drug strength; how much is needed for effect, not route dependent.
- Route affects absorption and dosing amount, but not intrinsic potency.
- Fentanyl requires extremely small doses for effect; highly potent and overdose risk.
Opioid Dose Examples and Relative Potency
| Drug | Example Dose for Pain Relief | Key Point |
|---|
| Oxycodone (in Percocet) | 10 mg | Combined with acetaminophen; moderate potency |
| Hydromorphone | 1 mg | More potent than oxycodone |
| Ketorolac | 60 mg | Non-opioid analgesic; far less potent than opioids |
| Fentanyl | 0.1 mg (100 mcg) | Most potent among listed; small dose effective |
Adverse Effects vs Side Effects: Decision Strategy
- Side effects: expected, manageable; do not stop drug or call provider.
- Adverse effects: concerning, potentially dangerous; stop drug and notify provider.
- Common side effects: GI symptoms (nausea, diarrhea), headache; manage symptomatically.
- Concerning signs: rash, wheezing, bleeding, hemorrhage, chest pain, severe edema, cancer.
Applying the Strategy to Piperacillin–Tazobactam
- Nausea: side effect; advise taking with food or provide antiemetic.
- Diarrhea: side effect; GI effects are common and managed.
- Headache: side effect; treat with acetaminophen as needed.
- Rash: adverse effect; possible allergy; contact provider.
- Wheezing: adverse effect; possible allergic reaction; contact provider.
Smoking Cessation: Indication Matching
- Varenicline is indicated for smoking cessation; brand commonly known as Chantix.
- Dutasteride treats benign prostatic hyperplasia; not for cessation.
- Sildenafil treats erectile dysfunction; not for cessation.
- Aripiprazole is an atypical antipsychotic; not for cessation.
Drug-Use Matching for Smoking Cessation Question
| Generic Name | Indication | Select for Smoking Cessation? |
|---|
| Varenicline | Smoking cessation | Yes |
| Dutasteride | BPH | No |
| Sildenafil | Erectile dysfunction | No |
| Aripiprazole | Atypical antipsychotic | No |
Allergic Rhinitis: Selecting Appropriate Therapy
- Severe allergic rhinitis targets nasal symptoms; route should match nasal site.
- Fluticasone nasal spray is appropriate for allergic rhinitis (intranasal steroid).
- Methylprednisolone systemic steroid is overkill for nasal allergies.
- Montelukast (Singulair) is inhaled/oral for asthma/allergy control; route mismatch for isolated rhinitis.
- Memantine is not for allergies; inappropriate.
Allergic Rhinitis Medication Selection
| Drug | Class/Route | Use in Severe Allergic Rhinitis? | Rationale |
|---|
| Fluticasone (nasal) | Intranasal corticosteroid | Yes | Direct nasal anti-inflammatory effect |
| Methylprednisolone | Systemic corticosteroid | No | Overly broad; not first-line for nasal symptoms |
| Montelukast | Leukotriene modifier (inhaled/oral) | No (route mismatch) | Not targeted to nasal route here |
| Memantine | NMDA antagonist | No | Not indicated for allergies |
Key Terms & Definitions
- Potency: amount of drug needed to achieve effect; lower dose needed means higher potency.
- Side effect: expected, manageable effect; typically do not stop medication.
- Adverse effect: harmful, unexpected effect; stop medication and notify provider.
- Allergic rhinitis: nasal congestion and allergy symptoms; treat with intranasal agents.
Action Items / Next Steps
- Memorize indication–drug pairs: lithium–bipolar; varenicline–smoking cessation; fluticasone–allergic rhinitis.
- Practice distinguishing side effects vs adverse effects; prioritize safety signs.
- Remember sodium–lithium relationship for lab interpretation and toxicity risk.
- Compare opioid doses to infer potency; recognize fentanyl’s high potency and risk.