NCLEX Must-Knows

• Antidote for Benzodiazepines
• Do not give Flumazenil to clients with ↑ ICP or status epilepticus, it will aggravate the problem. 
• ICP will increase even more
• Seizures/epilepsy will get worse

• Dilute with NS only.  It will precipitate in D5W
• Give slow to prevent cardiac dysrhythmias.  Give about 50mg/minute or less.
• Causes birth defects if given in pregnancy. 
• For pregnancy, use phenobarbital for seizures instead.
• Phenytoin decreases effectiveness of birth control.

• Never stop anticholinergics abruptly because symptoms of parkinsonism will occur: rigidity, tremors, bradykinesia, akinesia, shuffling gait, and masked facies.
• Anticholinergics
  • atropine
  • benztropine
  • glycopyrrolate
  • scopolamine
  • trihexyphenidyl
  • diphenhydramine
  • flavoxate
  • oxybutynin
  • orphenadrine

• Treats Parkinson’s Disease
• Do not take with MAOI to prevent hypertensive crisis

• Atropine is an anticholinergic
• When doing an edrophonium/Tensilon test, you must have it ready.
• Tensilon test: Determines whether a client with myasthenia gravis is having a myasthenic crisis or a cholinergic crisis.  
• Tensilon or edrophonium is a cholinergic medication.
• If after receiving edrophonium, the client gets better (less weakness), the client is having a myasthenic crisis and needs more medication.
• If after receiving edrophonium, the client gets weaker, the client is having a cholinergic crisis or getting too much medication. 
• Atropine must be ready to be injected in case the client has a severe cholinergic crisis after receiving edrophonium.

Atropine is an Anticholinergic and this is what it does.  Notice that it increases heart rate

Edrophonium is a cholinergic and this is what it does

• A cholinergic 
• Bethanechol is used for urinary retention because it causes urination

• Do not give if the client has a urinary obstruction or stricture.  The bladder will explode.

• Stop 48 hours prior to a procedure with iodinated contrast to prevent lactic acidosis

• Monitor for respiratory depression.  This is the priority concern.

• Do not give to clients with hepatic disease or alcoholism.
• Antidote is Acetycysteine

• Avoid in children under 15 to prevent Reye’s syndrome (encephalopathy and liver failure)
• Monitor platelets
• Drug of choice to prevent heart attacks and strokes.

• Give with a full glass of water 
• Drink lots of water to prevent crystalluria
• Urine output must be good

• Do not give if client develops a rash.
• Notify MD
• One example is Bactrim (sulfamethoxazole and trimethoprim)

• Rifampin, a tuberculosis medication, will cause urine, saliva, sputum, sweat, teeth, and tears to turn a reddish-orange to reddish-brown color.
• It is a harmless side effect.
• Will stain clothes permanently

Examples:

• • Baclofen 
  • Carisoprodol
  • Cyclobenzaprine 
  • Dantrolene 
  • Metaxalone 

• Primary concern is safety since they cause drowsiness: High risk for falls
• Monitor liver function test since they are hepatotoxic

• Do not take with aspirin to prevent elevation of uric acid
• Encourage client to take acetaminophen for pain instead. 

• Urinary antispasmodic agents increase bladder capacity, delay the desire to void, decrease the frequency and urgency to urinate, and reduce pain caused by difficulty in urination.
• Examples: Oxybutynin, flavoxate, and tolterodine.
• These medications are anticholinergics
• Notice how anticholinergics cause urinary retention.  So if a client has an overactive bladder (peeing here and there), a drug that causes some urinary retention can be useful. 

• Treat Angina
• Vasodilate coronary arteries
• Number one side effect is headache. Expected since brain vessels are also dilated
• Check expiration date because if expired, they do not work.
• Monitor for hypotension

• Educate client to report must pain since it could be rhabdomyolysis

• Treatment for hyperthyroidism
• Causes agranulocytosis.
• Report fever, sore throat or any signs of infection
• Use propylthiouracil during the first trimester then can switch to Methimazole to prevent birth defects.

Educate client about the following toxicities:

• Cause hepatotoxicity
• Nephrotoxicity
• Neurotoxicity
• Ototoxicity

• Treat Osteoporosis
• These include: Alendronate (Fosamax), a weekly pill. Risedronate (Actonel), a weekly or monthly pill.
• Can cause esophagitis
• Take early in the morning for full glass of water and remain sitting or standing
• Do not eat anything for at least 30 minutes

• Can be absorbed into the systemic circulation especially in permeable areas of the skin such as perineum, eyelids, face and neck. 
• Less likely to be absorbed in palms and soles of feet.

• Super teratogenic
• Causes fatal fetal abnormalities
• Strictly no pregnancy
• Must be on birth control

• Stains teeth
• Give using a straw 
• Brush teeth after administration

• Do not use Meperidine in pediatrics due to the risk of normeperidine-induced seizures
• In adults, be careful when giving large doses.
• Remember Meperidine and Seizures!

• Given to promote labor
• Discontinue for:
  • Uterine contraction frequency < 2 minutes
  • Uterine contraction duration > 90 seconds
  • Fetal distress

• Cyclophosphamide is used in the management and treatment of neoplasms, including multiple myeloma, sarcoma, and breast cancer.
• Causes Hemorrhagic cystitis
• Increase fluid intake

• As cancer drugs destroy cancer cells, uric acid is released. 
• Allopurinol is given to decrease uric acid levels.
• Also used in gout to prevent elevation of uric acid.
• Not for acute gout.

•  Used to treat the symptoms of asthma, bronchitis, emphysema, and other lung diseases.
• Toxicity occurs at levels > 20 mcg/ml.
• Signs of toxicity: Nausea, Vomiting, Restlessness, nervousness, tremors, palpitations, tachycardia, seizures and even death.

• These are short acting insulins that can be given IV