Hi actually tommarow is my pharmacology exam and 3 units are coming and I don't know how to study so tell me and I am pursuing bsc nursing
Reading File
Searching the Web
BSc nursing pharmacology exam 3 units syllabus important topics
Asking for Preferences
1000341704.png
These 3 units
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I now have enough content to build your complete study plan. Here it is:
🩺 BSc Nursing Pharmacology - Last Night Study Plan
Exam Tomorrow | 3 Units | Smart Revision Strategy
⏰ TIME PLAN (Tonight)
| Time | What to Do |
|---|---|
| 8:40 PM - 9:30 PM | Unit I - ENT & Eye Drugs (50 min) |
| 9:30 PM - 9:40 PM | Short break |
| 9:40 PM - 10:30 PM | Unit II - Urinary System Drugs (50 min) |
| 10:30 PM - 10:40 PM | Short break |
| 10:40 PM - 12:00 AM | Unit III - Nervous System Drugs (80 min - biggest unit!) |
| 12:00 AM - 12:30 AM | Quick revision of key drug tables |
| Sleep by 1 AM | Fresh brain = better recall in exam! |
UNIT I - Drugs for Ear, Nose, Throat & Eye (4 hrs theory)
1. Antihistamines (MOST IMPORTANT for exam)
Two Generations - Always comes in exam:
| Feature | 1st Generation (Sedating) | 2nd Generation (Non-sedating) |
|---|---|---|
| Examples | Chlorpheniramine, Diphenhydramine, Promethazine | Cetirizine, Loratadine, Fexofenadine |
| CNS effect | Sedation, drowsiness | Minimal/no sedation |
| Anticholinergic | Yes (dry mouth, urinary retention) | No |
| Route | Oral, IV, IM | Oral |
| Use | Allergies, motion sickness, cold | Allergic rhinitis, urticaria |
Mechanism: Block H1 receptors - prevent histamine from causing vasodilation, itching, bronchoconstriction
Nursing Responsibilities:
- Warn patient about drowsiness (don't drive) - 1st gen
- Monitor for urinary retention
- Give with food to reduce GI upset
- Avoid alcohol with 1st gen (additive CNS depression)
2. Topical Eye Drops
| Drug | Use | Key Nursing Point |
|---|---|---|
| Chloramphenicol eye drops | Bacterial conjunctivitis | Shake well, avoid contaminating dropper tip |
| Gentamycin eye drops | Serious bacterial eye infections | Monitor for local irritation |
| Soda Glycerin | Lubricant/osmotic (corneal edema) | Short-term use only |
Nursing for Eye Drops: Pull lower eyelid down, instill in conjunctival sac, apply gentle pressure on lacrimal sac (nasolacrimal duct), patient should blink gently.
3. Ear & Nasal Drugs
| Drug | Use | Key Point |
|---|---|---|
| Boric Spirit ear drops | Otitis externa, ear cleaning | Warm to body temp before use |
| Chlorhexidine mouthwash | Oral antiseptic, gingivitis | Do not swallow, rinse 30 min after eating |
Nursing for Ear Drops: Straighten ear canal - pull pinna up and back (adults), down and back (children under 3). Patient lie on side for 5 minutes after.
UNIT II - Drugs Acting on the Urinary System (4 hrs theory)
1. Renin-Angiotensin System (RAS) Drugs
RAAS pathway (remember this chain):
Kidney releases Renin → converts Angiotensinogen to Angiotensin I → ACE converts to Angiotensin II → causes vasoconstriction + aldosterone release → raises BP
Key Drug Classes:
| Drug Class | Example | Mechanism | Key Side Effect |
|---|---|---|---|
| ACE Inhibitors | Enalapril, Lisinopril, Captopril | Block ACE → less Ang II | Dry cough (most common), hyperkalemia |
| ARBs (Ang II blockers) | Losartan, Valsartan | Block AT1 receptor | No cough, hyperkalemia |
| Renin Inhibitors | Aliskiren | Directly block renin (earliest point) | Hyperkalemia, avoid in pregnancy |
Nursing: Monitor BP, K+ levels, renal function. Never give ACE inhibitors/ARBs in pregnancy (teratogenic). Don't combine ACE inhibitor + ARB.
2. Diuretics (Very High Yield!)
| Type | Example | Site of Action | Key Effect | Side Effect |
|---|---|---|---|---|
| Loop diuretics | Furosemide (Lasix) | Loop of Henle | Most potent, blocks Na/K/2Cl | Hypokalemia, ototoxicity |
| Thiazides | Hydrochlorothiazide | Distal tubule | Blocks NaCl cotransport | Hypokalemia, hyperuricemia |
| K+-sparing | Spironolactone, Amiloride | Collecting duct | Retain K+ | Hyperkalemia, gynecomastia (spiro) |
| Osmotic | Mannitol | Proximal tubule | Pulls water out osmotically | Dehydration |
| Carbonic Anhydrase Inhibitors | Acetazolamide | Proximal tubule | Inhibit HCO3 reabsorption | Acidosis |
Antidiuretics: ADH/Vasopressin - used in diabetes insipidus. Desmopressin is synthetic ADH.
Nursing for Diuretics:
- Give loop diuretics in morning (to avoid nighttime urination)
- Monitor weight daily, intake/output
- Monitor electrolytes (especially K+)
- With furosemide: supplement potassium (banana, orange juice)
3. Nephrotoxic Drugs (Drugs Toxic to Kidney)
REMEMBER: "A GANG of nephrotoxins"
- Aminoglycosides (gentamicin, tobramycin)
- Goldman - Contrast dyes (radiocontrast)
- Amphotericin B
- NSAIDs (especially in dehydrated patients)
- Glycopeptides (Vancomycin)
- Cisplatin (chemotherapy)
Nursing: Monitor BUN, creatinine, urine output. Ensure hydration before nephrotoxic drugs.
4. Urinary Antiseptics & UTI Treatment
| Drug | Use | Key Point |
|---|---|---|
| Nitrofurantoin | UTI (lower) | Turns urine dark yellow/brown - warn patient! |
| Nalidixic acid | UTI | Older quinolone |
| Trimethoprim | UTI prophylaxis | Given with sulfamethoxazole (co-trimoxazole) |
UTI Acidifiers: Ammonium chloride, ascorbic acid (Vitamin C) - acidify urine to inhibit bacterial growth
UTI Alkalinizers: Sodium bicarbonate, potassium citrate - used when acidification worsens symptoms (dysuria relief)
UNIT III - Drugs Acting on the Nervous System (10 hrs - BIGGEST UNIT!)
1. NSAIDs (Non-Steroidal Anti-Inflammatory Drugs)
Mechanism: Inhibit COX enzymes (COX-1 and COX-2) → less prostaglandin synthesis → less pain, fever, inflammation
| Drug | Key Feature |
|---|---|
| Ibuprofen | Most common NSAID, OTC |
| Diclofenac | Available as oral, topical, injection |
| Aspirin | Also antiplatelet (low dose); inhibits COX irreversibly |
| Indomethacin | Most potent, used for gout |
| Celecoxib | Selective COX-2 inhibitor, less GI side effects |
Side Effects of NSAIDs: GI ulcer/bleeding (most common), renal damage (reduce prostaglandin-mediated renal blood flow), fluid retention, avoid in pregnancy (3rd trimester - premature closure of ductus arteriosus)
Nursing: Give with food or milk. Avoid in peptic ulcer patients. Monitor renal function.
2. Antipyretics
| Drug | Key Point |
|---|---|
| Paracetamol (Acetaminophen) | Safest antipyretic, no GI side effects, but hepatotoxic in overdose |
| Aspirin | Avoid in children < 12 years (Reye's syndrome) |
3. Opioid Analgesics (High Yield!)
Mechanism: Act on mu (μ), kappa (κ), delta (δ) opioid receptors in CNS and periphery
| Drug | Type | Key Feature |
|---|---|---|
| Morphine | Strong opioid | Gold standard for severe pain; causes constipation, respiratory depression |
| Codeine | Weak opioid | Antitussive + mild pain; prodrug converted to morphine |
| Tramadol | Weak opioid + SNRI | Moderate pain; lower abuse potential |
| Pethidine (Meperidine) | Moderate opioid | Used in labor pain; shorter duration |
| Fentanyl | Very strong opioid | Transdermal patch; 100x more potent than morphine |
Opioid Side Effects (remember "COWARDS"):
- Constipation
- Opioid-induced respiratory depression (most dangerous)
- Weak (miosis/pinpoint pupils)
- Addiction/dependence
- Retention of urine
- Drowsiness/sedation
- Slow heart rate (bradycardia)
Antidote for Opioid overdose = NALOXONE (Narcan)
Nursing for Opioids: Assess pain score before and after. Monitor respiratory rate (hold if < 12/min). Keep naloxone ready. Prevent constipation (stool softeners). Do not drive.
4. General Anaesthesia (GA)
Stages of GA (Guedel's stages):
- Analgesia - conscious, reduced pain
- Excitement/Delirium - unconscious, irregular breathing (dangerous!)
- Surgical anaesthesia - regular breathing, surgical procedures done here
- Medullary depression - respiratory/CV collapse (overdose - avoid!)
Pre-anaesthetic Medication (PAM):
| Drug | Purpose |
|---|---|
| Diazepam/Midazolam | Reduce anxiety (anxiolytic) |
| Morphine/Pethidine | Pre-op analgesia |
| Atropine | Reduce secretions, prevent bradycardia |
| Metoclopramide | Prevent aspiration (prokinetic) |
Inhalational Agents: Nitrous oxide (N2O - laughing gas, used with O2), Halothane, Isoflurane, Sevoflurane
Nursing in GA: Pre-op - NPO 6-8 hrs (nil by mouth), consent, remove jewelry. Post-op - recovery position, monitor airways, vital signs, pain.
5. Local Anaesthetics
| Drug | Feature |
|---|---|
| Lidocaine (Lignocaine) | Most common; also antiarrhythmic IV |
| Bupivacaine | Long-acting; used in spinal/epidural |
| Cocaine | Natural, vasoconstriction (ENT use only) |
| Benzocaine | Topical only |
Mechanism: Block Na+ channels → prevent nerve impulse conduction
Types: Topical, infiltration, nerve block, spinal (subarachnoid), epidural
Nursing: Monitor for systemic toxicity (seizures, cardiac arrest), keep resuscitation equipment ready.
6. Hypnotics & Sedatives
| Drug Class | Example | Key Point |
|---|---|---|
| Benzodiazepines | Diazepam, Lorazepam, Midazolam | GABA-A enhancers; antidote = Flumazenil |
| Barbiturates | Phenobarbitone, Thiopentone | Older, more dangerous; used in epilepsy/GA |
| Non-BZD hypnotics | Zolpidem (Ambien) | "Z-drugs", for insomnia only |
Nursing: Risk of dependence, fall risk (elderly), avoid alcohol.
7. Skeletal Muscle Relaxants
| Drug | Type | Use |
|---|---|---|
| Succinylcholine | Depolarizing | Rapid intubation (short duration) |
| Atracurium, Vecuronium | Non-depolarizing (competitive) | Surgery |
| Baclofen, Diazepam | Central acting | Spasticity |
Antidote for non-depolarizing blockers = Neostigmine (anticholinesterase)
8. Antipsychotics
| Type | Example | Key Points |
|---|---|---|
| Typical (1st gen) | Chlorpromazine, Haloperidol | Block D2 receptors; EPS side effects (tardive dyskinesia, akathisia) |
| Atypical (2nd gen) | Clozapine, Risperidone, Olanzapine | Less EPS; metabolic syndrome |
Key Side Effect: Extrapyramidal Symptoms (EPS):
- Acute dystonia (muscle spasms) - treat with Benztropine
- Parkinsonism - Tremor, rigidity
- Tardive dyskinesia - late onset, irreversible involuntary movements
Nursing: Monitor for EPS. Clozapine requires regular WBC monitoring (risk of agranulocytosis).
9. Mood Stabilizers
| Drug | Use | Key Monitoring |
|---|---|---|
| Lithium | Bipolar disorder (gold standard) | Narrow therapeutic index! Monitor serum levels (0.6-1.2 mEq/L); toxicity = tremors, nausea, seizures |
| Valproate | Bipolar + epilepsy | Monitor LFTs, teratogenic |
| Carbamazepine | Bipolar + epilepsy | Monitor CBC, induces liver enzymes |
Nursing for Lithium: Adequate fluid and salt intake (dehydration increases toxicity). Avoid NSAIDs (raise lithium levels). Regular blood level checks.
🔑 GOLDEN EXAM TIPS for Tomorrow
- For every drug, remember: Action → Indication → Side effects → Nursing responsibility (this is the standard question pattern)
- Most common short answers: Antihistamine classification, Furosemide nursing care, Opioid antidote, Lithium toxicity, Pre-anaesthetic medication
- Objective type tricks: First line UTI drug = Nitrofurantoin, Antidote opioid = Naloxone, Antidote BZD = Flumazenil, Antidote NMB = Neostigmine
- Nursing responsibilities are always 3-5 points - monitoring, patient education, safety precautions
- Sleep by 1 AM minimum - your brain consolidates memory during sleep!
You've got this! Focus on drug names + mechanism + 2-3 side effects + nursing points for each category. That covers 80% of what will be asked. All the best for tomorrow! 🍀
"Anti histamine Raas Diuretic Drug toxicity Topical application of eye Opioids Hypnotic and sedative Anti-convulsion Antipsychotic " teacher give this as a important question
Finding Sources
Finding Sources
Finding Sources
Finding Sources
Finding Sources
I have all the information I need. Here is your focused, teacher-given important question study notes - everything in one place:
📚 IMPORTANT QUESTIONS - FOCUSED STUDY NOTES
BSc Nursing Pharmacology | Exam Tomorrow
1. 🔴 ANTIHISTAMINES
Definition: Drugs that block histamine receptors to prevent allergic reactions.
Classification:
| Feature | 1st Generation | 2nd Generation |
|---|---|---|
| Examples | Chlorpheniramine, Diphenhydramine, Promethazine | Cetirizine, Loratadine, Fexofenadine |
| Sedation | YES (crosses blood-brain barrier) | NO/minimal |
| Anticholinergic effects | YES | NO |
| Duration | 4-6 hours | 12-24 hours |
| Uses | Allergy, motion sickness, cold, itching | Allergic rhinitis, urticaria, hay fever |
Mechanism: Block H1 histamine receptors → prevent vasodilation, itching, bronchoconstriction, mucus secretion
Side Effects:
- 1st gen: Drowsiness, dry mouth, urinary retention, constipation, blurred vision
- 2nd gen: Headache, dry mouth (minimal)
Nursing Responsibilities:
- Warn patient NOT to drive (1st gen causes drowsiness)
- Avoid alcohol (increases CNS depression)
- Give with food if GI upset occurs
- Monitor elderly for urinary retention and confusion
- Caution in BPH (benign prostatic hyperplasia) patients
2. 🔴 RAAS (Renin-Angiotensin-Aldosterone System) DRUGS
The RAAS pathway (must know this chain):
Kidney → releases Renin → converts Angiotensinogen → Angiotensin I → ACE enzyme → Angiotensin II → causes Vasoconstriction + Aldosterone release → ↑ Blood Pressure
Drug Classes that block this chain:
| Drug Class | Examples | Mechanism | Side Effects |
|---|---|---|---|
| ACE Inhibitors | Enalapril, Lisinopril, Captopril, Ramipril | Block ACE enzyme → less Ang II | Dry cough (most common!), hyperkalemia, angioedema |
| ARBs (AT1 blockers) | Losartan, Valsartan, Telmisartan | Block AT1 receptor | Hyperkalemia, NO cough |
| Renin Inhibitors | Aliskiren | Directly block renin (earliest point in chain) | Hyperkalemia |
| Aldosterone Antagonists | Spironolactone | Block aldosterone receptor | Hyperkalemia, gynecomastia |
Uses: Hypertension, heart failure, diabetic nephropathy, post-MI
Nursing Responsibilities:
- Monitor BP and pulse before each dose
- Monitor serum potassium (risk of hyperkalemia)
- Monitor renal function (BUN, creatinine)
- NEVER give in pregnancy (teratogenic - causes fetal renal agenesis)
- Do NOT combine ACE inhibitor + ARB together
- Teach patient: dry cough with ACE inhibitors is expected; switch to ARB if severe
3. 🔴 DIURETICS
Definition: Drugs that increase urine output by reducing reabsorption of Na+ and water in the kidneys.
| Type | Drug | Site of Action | Special Features | Side Effects |
|---|---|---|---|---|
| Loop diuretics | Furosemide (Lasix), Bumetanide | Loop of Henle (thick ascending limb) | Most potent diuretic; blocks Na/K/2Cl transporter | Hypokalemia, ototoxicity (deafness), dehydration |
| Thiazide diuretics | Hydrochlorothiazide (HCTZ), Chlorthalidone | Distal convoluted tubule | First-line for hypertension | Hypokalemia, hyperuricemia (gout), hyperglycemia |
| K+-sparing | Spironolactone, Amiloride, Triamterene | Collecting duct | Retain potassium | Hyperkalemia, spironolactone → gynecomastia |
| Osmotic | Mannitol | Proximal tubule + loop | Pulls water by osmosis | Dehydration, hyponatremia; used in cerebral edema |
| Carbonic Anhydrase Inhibitors | Acetazolamide | Proximal tubule | Rarely used as diuretic; used for glaucoma | Metabolic acidosis |
Antidiuretics: ADH/Vasopressin, Desmopressin - used in diabetes insipidus
Nursing Responsibilities for Furosemide (most exam-asked):
- Give in morning to avoid nocturia
- Monitor daily weight (1 kg gain = 1 L fluid retention)
- Strict intake/output charting
- Monitor electrolytes, especially K+ (supplement with potassium-rich foods)
- Assess for dehydration (dry mouth, low BP, concentrated urine)
- Monitor hearing with long-term use (ototoxicity)
4. 🔴 DRUG TOXICITY (Nephrotoxic Drugs)
Nephrotoxic drugs (drugs toxic to the kidney):
| Drug | Mechanism of Toxicity | Signs | Nursing |
|---|---|---|---|
| Aminoglycosides (Gentamicin, Tobramycin, Amikacin) | Direct tubular damage | Rising creatinine, reduced urine output | Monitor BUN/creatinine, trough levels |
| NSAIDs | Reduce prostaglandin-mediated renal blood flow | Acute kidney injury | Avoid in dehydrated/elderly patients |
| Amphotericin B | Direct tubular toxicity | Hypokalemia, renal failure | Adequate hydration before infusion |
| Vancomycin | Tubular damage | Rising creatinine | Monitor trough levels ("red man syndrome" = infusion reaction, not allergy) |
| Cisplatin (chemotherapy) | DNA damage in tubules | Hypomagnesemia, renal failure | Aggressive IV hydration before and after |
| Contrast dyes (radiocontrast) | Vasoconstriction of renal vessels | Acute contrast nephropathy | Hydration before procedure, monitor creatinine |
| Lithium | Nephrogenic DI, interstitial nephritis | Polyuria, rising creatinine | Serum lithium levels, adequate hydration |
General Nursing for all nephrotoxic drugs:
- Monitor urine output (report < 30 mL/hour)
- Monitor BUN and serum creatinine
- Ensure adequate hydration
- Avoid combining multiple nephrotoxic agents
- Dose-adjust in existing renal impairment
5. 🔴 TOPICAL APPLICATIONS FOR THE EYE
Key Ophthalmic Drugs:
| Drug | Class | Use | Key Points |
|---|---|---|---|
| Chloramphenicol eye drops/ointment | Antibiotic | Bacterial conjunctivitis, trachoma | Broad-spectrum; can cause aplastic anemia with systemic use (not topical) |
| Gentamicin eye drops | Aminoglycoside antibiotic | Severe bacterial infections (keratitis, conjunctivitis) | Effective against Pseudomonas |
| Soda Glycerin (Glycerol) | Osmotic agent | Corneal edema, pre-op for acute glaucoma | Reduces intraocular pressure temporarily |
| Timolol | Beta-blocker | Glaucoma | Reduces aqueous humor production |
| Pilocarpine | Cholinergic (miotic) | Glaucoma | Constricts pupil, increases outflow |
How to Instill Eye Drops - Nursing Procedure:
- Wash hands thoroughly
- Ask patient to tilt head back and look upward
- Pull lower eyelid down to form a conjunctival sac
- Instill prescribed number of drops into the sac (NOT on cornea directly)
- Ask patient to close eyes gently (not squeeze)
- Apply gentle pressure on nasolacrimal duct (inner corner) for 1-2 minutes - prevents systemic absorption
- Wipe any excess with clean cotton
- Do NOT let dropper tip touch the eye
Important: If using multiple eye drops, wait 5 minutes between each.
6. 🔴 OPIOID ANALGESICS
Mechanism: Bind to opioid receptors (μ-mu, κ-kappa, δ-delta) in CNS and peripheral tissues → reduce pain perception
Classification:
| Drug | Potency | Key Feature |
|---|---|---|
| Morphine | Strong | Gold standard for severe pain; natural opioid |
| Codeine | Weak | Antitussive (cough suppression); converted to morphine in liver |
| Tramadol | Moderate | Also inhibits serotonin/norepinephrine reuptake; lower abuse potential |
| Pethidine (Meperidine) | Moderate | Used in labor pain; shorter duration (2-3 hrs) |
| Fentanyl | Very strong (100x morphine) | Transdermal patch for chronic pain; also IV in surgery |
| Buprenorphine | Partial agonist | Used in opioid dependence treatment |
| Naloxone (Narcan) | Antagonist | ANTIDOTE for opioid overdose |
Side Effects (remember "COWARDS"):
- C - Constipation (most common)
- O - respiratory depressiOn (most dangerous - rate < 12/min is emergency)
- W - miosis (pin-point pupils - Warning sign of overdose)
- A - Addiction/dependence
- R - uRinary Retention
- D - Drowsiness/sedation
- S - bradycardia, nauSea, vomiting
Opioid Overdose Triad: Unconsciousness + Pinpoint pupils + Respiratory depression → Give NALOXONE IV immediately
Nursing Responsibilities:
- Assess pain (0-10 scale) before and after giving opioid
- Monitor respiratory rate - hold dose and report if < 12 breaths/min
- Keep Naloxone (antidote) readily available
- Monitor level of consciousness
- Prevent constipation - give stool softeners, increase fluids
- Avoid in head injury (increases intracranial pressure)
- Patient teaching: do NOT drive, avoid alcohol
- Monitor for urinary retention
7. 🔴 HYPNOTICS & SEDATIVES
Definition: Drugs that induce sleep (hypnotics) or reduce anxiety/cause calmness (sedatives). Often the same drug - dose determines effect.
Classification:
| Class | Examples | Mechanism | Key Facts |
|---|---|---|---|
| Benzodiazepines (BZDs) | Diazepam, Lorazepam, Midazolam, Nitrazepam, Alprazolam | Enhance GABA-A receptor activity → ↑ Cl- influx → CNS depression | Antidote = Flumazenil |
| Barbiturates | Phenobarbitone, Thiopentone, Pentobarbitone | Also enhance GABA-A but more dangerous (narrow safety margin) | Phenobarbitone also used for epilepsy |
| Non-BZD (Z-drugs) | Zolpidem (Ambien), Zaleplon | Act on BZD site of GABA-A receptor | For insomnia only, shorter acting |
| Melatonin agonists | Ramelteon | Activate MT1/MT2 receptors | No dependence risk |
Benzodiazepine uses (SAVE mnemonic):
- S - Sedation/Sleep
- A - Anxiety (anxiolytic)
- V - seiZure/conVulsion control (status epilepticus)
- E - muscle rElaxation
Side Effects (BZDs): Sedation, confusion, falls (especially elderly), amnesia, dependence, respiratory depression with alcohol
Nursing Responsibilities:
- Fall risk - put up bed rails, call bell within reach, assist with ambulation
- Avoid in elderly (Beers criteria - high fall and confusion risk)
- Never abruptly stop BZDs (causes withdrawal seizures)
- Avoid alcohol (dangerous additive CNS depression)
- Dependence can develop - use for short-term only
- Antidote for overdose = Flumazenil
8. 🔴 ANTICONVULSANTS (Anti-epileptics)
Types of Seizures + First-line Drug:
| Seizure Type | Description | Drug of Choice |
|---|---|---|
| Tonic-clonic (Grand mal) | Whole body stiffening + jerking | Phenytoin, Valproate, Carbamazepine |
| Absence (Petit mal) | Brief staring spells (children) | Ethosuximide (1st line) |
| Partial (focal) seizures | One body part | Carbamazepine |
| Status epilepticus | Continuous seizures > 5 min - EMERGENCY | IV Diazepam (1st) → IV Phenytoin |
| Myoclonic seizures | Sudden muscle jerks | Valproate |
Key Drugs in Detail:
| Drug | Mechanism | Uses | Key Side Effects |
|---|---|---|---|
| Phenytoin | Block Na+ channels (stabilize membranes) | Tonic-clonic, partial seizures | Gingival hyperplasia, hirsutism, ataxia, nystagmus, teratogenic (fetal hydantoin syndrome) |
| Carbamazepine | Block Na+ channels | Partial seizures, trigeminal neuralgia, bipolar | Diplopia, ataxia, aplastic anemia, induces liver enzymes (drug interactions!) |
| Valproate (Valproic acid) | Multiple - GABA increase + Na+ channel block | Broad spectrum (all seizure types), bipolar, migraine | Hepatotoxicity, teratogenic (neural tube defects), weight gain, hair loss |
| Ethosuximide | Block T-type Ca2+ channels | Absence seizures ONLY | Nausea, GI upset |
| Phenobarbitone | Enhance GABA-A | Tonic-clonic, status epilepticus | Sedation, dependence, enzyme inducer |
| Benzodiazepines (Diazepam, Clonazepam) | Enhance GABA-A | Status epilepticus, anxiety + seizures | Sedation, dependence |
| Lamotrigine | Block Na+ channels | Partial + generalized seizures | Stevens-Johnson syndrome (serious skin rash) |
| Levetiracetam | SV2A modulation | Partial + generalized seizures | Behavioral changes, well tolerated |
Nursing Responsibilities:
- NEVER abruptly stop anticonvulsants (causes rebound seizures)
- Monitor drug levels (Phenytoin therapeutic range: 10-20 mcg/mL)
- Seizure precautions: padded side rails, remove sharp objects, suction available
- During seizure: turn patient to side (recovery position), protect head, time the seizure, DO NOT put anything in mouth
- Monitor for teratogenicity - counsel women of childbearing age (folic acid supplementation)
- Valproate: monitor liver function tests (LFTs)
- Carbamazepine: monitor CBC (blood count) - risk of aplastic anemia
- Phenytoin: teach oral hygiene (causes gum overgrowth)
9. 🔴 ANTIPSYCHOTICS
Uses: Schizophrenia, bipolar disorder (manic phase), severe agitation
Classification:
| Type | Examples | Mechanism | Key Difference |
|---|---|---|---|
| Typical (1st gen) | Chlorpromazine, Haloperidol, Fluphenazine, Trifluoperazine | Block D2 dopamine receptors | MORE extrapyramidal side effects (EPS) |
| Atypical (2nd gen) | Clozapine, Risperidone, Olanzapine, Quetiapine, Aripiprazole | Block D2 + 5-HT2A (serotonin) receptors | LESS EPS, but metabolic syndrome |
Extrapyramidal Side Effects (EPS) - EXAM FAVOURITE:
| EPS Type | When it Occurs | Features | Treatment |
|---|---|---|---|
| Acute dystonia | Hours to days | Muscle spasms, neck twisting (torticollis), oculogyric crisis | Benztropine, Diphenhydramine (IM/IV) |
| Akathisia | Days to weeks | Restlessness, inability to sit still | Reduce dose, Propranolol |
| Parkinsonism | Weeks | Tremor, rigidity, bradykinesia | Benztropine, Trihexyphenidyl |
| Tardive Dyskinesia | Months to years | Involuntary repetitive movements (lip smacking, tongue protrusion) | Irreversible! - stop drug or switch to atypical |
Other Side Effects:
- Chlorpromazine: photosensitivity, postural hypotension, jaundice
- Clozapine: Agranulocytosis (life-threatening low WBC) - weekly WBC monitoring mandatory!
- Atypicals: Weight gain, hyperglycemia, metabolic syndrome
- All antipsychotics: QT prolongation, sedation, anticholinergic effects
Neuroleptic Malignant Syndrome (NMS) - EMERGENCY:
- Features: High fever, muscle rigidity, altered consciousness, autonomic instability
- Treatment: Stop antipsychotic immediately, IV dantrolene, bromocriptine
Nursing Responsibilities:
- Monitor for EPS signs at every visit
- Clozapine: weekly CBC (absolute neutrophil count monitoring)
- Teach patient to rise slowly (postural hypotension)
- Protect from sun exposure (photosensitivity - especially Chlorpromazine)
- NEVER stop abruptly - taper dose
- Monitor weight and blood glucose (atypicals cause metabolic syndrome)
- Patient education: take medication even when feeling well (relapse prevention)
⚡ LAST-MINUTE CHEAT SHEET - ANTIDOTES & KEY FACTS
| Drug / Situation | Key Fact |
|---|---|
| Opioid overdose antidote | Naloxone |
| Benzodiazepine overdose antidote | Flumazenil |
| Non-depolarizing NMB antidote | Neostigmine |
| ACE inhibitor unique side effect | Dry cough |
| Lithium toxicity monitoring | Serum level 0.6-1.2 mEq/L |
| Most dangerous opioid side effect | Respiratory depression |
| Antipsychotic causing agranulocytosis | Clozapine (monitor WBC!) |
| EPS antidote (acute dystonia) | Benztropine |
| Absence seizure drug | Ethosuximide |
| Status epilepticus first drug | IV Diazepam |
| Furosemide electrolyte concern | Hypokalemia |
| Phenytoin therapeutic level | 10-20 mcg/mL |
| Antihistamine (non-sedating) | Cetirizine, Loratadine |
| Valproate most serious side effect | Hepatotoxicity + Teratogenic |
🎯 HOW TO WRITE EXAM ANSWERS (Format your teacher expects)
For any drug asked in "Short Answer" type:
- Definition (1 line)
- Classification / Examples (with a table if time permits)
- Mechanism of Action (1-2 lines)
- Uses / Indications
- Side Effects (3-5 points)
- Nursing Responsibilities (5 points minimum - this scores well in nursing exams!)
Study priority tonight: RAAS > Diuretics > Anticonvulsants > Antipsychotics (most content) - the rest you already have well covered. Sleep by 12:30 AM. Best of luck tomorrow! 🍀
This is a shared conversation. Sign in to Orris to start your own chat.