Pharmacology Friday: How to Study Pharmacology in Nursing School

One of the most common questions I get is “how do I study pharmacology?”

So, here are a few tips to help you more effectively and efficiently study pharmacology in nursing school….

#1 - Initially, focus on learning commonalities within drug classes…then focus on the most common medications

You will definitely have to learn some individual medications, but understanding the ins and outs of the medication class, as opposed to trying to know every individual medication will save you a lot of time and energy. So first, master the medication classes, then spend time learning the most important info about the most common medications that you are likely to administer and see on NCLEX. (A list of these medications can be found in RN School and our Nursing Pharmacology course that we are currently building out.)

#2 - Know the common medication prefixes and suffixes for each drug class

Committing to memory the common endings that occur in drug classes can help you get a better overall feel for medications. For example, if your patient mentions that they take metoprolol - you can deduce that since it ends in -lol that this medication is probably a beta-blocker. If you followed tip #1, then you would know all about beta-blockers and would have an idea of what the med does, potential reasons the patient would be taking it, side effects and so on. (A common prefixes and suffixes cheatsheet can be found in RN School and our Nursing Pharmacology course that we are currently building out.)

#3 - focus on generic names

It is really tempting to learn brand names because they are typically what we are more familiar with and often easier to remember, but you will be faced with generic names on NCLEX…so it is definitely best to remember them.

#4 - use medication cards or flash cards…but make your own

Making your own medication cards is one of the best things you can do to help you memorize your meds. First off, writing something down in your own hand helps your brain process it and commit it to memory (especially if you’ve written it down 3 times). But the great thing about medication cards is that you can take them with you to clinical and use them as you refresh on the medications that you are about to administer to your patient.

As a clinical instructor, I had my students make cards for the meds their patients were on each week. Each medication and it's’ information would be written on an index card and they would be kept together by a ring clip. They never had to re-create the card (because you know that so many patients in the hospital are on the exact same medications), they would only tweak it as needed depending on why their patient was taking it (i.e. reason for use in that patient might be different than the reason the previous patient was taking it). This way they could easily refresh on the med before it was time to give it to the patient and they could use them to quiz themselves or each other.

But again let me reiterate - if you are going to use med cards you should make them yourself. Trust me it will help. And if you are a highly visual person, then using a color method with your cards (and school notes) might help - for instance using red cards for cardiac meds, yellow for renal, etc.

#5 - one of my top tips for studying anything in nursing school, including pharmacology….

study systematically

I say this all of the time because (especially in nursing school) it is important and really helps - study systematically - meaning, always approach studying each medication in the same way.

For example,

• start with the name and drug class

• does it have a common ending?

• what is the mechanism of action?

• potential uses

• side effects/adverse effects

• contraindications

• nursing considerations

• patient teaching

If you study each med in the same systematic way you are less likely to forget something important and your brain thrives with repetition and routine.

i hope these tips help you master your medications!

and remember…

the ultimate way to remember medications is to actually administer them to your patients while in clinical. Look up your meds before you administer them every time until you have got them down!

Be sure to come back next Friday for another round of Pharmacology Friday!

For pharmacology templates, cheatsheets, practice questions and so much more, be sure to check out our membership, RN School, that has everything you need to Thrive in Nursing School! And keep an eye out for our Nursing Pharmacology Course which is coming soon!

Pharmacology Friday: Thrombolytics

Check here every Friday for tips and tricks to help you master Nursing Pharmacology.

Today we are discussing Thrombolytics (also known as fibrinolytics)

To best understand how these medications work, let’s first discuss blood clotting/coagulation…

Our blood is flowing throughout our blood vessels at all times. So, what happens when we have an injury?

Our body acts to prevent the blood from moving out of the body through a process called coagulation. Through coagulation, blood holds firmly together at the site of injury to prevent further blood loss. Simply explained, the process looks like this:

1. We get an injury of some kind, be it a cut or tear in a blood vessel.

2. Our blood vessels vasoconstrict in an effort to reduce blood flow to that area (and thereby limit further loss).

3. Then, platelets are activated to create a platelet plug; platelets stick to each other and to the side of the vessel wall. Clotting factors are activated.

4. Fibrin, a strong, fibrous protein involved in the clotting of blood, is produced and works to create a fibrin clot. The fibrin clot is very secure and keeps the plug stable.

The ability to form clots is vital for hemostasis, but too much clotting can be detrimental…think pulmonary embolism, myocardial infarction, ischemic stroke. When clots form we can administer medications called thrombolytics to help dissolve the clot.

Thrombolytics work by converting plasminogen to plasmin. Plasmin lyses clots by breaking down the fibrinogen and fibrin contained in the clot.

 Thrombolytics are sometimes referred to as “clot-busters” because they do just that, bust-up or dissolve the clot causing the issue.

so…If that’s how they work and what they do, in what instances would they be useful?

myocardial infarction, acute ischemic stroke, venous thrombosis, pulmonary embolism, arterial thromboembolism

Other useful info about :

·       common ending: -ase or -plase

·       examples: tenecteplase, streptokinase, activase

·       side effects: bleeding, nausea, vomiting, fever

·       adverse effects: anaphylaxis, angioedema, laryngeal edema, microembolism, intracerebral hemorrhage, stroke, atrial and ventricular dysrhythmias, pulmonary edema

·       nursing considerations/patient teaching: 

• assess baseline VS and at least every 15 minutes throughout treatment and frequently post treatment

• frequently assess neuro status

• obtain CBC, PT, INR before administering

• ensure there are no contraindications to patient receiving thrombolytics

• must be administered within appropriate time-frame from symptom onset (i.e. for ischemic stroke must be administered within 4.5 hours of symptom onset)

• monitor for resolution of symptoms (i.e. patient being treated for MI should report decrease in chest pain)

• report bleeding, lightheadedness, dizziness, palpitations, SOB, dyspnea, throat constriction, excessive drooling

Because these medications are highly effective and present such a high risk of bleeding, there are numerous contraindications to using thrombolytics.

• some absolute contraindications for thrombolytic therapy

  • recent intracranial or spinal surgery

  • significant head injury or facial trauma

  • recent intracranial hemorrhage

  • severe uncontrolled hypertension

  • possible aortic dissection

  • ischemic stroke within 3 months

  • previous treatment with streptokinase within 6 months

  • intracranial neoplasm

• some relative contraindications for thrombolytic therapy

  • severe hypertension

  • history of ischemic stroke

  • pregnancy

  • dementia

  • internal bleeding within past 2 - 4 weeks

  • prolonged CPR

Be sure to check out the cheatsheet and podcast below…

Be sure to come back next Friday for another round of Pharmacology Friday!

For pharmacology templates, cheatsheets, practice questions and so much more, be sure to check out our membership, RN School, that has everything you need to Thrive in Nursing School!

Pharmacology Friday: DIGOXIN

Check here every Friday for tips and tricks to help you master Nursing Pharmacology.

Today we are discussing DIGOXIN

Digoxin is a cardiac glycoside - which are drugs derived from digitalis, a substance naturally occurring in foxglove plants.

 How it works…

Cardiac glycosides inhibit the sodium-potassium pump, thereby increasing intracellular calcium, which causes the heart muscle to contract more efficiently. They produce a positive inotropic effect, meaning they increase the force of the contraction of the heart. At the same time they also produce a negative chronotropic effect, wherein they decrease the heart rate, while also slowing electrical conduction through the AV node (negative dromotropic effect).

So when we give DIGOXIN, we are effectively increasing our cardiac contractility, while decreasing the heart rate and prolonging the cardiac refractory period.

- let’s do a quick review here to better understand what’s happening when we give this medication -

If we think about how the heart works for a second and really visualize it, we will better understand exactly how the cardiac glycosides like digoxin work and therefore how they can help in certain instances.

…so, blood flows into the right atrium through the tricuspid valve to the right ventricle through the pulmonic valve into our pulmonary circulation (pulmonary arteries —> gas exchange —> pulmonary veins) into the left atrium through the mitral valve into the left ventricle through the aortic valve up into the aortic arch and out into systemic circulation.

In order to keep the blood moving throughout, the heart is relaxing (i.e. chambers are filling with blood) and then contracting (i.e. squeezing blood into the next section of the heart or into systemic circulation).

The fill time (time when the heart is relaxed and chambers are filling with blood) is dependent upon how quickly the heart is beating - the faster the heart rate (HR), the less fill time between contractions and conversely, the slower the heart rate, the longer the fill time between contractions.

DIGOXIN allows the heart to slow down (decreases the heart rate) meaning that it will have a longer fill time between contractions. Increased fill time means more blood fills the left ventricle, before the medication then causes increased contractility (a more efficient squeeze) when it contracts causing more blood to pump into circulation with each beat. This leads to increased cardiac output (CO).

decreased HR + increased contractility = increased CO

and increased CO leads to less blood backing up into the lungs and venous circulation causing issues like edema & pulmonary congestion.

so…If that’s how it works and what it does, in what instances would this be useful?

instances like Heart Failure (HF), cardiogenic shock, atrial fibrillation; atrial flutter; SVT

Other useful info about :

·       therapeutic index: 0.5 to 2 ng/mL

·       antidote: digoxin immune fab (Digibind)

·       contraindications: ventricular dysrhythmias; 2nd & 3rd degree heart block

·       use caution: patients with renal disease, hypothyroidism, hypokalemia

·       side effects: headache, hypotension, fatigue, bradycardia, dizziness

·       adverse effects: digoxin toxicity (presents with GI manifestations - anorexia, N/V/D; blurred vision or yellow-green halos; diplopia, weakness, drowsiness, bradycardia)

·       nursing considerations/patient teaching: 

• monitor digoxin levels and for digoxin toxicity

• monitor electrolytes, especially potassium (toxicity is more likely to happen with hypokalemia, hypomagnesemia, hypothyroidism, and hypercalcemia)

• monitor apical pulse for 60 sec prior to administering med - if < 60 bpm hold med and notify HCP

• teach patient how to take their own pulse and to do it prior to taking med every time

• how & when to take: don’t miss dose; do NOT take a double dose if you missed previous dose; do NOT open, chew or crush capsules

• talk to HCP before taking any OTC meds

• teach patient signs/symptoms of digoxin toxicity and to report immediately

• diet: sodium restricted; potassium rich to keep potassium levels normal

Be sure to check out the cheatsheet and podcast below

Be sure to come back next Friday for another round of Pharmacology Friday!

For pharmacology templates, cheatsheets, practice questions and so much more, be sure to check out our membership, RN School, that has everything you need to Thrive in Nursing School!

Pharmacology Friday: Statins

Check here every Friday for tips and tricks to help you master Nursing Pharmacology!

Today we are discussing Statins.

…also known as 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors…and antilipemics.

These meds lower lipid levels by interfering with cholesterol synthesis.

Basically, they reduce serum levels of cholesterol, triglycerides, or low-density lipoproteins, thereby reducing a patient’s risk for coronary artery disease (CAD).

…remember as far as cholesterols go, HDL = healthy and LDL = lethal

so…If that’s how they work and what they do, in what instances would they be useful?

Statins are useful for patients that have high cholesterol levels and are at elevated risk for CAD, especially those that have already made other lifestyle modifications (i.e. smoking cessation, dietary changes, etc.) but are still experiencing high cholesterol.

Other useful info about :

·       common ending: -statin

·       examples: atorvastatin, fluvastatin, lovastatin, simvastatin,

·       side effects: myalgia; muscle cramps; nausea; vomiting; diarrhea; headache; flushing; pruritus

·       adverse effects: elevated liver enzymes, rhabdomyolysis; myopathy

·       nursing considerations/patient teaching: 

• assess baseline LFTs prior to starting drug therapy, then monitor lipid levels every 4 - 6 weeks for the first 6 months of lipid therapy, then periodically throughout the first year

• contact physician for unexplained muscle pain, weakness, tenderness, especially if accompanied by fever and malaise

• monitor for fat-soluble vitamin deficiency

• avoid grapefruit and grapefruit juice

• taking med in relation to food varies depending upon which statin is prescribed

Be sure to check out the cheatsheet and podcast below!

Be sure to come back next Friday for another round of Pharmacology Friday!

For pharmacology templates, cheatsheets, practice questions and so much more, be sure to check out our membership, RN School, that has everything you need to Thrive in Nursing School!