-olol = beta blocker. 'Block the BASH' — Bradycardia, AV block, Spasm (broncho), Hypotension.
Beta Blocker Side Effects
The most tested drug class on NCLEX — know the suffix and the side effects cold
All beta blockers end in -olol (metoprolol, atenolol, propranolol, carvedilol). Block beta-1 (heart) and beta-2 (lungs) receptors. Side effects — BASH: Bradycardia (hold if HR <60), AV block, Bronchospasm (avoid in asthma/COPD), Sexual dysfunction, Hypotension. Never stop abruptly — taper to avoid rebound hypertension and angina. Check apical pulse before giving. Used for: HTN, heart failure, angina, dysrhythmias, post-MI.
One of the highest-yield drug classes — the cough and angioedema are classic NCLEX traps
All ACE inhibitors end in -pril (lisinopril, enalapril, captopril, ramipril). Block conversion of angiotensin I → II → less vasoconstriction, less aldosterone → lower BP + less sodium/water retention. Key side effects: Dry hacking cough (most common reason stopped — switch to ARB). Angioedema: life-threatening swelling of airway — STOP immediately, epinephrine. Hyperkalemia (blocks aldosterone). Teratogenic (category D/X) — never in pregnancy. First-dose hypotension. Check K+ and creatinine.
Cough
Dry hacking — most common SE
Angioedema
Airway swelling — STOP, give epinephrine
Potassium ↑
Monitor K+ levels
hypOtension
Especially first dose
Pregnancy X
Teratogenic — never give
Renal
Can worsen renal failure
Digoxin Toxicity
Digoxin toxicity: early = GI (nausea, vomiting, anorexia) + visual (yellow-green halos). Hold if HR <60.
Digoxin
The classic narrow therapeutic index drug — toxicity is a NCLEX favorite
Digoxin: cardiac glycoside — slows HR (negative chronotrope), strengthens contraction (positive inotrope). Therapeutic level: 0.5–2 ng/mL. Toxicity signs — early GI: nausea, vomiting, anorexia. Visual: yellow-green halos around lights (classic). Cardiac: bradycardia, heart block, dysrhythmias. Hypokalemia potentiates toxicity (K+ competes at same receptor). Antidote: Digibind (digoxin immune fab). Hold if apical pulse <60. Assess K+ before giving. Toxicity treated with: hold drug, K+ replacement, Digibind for severe.
Early
Nausea, vomiting, anorexia
Visual
Yellow-green halos
Cardiac
Brady, blocks, dysrhythmias
Risk factor
Hypokalemia — K+ check first
Antidote
Digibind — digoxin immune fab
Warfarin (Coumadin)
Warfarin: monitor PT/INR (normal INR 2–3 for most, 2.5–3.5 for mechanical valves). Antidote: Vitamin K.
Warfarin Nursing
The original anticoagulant — full of interactions and monitoring requirements
Vitamin K antagonist — inhibits clotting factors II, VII, IX, X. Monitor INR (not PTT — that's heparin). Therapeutic INR: 2–3 (most indications), 2.5–3.5 (mechanical heart valves). Foods high in Vitamin K (green leafy vegetables) DECREASE warfarin effect — consistent intake, not elimination. Drug interactions: enormous — antibiotics, NSAIDs, many others. Antidote: Vitamin K (slow, oral/IV) or FFP (fast, emergency). Bleeding precautions: soft toothbrush, electric razor. Hold for procedures. Takes 3–5 days to reach therapeutic level.
Fast-acting anticoagulant — the aPTT and antidote are high-yield NCLEX content
Heparin activates antithrombin III → inhibits thrombin and factor Xa. Monitor aPTT (activated partial thromboplastin time) — therapeutic: 60–100 seconds (1.5–2.5× normal of ~40 sec). NOT INR (that's warfarin). Antidote: protamine sulfate. HIT (Heparin-Induced Thrombocytopenia): paradoxical clotting — check platelets. If platelets drop >50% → STOP heparin, switch to argatroban. LMWH (enoxaparin/Lovenox): does NOT require monitoring, give SubQ, do not rub. Overdose signs: bleeding — gums, urine (hematuria), stools (melena).
The most NCLEX-tested pain medication — respiratory depression is priority
Opioids (morphine, oxycodone, hydromorphone, fentanyl): bind mu receptors. Side effects — COAT: Constipation (always give stool softener), Over-sedation, Aspiration risk (nausea/vomiting), respiratory depression (most dangerous). Respiratory depression: RR <12, O2 sat dropping → administer naloxone (Narcan). Tolerance: need more for same effect. Physical dependence: withdrawal if stopped abruptly. Assess pain BEFORE giving, reassess 30–60 min after. Naloxone: short-acting — may need repeat doses. Hold if RR <12.
Three classes of diuretics — knowing which loses and which spares potassium saves patients
Loop diuretics (furosemide/Lasix, bumetanide): most potent. Act in loop of Henle. Lose K+, Na+, Mg2+, Ca2+. Monitor K+ — hypokalemia potentiates digoxin toxicity. Ototoxicity (hearing loss) — avoid with other ototoxic drugs. Thiazides (HCTZ, chlorthalidone): act in DCT. Also lose K+. Used for HTN. Potassium-sparing (spironolactone, triamterene): act in collecting duct. KEEP K+ — monitor for hyperkalemia. Spironolactone: anti-aldosterone, used in heart failure. Osmotic (mannitol): draws fluid out of brain — used for cerebral edema. Monitor I&O and daily weights for all diuretics.
Loop
Furosemide — loses K+, ototoxic
Thiazide
HCTZ — loses K+, used for HTN
K-sparing
Spironolactone — keeps K+
Osmotic
Mannitol — cerebral edema
Antibiotics — Nursing Considerations
Before antibiotics: always get culture first. Check allergies. Monitor for superinfection (C. diff, thrush).
Antibiotic Nursing Care
Cross-class nursing considerations that apply to every antibiotic — high-yield for NCLEX
Culture before antibiotics — 'culture before cure.' Allergy history: penicillin allergy — 1–10% cross-reactivity with cephalosporins. Anaphylaxis kit at bedside after first dose. Aminoglycosides (gentamicin, tobramycin): nephrotoxic + ototoxic — monitor BUN/creatinine, peak/trough levels. Fluoroquinolones: tendon rupture risk, avoid in children. Tetracyclines: avoid in pregnancy, children <8 (discolors teeth), take with full glass of water, no dairy. Superinfection: C. diff (watery diarrhea after antibiotics — contact precautions), oral thrush. Complete the full course.
First
Culture before giving antibiotic
Aminoglycosides
Monitor renal function, peak/trough
Fluoroquinolones
Tendon rupture risk
Tetracyclines
No dairy, no pregnancy, no <8 yr
Superinfection
C. diff, oral thrush — monitor
Insulin
Insulin types: Rapid (Lispro), Short (Regular — only IV), Intermediate (NPH), Long (Glargine — no mixing). 'RINS'
Insulin Types and Nursing
The most dangerous medication nurses give — every detail matters
Rapid-acting (lispro/Humalog, aspart/NovoLog): onset 15 min, give WITH meal or right after. Short-acting (Regular/Humulin R): onset 30–60 min, only insulin given IV. Intermediate (NPH/Humulin N): onset 2–4 hr, cloudy — gently roll, never shake. Long-acting (glargine/Lantus, detemir/Levemir): no peak, 24 hr. NEVER mix glargine. Draw clear before cloudy (Regular before NPH). Hypoglycemia: BS <70, diaphoresis, tremor, confusion — give 15g fast carbs, recheck in 15 min (15-15 rule). Insulin sites: rotate — abdomen absorbs fastest.