Pharmacology Flashcards for Nursing

Cardiovascular drugs are among the most commonly prescribed and most frequently tested medication classes. These cards cover antihypertensives, anticoagulants, antiarrhythmics, and heart failure medications.

ACE Inhibitors and ARBs

ACE inhibitors (lisinopril, enalapril) block angiotensin-converting enzyme, reducing the vasoconstrictor angiotensin II and aldosterone. They treat hypertension, heart failure, and diabetic nephropathy. The most common side effect is dry cough, which often leads to discontinuation. Watch for hyperkalemia and angioedema (rare but serious). Monitor potassium and renal function. ACE inhibitors are contraindicated in pregnancy.

ARBs (losartan, valsartan) block angiotensin II receptors directly. They offer similar benefits to ACE inhibitors without the cough. Side effects include hyperkalemia, hypotension, and angioedema (less common). Also contraindicated in pregnancy. Both drug classes are first-line for diabetic patients with hypertension.

Beta-Blockers and Calcium Channel Blockers

Beta-blockers (metoprolol, atenolol, propranolol) block beta-adrenergic receptors. They decrease heart rate, contractility, and conduction. Watch for bronchoconstriction in patients with asthma or COPD. Hold if heart rate is less than 60 or systolic BP below 100. Never stop abruptly, as this causes rebound tachycardia. Beta-blockers also mask hypoglycemia symptoms in diabetic patients.

Calcium channel blockers come in two types. Dihydropyridines (amlodipine, nifedipine) cause vasodilation and treat hypertension. Non-dihydropyridines (diltiazem, verapamil) also decrease heart rate and contractility, treating arrhythmias and angina. Do not combine with beta-blockers due to risk of severe bradycardia. Avoid grapefruit juice with all calcium channel blockers.

Anticoagulants

Warfarin (Coumadin) is a vitamin K antagonist that inhibits factors II, VII, IX, and X. It takes 3 to 5 days for full effect. Monitor INR with a goal of 2.0 to 3.0. Many drug and food interactions exist. Vitamin K is the antidote. Warfarin is teratogenic, so teach consistent diet, report bleeding, avoid alcohol, and wear a med-alert bracelet.

Heparin and enoxaparin work quickly. Unfractionated heparin is given IV or subcutaneously and monitored by aPTT (goal 1.5 to 2.5 times normal). Protamine sulfate is the antidote. Enoxaparin (LMWH) is given subcutaneously only, has more predictable levels, and requires no routine aPTT monitoring. Both carry risk of heparin-induced thrombocytopenia (HIT), so check platelets. Never give heparin intramuscularly, and do not rub the injection site.

DOACs (rivaroxaban, apixaban, dabigatran) are direct oral anticoagulants. Rivaroxaban and apixaban inhibit factor Xa. Dabigatran inhibits thrombin directly, and idarucizumab is its antidote. Advantages include no routine monitoring and fewer food interactions than warfarin. All require renal dose adjustment and carry increased bleeding risk. Take rivaroxaban with food.

Additional Cardiovascular Medications

Digoxin (Lanoxin) is a cardiac glycoside that increases contractility (positive inotrope) and decreases heart rate (negative chronotrope). It has a very narrow therapeutic index of 0.5 to 2.0 ng/mL. Always check the apical pulse for 1 full minute before giving. Hold if the heart rate is below 60. Toxicity causes visual changes (yellow-green halos), GI symptoms, and arrhythmias. Hypokalemia increases toxicity risk.

Nitroglycerin is a vasodilator for angina and acute MI. It dilates veins (decreasing preload) and coronary arteries. Sublingual tablets are given 1 tablet every 5 minutes for up to 3 doses. Call 911 if no relief after 3 doses. Side effects include headache, hypotension, and flushing. Store in dark glass containers. Assess blood pressure before giving and hold if systolic BP is below 90. Contraindicated within 24 to 48 hours of sildenafil (Viagra) due to severe hypotension.

Statins (atorvastatin, rosuvastatin) inhibit HMG-CoA reductase and lower LDL cholesterol. Take in the evening when cholesterol synthesis peaks. Monitor liver function tests and CPK (rhabdomyolysis risk). Tell patients to report muscle pain. Side effects include myalgia, hepatotoxicity, and GI upset. Avoid grapefruit juice. First-line treatment for high cholesterol.

Loop diuretics (furosemide, bumetanide) block the Na/K/Cl cotransporter in the loop of Henle. They are the most potent diuretics, treating edema from heart failure, cirrhosis, and renal disease. Side effects include hypokalemia, hypomagnesemia, dehydration, and ototoxicity. Monitor electrolytes, intake and output, daily weights, and hearing. Give in the morning to avoid nighttime urination. Infuse IV slowly to prevent ototoxicity.

Thiazide diuretics (hydrochlorothiazide) block the Na/Cl cotransporter in the distal tubule. Less potent than loop diuretics, they are first-line for hypertension. Side effects include hypokalemia, hyperglycemia, hyperuricemia (gout), hypercalcemia, and photosensitivity. Monitor electrolytes. Often combined with potassium-sparing diuretics or ACE inhibitors.

Potassium-sparing diuretics (spironolactone) are aldosterone antagonists. Though mild diuretics, their main use is potassium conservation. They treat heart failure (with mortality benefit), ascites, and hyperaldosteronism. Side effects include hyperkalemia and gynecomastia (spironolactone). Do not combine with ACE inhibitors without careful monitoring. Monitor potassium levels closely.

Amiodarone is a class III antiarrhythmic for life-threatening ventricular arrhythmias and atrial fibrillation. Its very long half-life of 40 to 55 days means careful monitoring is essential. Serious toxicities include pulmonary fibrosis (monitor with chest X-ray and pulmonary function tests), thyroid dysfunction (contains iodine, monitor TSH), hepatotoxicity (monitor liver function tests), corneal deposits, blue-gray skin discoloration, and photosensitivity. Multiple drug interactions occur.

Aspirin irreversibly inhibits cyclooxygenase (COX), blocking thromboxane A2 production. Low-dose aspirin (81 to 325 mg) prevents MI and stroke. Side effects include GI bleeding and tinnitus (toxicity). Do not give to children with viral illness due to Reye syndrome risk. Discontinue 7 days before surgery.

Clopidogrel (Plavix) blocks ADP receptors and prevents platelet aggregation. Uses include post-MI, post-stent, and stroke prevention. Often combined with aspirin as dual antiplatelet therapy. Side effects include bleeding, bruising, and thrombotic thrombocytopenic purpura (rare). Avoid omeprazole, which reduces effectiveness. Discontinue 5 to 7 days before surgery. Genetic testing identifies poor metabolizers with reduced effectiveness.

These drug classes span multiple body systems and are among the most commonly encountered in clinical practice. Understanding key mechanisms and nursing considerations is essential for safe administration.

Pain Management

Opioid analgesics (morphine, hydromorphone, oxycodone, fentanyl) bind mu-opioid receptors in the central nervous system. They provide strong pain relief for moderate to severe pain. Respiratory depression is the most dangerous side effect. Hold if respiratory rate is below 12. Constipation is almost universal, so order a bowel regimen. Other side effects include sedation, nausea, hypotension, and urinary retention. Naloxone (Narcan) is the antidote. Assess pain using a pain scale before and after administration. Opioids are Schedule II controlled substances with high abuse potential.

NSAIDs (ibuprofen, naproxen, ketorolac) inhibit COX-1 and COX-2, blocking prostaglandin synthesis. They provide anti-inflammatory, analgesic, and antipyretic effects. Side effects include GI bleeding and ulcers (take with food), renal impairment (monitor BUN and creatinine), cardiovascular risk (long-term use), and platelet inhibition. Contraindicate in third trimester pregnancy, active GI bleed, and severe renal disease. Ketorolac is limited to 5 days maximum due to GI and renal risk.

Acetaminophen (Tylenol) provides analgesia and antipyresis but is not anti-inflammatory. The maximum dose is 4 grams per day (lower in liver disease or with alcohol use). Hepatotoxicity is the main concern. N-acetylcysteine (NAC) is the antidote, most effective within 8 hours of overdose. Check all medications for hidden acetaminophen, as it appears in many combination products.

Antibiotics

Penicillins (amoxicillin, ampicillin) are beta-lactam antibiotics that inhibit cell wall synthesis. They are bactericidal. Common uses include strep throat, otitis media, UTI, and pneumonia. Side effects range from rash to anaphylaxis. Always ask about allergies first. Diarrhea and C. difficile infection are risks. Cross-reactivity with cephalosporins is 1 to 2%. Teach patients to take the full course even if feeling better.

Fluoroquinolones (ciprofloxacin, levofloxacin) are broad-spectrum antibiotics with black box warnings: tendon rupture, peripheral neuropathy, CNS effects, and aortic dissection. Avoid in children, pregnant or nursing women, and elderly patients on corticosteroids. Do not take with dairy, calcium, antacids, or iron, as these reduce absorption. Increase fluid intake. Photosensitivity is common.

Vancomycin is a glycopeptide antibiotic for serious gram-positive infections (MRSA, C. difficile). Give IV for systemic infections and orally only for C. difficile. Monitor trough levels (goal 15 to 20 mcg/mL for serious infections), renal function (nephrotoxic), and hearing (ototoxic). Infuse over 60 or more minutes to prevent Red Man Syndrome (histamine-mediated flushing, not a true allergy). Slowing the infusion rate alleviates this.

Endocrine Medications

Metformin is first-line for Type 2 diabetes. It decreases hepatic glucose production and increases insulin sensitivity. Unlike insulin, metformin does not cause hypoglycemia when used alone. Hold for 48 hours before and after contrast dye. Side effects include GI upset and lactic acidosis (rare, mostly with renal impairment). Monitor renal function and B12 levels long-term. Take with meals.

Insulin requires careful administration. Always verify the dose with another nurse. Rotate injection sites to prevent lipodystrophy. Rapid-acting insulins are given with meals and can cause hypoglycemia if meals are delayed. NPH is the only cloudy insulin and can be mixed with regular insulin. Glargine and detemir are clear insulins that are never mixed. Store unopened vials in the refrigerator and opened vials at room temperature for up to 28 days. Teach patients signs of hypoglycemia, sick-day rules, and proper injection technique.

Levothyroxine is synthetic T4 for hypothyroidism. Take on an empty stomach 30 to 60 minutes before breakfast. Separate from calcium, iron, and antacids by 4 hours. Monitor TSH, which should decrease. Start low and increase slowly in elderly or cardiac patients. Signs of overreplacement mimic hyperthyroidism (tachycardia, weight loss, anxiety).

Prednisone and methylprednisolone are corticosteroids with anti-inflammatory and immunosuppressant effects. Uses include asthma, autoimmune diseases, and organ rejection. Side effects include hyperglycemia, immunosuppression (infection risk), osteoporosis, weight gain, and adrenal suppression. Never stop abruptly after long-term use, as this causes adrenal crisis. Taper slowly. Monitor blood glucose and give with food.

Psychiatric and Neurological Medications

SSRIs (sertraline, fluoxetine, escitalopram) are first-line antidepressants. They inhibit serotonin reuptake. Uses include depression, anxiety, OCD, and PTSD. Full effects appear after 2 to 6 weeks. Side effects include sexual dysfunction, nausea, insomnia, and weight changes. A black box warning notes increased suicidality in young adults, so monitor closely in the first few weeks. Serotonin syndrome is a risk if combined with MAOIs, tramadol, or other serotonergic drugs. Do not stop abruptly.

Benzodiazepines (lorazepam, midazolam, diazepam) enhance GABA activity (CNS depression). Uses include anxiety, seizures, alcohol withdrawal, and procedural sedation. Side effects include sedation, respiratory depression, dependence, and paradoxical agitation in elderly. Flumazenil is the antidote. Do not stop abruptly after chronic use due to seizure risk. Taper slowly. Avoid combining with opioids (combined respiratory depression). Use short-term only.

Albuterol and ipratropium treat airway obstruction. Albuterol is a short-acting beta-2 agonist used as a rescue inhaler (bronchodilation in 5 to 15 minutes). Side effects include tachycardia, tremor, and hypokalemia. Ipratropium is an anticholinergic bronchodilator with slower onset but longer duration. Often combined in nebulizer (DuoNeb). Give the bronchodilator first if using with an inhaled corticosteroid. Monitor heart rate.

GI and Seizure Medications

Proton pump inhibitors (omeprazole, pantoprazole) suppress gastric acid secretion. Uses include GERD, peptic ulcers, Zollinger-Ellison syndrome, and H. pylori (triple therapy). Take 30 minutes before the first meal. Long-term risks include C. difficile, osteoporosis, hypomagnesemia, and B12 deficiency. IV pantoprazole treats acute GI bleeding. Avoid unnecessary long-term use.

Phenytoin (Dilantin) is an anticonvulsant and sodium channel blocker for seizures and status epilepticus. It has a narrow therapeutic index of 10 to 20 mcg/mL. Side effects include gingival hyperplasia (require rigorous oral care), hirsutism, nystagmus, and ataxia (toxicity signs). Teratogenic (fetal hydantoin syndrome). Multiple drug interactions exist. Give IV slowly in normal saline only (precipitates in dextrose solutions) with cardiac monitoring.

Magnesium sulfate prevents seizures in preeclampsia and eclampsia, treats tocolysis, corrects hypomagnesemia, and addresses torsades de pointes. Therapeutic level is 4 to 7 mEq/L. Monitor for toxicity: loss of deep tendon reflexes (first sign), respiratory depression (below 12 breaths per minute), and cardiac arrest. Calcium gluconate is the antidote and should be kept at bedside. Monitor deep tendon reflexes, respiratory rate, and urine output (maintain above 30 mL per hour).

Safe medication administration is a core nursing competency. These cards cover essential safety principles and high-alert medication considerations that prevent harmful errors.

Core Safety Principles

The Six Rights of Medication Administration form the foundation of safe practice: right patient (verify 2 identifiers), right drug, right dose, right route, right time, and right documentation. Additional rights recognized include: right reason, right to refuse, right assessment, right education, and right evaluation of response. Always verify allergies before the first dose.

High-alert medications carry increased risk of harm if given in error. Categories include insulin, opioids, anticoagulants (heparin, warfarin), concentrated electrolytes (IV potassium, hypertonic saline), chemotherapy, and neuromuscular blocking agents. These require independent double-checks, standardized protocols, and clear labeling.

Look-alike and sound-alike drugs cause preventable errors. Common confusions include metformin/metoprolol, hydroxyzine/hydralazine, prednisone/prednisolone, clonidine/clonazepam, and Celebrex/Celexa. Prevention strategies include tall man lettering (hydrOXYzine versus hydrALAzine), barcode scanning, and avoiding abbreviations.

Medication Administration Details

Medication reconciliation compares patient medication orders to all medications the patient is currently taking. Perform it at every transition of care (admission, transfer, discharge). It identifies discrepancies: omissions, duplications, interactions, and incorrect doses. This process is critical for patient safety.

Parenteral medication safety requires knowledge of IV push rates. Some medications require slow push over 3 to 5 minutes. Verify IV site patency before administration. Vesicants (chemotherapy, dopamine, potassium) cause tissue necrosis if infiltrated. Stop infusion immediately if extravasation signs appear. Always check medication compatibility before mixing in the same line.

Controlled substance management applies to Schedule II drugs (morphine, oxycodone, fentanyl, amphetamines). These have the highest abuse potential and medical use. Require count verification at shift change, two-nurse witness for waste, and proper documentation. Report discrepancies immediately. Document patient assessment and pain response before and after administration.

Peak and trough levels measure drug concentrations. Draw trough just before the next dose (lowest level). Draw peak after drug distribution (highest level). Uses include aminoglycosides (gentamicin, target peak under 10, trough under 2) and vancomycin (target trough 15 to 20 for serious infections). Timing the blood draw correctly is essential.

Key Drug Interactions and Patient-Specific Considerations

Critical drug interactions include:

• Warfarin + NSAIDs = increased bleeding
• ACE inhibitors + potassium supplements = hyperkalemia
• MAOIs + tyramine foods = hypertensive crisis
• Digoxin + hypokalemia = toxicity
• Methotrexate + NSAIDs = methotrexate toxicity
• Sildenafil + nitrates = severe hypotension

Always check interactions before adding new medications.

Special Populations

Adverse drug reactions (ADRs) differ from side effects. Side effects are expected, often predictable pharmacological responses (drowsiness from antihistamines). ADRs are unexpected, undesired, potentially harmful responses. Anaphylaxis is the most severe ADR. Assess airway, breathing, circulation, administer epinephrine IM, and call for rapid response. Report ADRs through proper channels.

Geriatric pharmacology requires special attention. Elderly patients have higher ADR risk due to decreased renal clearance, decreased hepatic metabolism, increased body fat (lipophilic drug accumulation), and decreased serum albumin (more free drug). Start low, go slow. The Beers Criteria lists potentially inappropriate medications for elderly (certain benzodiazepines, anticholinergics, long-term NSAIDs). Many medications increase fall risk.

Pediatric pharmacology bases doses on weight (mg/kg). Always verify weight in kilograms. Immature liver and kidneys affect drug metabolism and excretion. Liquid formulations work better for young children. The vastus lateralis is the preferred IM injection site in infants. Never use honey when administering meds to infants under 1 year due to botulism risk.

Pregnancy medication safety now uses narrative labeling (replaced A-X categories in 2015). Key teratogenic drugs include warfarin, ACE inhibitors, isotretinoin, methotrexate, valproic acid, lithium, statins, and fluoroquinolones. Acetaminophen is the safest analgesic in pregnancy. Folic acid supplementation prevents neural tube defects. Always verify medication safety before administration to pregnant patients.

IV Therapy and Special Situations

IV fluid types serve different purposes. Isotonic solutions (NS 0.9%, LR, D5W) expand intravascular volume and treat dehydration and shock. Hypotonic solutions (0.45% NS) shift fluid into cells for cellular dehydration. Hypertonic solutions (3% NaCl, D10W, D50W) draw fluid from cells, treating hyponatremia and hypoglycemia. D5W becomes hypotonic once dextrose is metabolized. Never give hypertonic solutions rapidly.

Blood transfusion safety requires verification steps. Verify order, obtain consent, and match blood type with 2 nurses at bedside. Use a dedicated line with normal saline only (dextrose causes hemolysis). Start slowly for the first 15 minutes, then monitor vital signs every 15 minutes. Transfusion reactions include febrile (most common, causes fever and chills), allergic (urticaria, itching), and hemolytic (most dangerous, causes flank pain, dark urine, fever). Stop transfusion immediately for any reaction.

Chemotherapy safety requires hazardous drug precautions. Use PPE (double gloving, gown, eye protection) during preparation and administration. Keep a spill kit available. Patient body fluids remain hazardous for 48 hours after treatment. Vesicant extravasation requires stopping the infusion, aspirating residual drug, applying hot or cold compresses (drug-specific), and notifying the provider. Monitor CBC closely, as nadir (lowest point) typically occurs 7 to 14 days after treatment.

Patient Education

Patient teaching for medications should include drug name (generic and brand), purpose, dose and schedule, how to take (with food, empty stomach, timing), expected effects, common side effects, serious side effects to report, interactions to avoid, storage, and missed dose instructions. Use the teach-back method to verify understanding. Provide written materials. Consider health literacy when explaining medications.

Mastering pharmacology nursing requires the right study approach, not just more hours. Research in cognitive science consistently shows that three techniques produce the best learning outcomes: active recall (testing yourself rather than re-reading), spaced repetition (reviewing at scientifically optimized intervals), and interleaving (mixing related topics rather than studying one in isolation). FluentFlash is built around all three.

Why Active Recall Matters

When you study pharmacology nursing with our FSRS algorithm, every term is scheduled for review at exactly the moment you're about to forget it. This maximizes retention while minimizing study time. The most common mistake students make is relying on passive review methods. Re-reading notes, highlighting textbook passages, or watching lecture videos feels productive, but research shows these methods produce only 10 to 20% of the retention that active recall achieves.

Flashcards force your brain to retrieve information, which strengthens memory pathways far more than recognition alone. Pair this with spaced repetition scheduling, and you can learn in 20 minutes daily what would take hours of passive review.

Your Practical Study Plan

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1. Generate flashcards using FluentFlash AI or create them manually from your notes
2. Study 15 to 20 new cards per day, plus scheduled reviews
3. Use multiple study modes (flip, multiple choice, written) to strengthen recall
4. Track your progress and identify weak topics for focused review
5. Review consistently, as daily practice beats marathon sessions

Flashcards aren't just for vocabulary. They're one of the most research-backed study tools for any subject, including pharmacology nursing. The reason comes down to how memory works. When you read a textbook passage, your brain stores that information in short-term memory, but without retrieval practice, it fades within hours.

The Testing Effect

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Every time you successfully recall a pharmacology nursing concept from a flashcard, you're making that concept easier to recall next time. You're building automaticity, not just memorization.

Spaced Repetition Amplifies Results

FluentFlash amplifies this effect with the FSRS algorithm, a modern spaced repetition system that schedules reviews at mathematically optimal intervals based on your actual performance. Cards you find easy get pushed further into the future. Cards you struggle with come back sooner. Over time, this builds remarkable retention with minimal time investment.

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