14 Must Know Meds For Nursing School And The NextGen NCLEX

Jon Haws, BS, BSN, RN, Alumnus CCRN 5-May

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Pharmacology Was New to Me and I Was Terrified

Medications Covered in This Blog Post

Oxytocin
Levothyroxine
Gabapentin
Metformin
Digoxin
Fentanyl
Epinephrine

Heparin
Warfarin
Albuterol
Insulin – Short Acting
Insulin – Intermediate Acting
Insulin – Long Acting
Insulin - Rapid Acting

I remember my first day as a sophomore nursing student in Nursing Pharmacology.
To say I was lost is an understatement. It was like someone had dropped me off in
a completely foreign land with incomprehensible language.

When I entered nursing school the only real health care experience I had was
working as a transporter in a large hospital. Pharmacology was new to me and I
was terrified that I would never be able to grasp the lingo.

The good news was my study partner had actually attended pharmacy school in India before coming to the United States to study nursing.

The bad news was that Pharmacology makes up about 15% of the questions on the NCLEX® and I only had a semester to learn it!

The next few months were spent intently studying and taking practice exams.

During the course, I was taking countless practice exams, and I would jot down every medication that was tested. I also would jot down the fact about the specific medication or class that was being tested.

I created a book of the compilation of the 140 must-know meds for the NCLEX® and
Nursing Pharmacology. You can get it for free (just pay shipping) click below to claim.

In this blog post I will go over 14 of the most common nursing medications you will need to know for nursing school and the NextGen NCLEX . . . these medications were the most tested.

Alright, let's get started!

Oxytocin

Generic Name for Oxytocin

Oxytocin

Trade Name for Oxytocin

Pitocin

Indication for Oxytocin

Labor induction, postpartum bleeding

Action for Oxytocin

Stimulates uterine smooth muscle

Therapeutic Class for Oxytocin

Hormones

Pharmacologic Class for Oxytocin

Oxytocics

Nursing Considerations for Oxytocin

Can cause ICH in the fetus
Can cause asphyxia in the fetus
May cause coma and seizures in the mother

May cause painful contractions
Assess fetus
Assess contractions

Monitor blood pressure
Assess maternal electrolytes
May cause uterine tetany

Nursing Case Study for Oxytocin

Mary, a 32-year-old, is admitted to the labor and delivery unit at 39 weeks of gestation. She is in active labor and progressing well. However, her labor has slowed down, and the healthcare team decides to initiate an intravenous infusion of Oxytocin to augment her contractions.

Levothyroxine

Generic Name for Levothyroxine

Levothyroxine

Trade Name for Levothyroxine

Levothroid

Indication for Levothyroxine

Thyroid hormone replacement in hypothyroidism

Action for Levothyroxine

Replaces thyroid hormone, increasing metabolism, promotes gluconeogenesis,
stimulates protein synthesis, restores normal hormone balance, and suppresses
thyroid cancer.

Therapeutic Class for Levothyroxine

Hormone

Pharmacologic Class for Levothyroxine

Thyroid preparations

Nursing Considerations for Levothyroxine

Assess pulse and monitor for tachyarrhythmias and chest pain
Monitor TSH levels
Therapy is lifelong
Increases the effects of warfarin

Overdose is presented as hyperthyroidism
Take directly after breastfeeding
Start with low doses and increase as indicated

Nursing Case Study for Levothyroxine

Tammy, a 38-year-old female, is admitted to the medical-surgical unit with a diagnosis of hypothyroidism. Her thyroid-stimulating hormone (TSH) levels are significantly elevated, indicating an underactive thyroid gland. The healthcare team has prescribed Levothyroxine, a synthetic thyroid hormone, to supplement her thyroid hormone levels.

Gabapentin

Generic Name for Gabapentin

Gabapentin

Trade Name for Gabapentin

Neurontin

Indication for Gabapentin

Seizures, peripheral neuropathy, neuropathic pain, prevention of migraines

Action for Gabapentin

The exact method of action is unknown, may play a role in stabilizing neural membranes

Therapeutic Class for Gabapentin

Analgesic adjuncts, therapeutic, anticonvulsants, mood stabilizers

Pharmacologic Class for Gabapentin

None

Nursing Considerations for Gabapentin

May cause suicidal thoughts, confusion, depression, drowsiness, ataxia, facial
edema, hypertension
Monitor pt closely for changes in behavior and depression
Assess seizure activity
Assess pain level
Patients should take medications exactly as prescribed

Nursing Case Study for Gabapentin

Sarah, a 65-year-old woman, is admitted to the neurology unit with a diagnosis of neuropathic pain related to diabetic peripheral neuropathy. The healthcare team has prescribed Gabapentin, an antiepileptic medication commonly used for neuropathic pain management.

Metformin

Generic Name for Metformin

Metformin

Trade Name for Metformin

Glucophage

Indication for Metformin

Management of Type II DM, PCOS

Action for Metformin

It decreases glucose production in the liver decreases absorption, and increases cellular insulin sensitivity

Therapeutic Class for Metformin

Antidiabetic

Pharmacologic Class for Metformin

Biguanide

Nursing Considerations for Metformin

Do not use with renal dysfunction, metabolic acidosis
May cause diarrhea, nausea, vomiting, lactic acidosis
Monitor patient closely for ketoacidosis and lactic acidosis, discontinue
medication immediately if acidotic
May cause a metallic taste
Instruct patient that medication does not cure diabetes

Nursing Case Study for Metformin

Jane, a 50-year-old woman, is admitted to the medical unit with a diagnosis of type 2 diabetes. The healthcare team has prescribed Metformin, an oral antidiabetic medication, to help manage her blood sugar levels.

Digoxin

Generic Name for Digoxin

Digoxin

Trade Name for Digoxin

Lanoxin

Indication for Digoxin

CHF, AFib, A-flutter

Action for Digoxin

Positive inotropic effect (increases the force of myocardial contraction), prolongs
refractory period, ↓ conduction through SA and AV nodes. Essentially digoxin is
given to increase cardiac output and slow the rate.

Therapeutic Class for Digoxin

Antiarrhythmic, inotropic

Pharmacologic Class for Digoxin

Digitalis glycosides

Nursing Considerations for Digoxin

Excreted by kidneys
Assess the patient for hypersensitivity
Contraindicated with uncontrolled ventricular arrhythmias
Hypokalemia increases the risk of toxicity
Monitor pulse rate for 1 full minute prior to dosing patient (hold for pulse <60)

Use caution with diuretic use as they may cause electrolyte abnormalities
that can lead to toxicity
Assess patient for cardiac arrhythmias including bradycardia
Signs of toxicity include vision changes (blurred vision, yellow, and green vision disturbances)
Hypercalcemia ↑ risk for toxicity

Nursing Case Study for Digoxin

Mark, a 70-year-old male, is admitted to the cardiac care unit with a diagnosis of heart failure. He has a history of hypertension and atrial fibrillation. The healthcare team has prescribed Digoxin to manage his heart failure symptoms and control his heart rate.

Fentanyl

Generic Name for Fentanyl

Fentanyl

Trade Name for Fentanyl

Sublimaze

Indication for Fentanyl

Supplement to general anesthesia, continuous IV infusions for the purpose of analgesia

Action for Fentanyl

Binds to opiate receptors in CNS altering the perception of pain, producing CNS
depression

Therapeutic Class for Fentanyl

Opioid Analgesic

Pharmacologic Class for Fentanyl

Opioid agonists

Nursing Considerations for Fentanyl

Use caution with increased ICP, head trauma, adrenal insufficiency
Avoid use with MAOIs
May cause apnea, laryngospasm, decreased respirations, bradycardia,
hypotension

Do not consume grapefruit while taking this medication
Monitor hemodynamics during the administration
Assess patient pain scale frequently

Nursing Case Study for Fentanyl

Lisa, a 45-year-old woman, is admitted to the post-anesthesia care unit (PACU) following abdominal surgery. The healthcare team administered Fentanyl, a potent opioid analgesic, to manage her postoperative pain during the surgical procedure.

Epinephrine

Generic Name for Epinephrine

Epinephrine

Trade Name for Epinephrine

Adrenalin, EpiPen

Indication for Epinephrine

Asthma and COPD exacerbations, allergic reactions, cardiac arrest, anesthesia adjunct

Action for Epinephrine

Affects both beta1 and beta2 and also has alpha agonist properties resulting in bronchodilation and increases in HR and BP. Inhibits hypersensitivity reactions.

Therapeutic Class for Epinephrine

Antiasthmatic, a bronchodilator, vasopressor

Pharmacologic Class for Epinephrine

Adrenergic agonist

Nursing Considerations for Epinephrine

Side effects include angina, tachycardia, hypertension, restlessness, nervousness, hyperglycemia
Use of MAOI may lead to a hypertensive crisis
Patients should not use stimulants (caffeine, guarana, etc)
Excessive use may cause bronchospasm

Assess lung sounds, pulse, BP, and other hemodynamic parameters
Patients should insure adequate fluid intake to liquefy secretions
The mouth should be rinsed after inhalation
Beta-blockers may negate the effects
May increase blood glucose levels
Monitor for chest pain
Instruct patient to use as directed

Nursing Case Study for Epinephrine

John, a 60-year-old male, is brought to the emergency department with symptoms of anaphylaxis after being stung by a bee. The healthcare team administers Epinephrine, a medication used to treat severe allergic reactions, manage his symptoms, and stabilize his condition.

Heparin

Generic Name for Heparin

Heparin

Trade Name for Heparin

Hep-Lock

Indication for Heparin

Venous thromboembolism prophylaxis and treatment, the low dose used to ensure
patency of IV catheters

Action for Heparin

Increases the inhibitory effect of antithrombin on factor Xa

Therapeutic Class for Heparin

Anticoagulant

Pharmacologic Class for Heparin

Antithrombotic

Nursing Considerations for Heparin

Monitor for signs of bleeding
Monitor platelet count
May cause hyperkalemia
Have the patient report any signs of bleeding

Nursing Case Study for Heparin

Sarah, a 65-year-old female, is admitted to the medical-surgical unit with a diagnosis of deep vein thrombosis (DVT) in her left leg. The healthcare team has prescribed Heparin, an anticoagulant, to prevent further clot formation and promote clot dissolution.

Warfarin

Generic Name for Warfarin

Warfarin

Trade Name for Warfarin

Coumadin

Indication for Warfarin

Venous thrombosis, pulmonary embolism, AFib, myocardial infarction

Action for Warfarin

Disrupts liver synthesis of Vitamin K dependent clotting factors

Therapeutic Class for Warfarin

Anticoagulant

Pharmacologic Class for Warfarin

Coumarins

Nursing Considerations for Warfarin

Contraindicated with bleeding, severe hypertension
Can cause bleeding
Aspirin and NSAIDs can increase the risk of bleeding
Azole antifungals increase the effects of warfarin
Cimetidine (Tagamet) increases warfarin levels
The patient should not drink alcohol
Vitamin K is antidote

Obtain a full history of supplements and herbs
Large amounts of vitamin K may antagonize the effects of warfarin
Assess for signs of bleeding
Therapeutic levels: PT 15.5 – 35 seconds, INR 2 – 3
Instruct patient to report any signs of bleeding
Bleeding times need to be monitored frequently

Nursing Case Study for Warfarin

Emily, a 55-year-old female, is admitted to the cardiology unit with a diagnosis of atrial fibrillation. The healthcare team has prescribed Warfarin, an oral anticoagulant, to prevent blood clots and reduce the risk of stroke.

Insulin

Insulin – Short-Acting

Generic Name for Insulin – Short-Acting

Insulin regular

Trade Name for Insulin – Short-Acting

Humulin R/Novolin R

Indication for Insulin – Short-Acting

Hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action for Insulin – Short-Acting

Stimulates uptake of glucose into muscle and fat cells inhibits production of glucose in the liver, prevents the breakdown of fat and protein

Route Onset Peak Duration for Insulin – Short-Acting

Route	Onset	Peak	Duration
Subcutaneous	30-45 min	1.5-2.5h	4.5-6h

Therapeutic Class for Insulin – Short-Acting

Antidiabetics, hormones

Pharmacologic Class for Insulin – Short-Acting

Pancreatics

Nursing Considerations for Insulin – Short-Acting

Assess for symptoms of hypoglycemia or hyperglycemia
Monitor body weight over time
May cause decreased inorganic phosphates, potassium, and magnesium
Monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Nursing Case Study for Insulin – Short-Acting

Alex, a 35-year-old male with type 1 diabetes, is admitted to the hospital with hyperglycemia. The healthcare team has prescribed short-acting insulin to manage his blood glucose levels.

Example of When You Would Use - Short-Acting

Short-acting insulin is used to rapidly lower blood glucose levels after meals in individuals with diabetes.

Insulin – Intermediate Acting

Generic Name for Insulin – Intermediate Acting

Insulin NPH

Trade Name for Insulin – Intermediate Acting

Humulin N, Novolin N

Indication for Insulin – Intermediate Acting

Hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action for Insulin – Intermediate Acting

Stimulates uptake of glucose into muscle and fat cells inhibits the production of glucose in the liver, prevents the breakdown of fat and protein

Route Onset Peak Duration for Insulin – Intermediate Acting

Route	Onset	Peak	Duration
Subcutaneous	1-2 hr	4-12 hr	18-24 hr

Therapeutic Class for Insulin – Intermediate Acting

Antidiabetics, hormones

Pharmacologic Class for Insulin – Intermediate Acting

Pancreatics

Nursing Considerations for Insulin – Intermediate Acting

Assess for symptoms of hypoglycemia or hyperglycemia
Monitor body weight over time
May cause decreased inorganic phosphates, potassium, and magnesium
Monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Nursing Case Study for Insulin – Intermediate Acting

Sarah, a 50-year-old female with type 2 diabetes, is admitted to the medical-surgical unit for uncontrolled blood glucose levels. The healthcare team has prescribed intermediate-acting insulin to manage her diabetes.

Example of When You Would Use - Intermediate-Acting

Intermediate-acting insulin is used to provide basal insulin coverage and help regulate blood glucose levels between meals and overnight in individuals with diabetes.

Insulin – Long Acting

Generic Name for Insulin – Long Acting

Insulin detemir, Insulin glargine

Trade Name for Insulin – Long Acting

Levemir, Lantus

Indication for Insulin – Long Acting

Hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action for Insulin – Long Acting

Stimulates uptake of glucose into muscle and fat cells inhibits production of glucose in the liver, prevents the breakdown of fat and protein

Route Onset Peak Duration for Insulin – Long Acting

Route	Onset	Peak	Duration
Detemir	3-4 hr	3-14 hr	24 hour
Glargine	3-4 hr	none	24 hour

Therapeutic Class for Insulin – Long Acting

Antidiabetics, hormones

Pharmacologic Class for Insulin – Long Acting

Pancreatics

Nursing Considerations for Insulin – Long Acting

Assess for symptoms of hypoglycemia or hyperglycemia
Monitor body weight over time
May cause decreased inorganic phosphates, potassium, and magnesium
Monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Nursing Case Study for Insulin - Long-Acting

Michael, a 65-year-old male with type 2 diabetes, is admitted to the hospital with poorly controlled blood glucose levels. The healthcare team has prescribed long-acting insulin to manage his diabetes.

Example of When You Would Use Insulin - Long-Acting

Long-acting insulin is used to provide a consistent background level of insulin throughout the day, helping to maintain stable blood glucose levels between meals and during periods of fasting in individuals with diabetes.

Insulin – Rapid Acting

Generic Name for Insulin – Rapid Acting

Insulin aspart, Insulin lispro, Insulin glulisine

Trade Name for Insulin – Rapid Acting

Novolog, humalog, apidra

Indication for Insulin – Rapid Acting

Hyperglycemia with diabetes type 1 and 2, diabetic ketoacidosis

Action for Insulin – Rapid Acting

Stimulates uptake of glucose into muscle and fat cells inhibits production of glucose in the liver, prevents the breakdown of fat and protein

Route Onset Peak Duration for Insulin – Rapid Acting

Route	Onset	Peak	Duration
Aspart	10-20 min	1-3 hr	3-5 hr
Glulisine	15 min	1 hr	2-4 hr
Lispro	15 min	1-1.5 hr	3-4 hr

Therapeutic Class for Insulin – Rapid Acting

Antidiabetics, hormones

Pharmacologic Class for Insulin – Rapid Acting

Pancreatics

Nursing Considerations for Insulin – Rapid Acting

Assess for symptoms of hypoglycemia or hyperglycemia
Monitor body weight over time
May cause decreased inorganic phosphates, potassium, and magnesium
Monitor blood sugars every 6 hours, monitor A1C every 3-6 months

Nursing Case Study for Insulin – Rapid Acting

Jessica, a 40-year-old female with type 1 diabetes, is admitted to the hospital with diabetic ketoacidosis (DKA). The healthcare team has prescribed rapid-acting insulin to manage her blood glucose levels.

Example of When You Would Use Insulin – Rapid Acting

A rapid-acting insulin is typically used to control blood glucose levels during mealtime or to correct high blood sugar levels.

Albuterol

Generic Name for Albuterol

Albuterol

Trade Name for Albuterol

Proventil

Indication for Albuterol

Bronchodilators used to prevent airway obstruction in asthma and COPD

Action for Albuterol

Binds to Beta2 adrenergic receptors in the airway leading to relaxation of the
smooth muscles in the airways

Therapeutic Class for Albuterol

Bronchodilator

Pharmacologic Class for Albuterol

Adrenergic

Nursing Considerations for Albuterol

May decrease the effectiveness of Beta Blockers
Overuse of inhalers can lead to bronchospasm
Monitor for chest pain and palpitations
Can decrease digoxin levels

Use caution with
- Heart disease
- Diabetes
- Glaucoma
- Seizure disorder

Nursing Case Study for Albuterol

Sarah, a 35-year-old female with a history of asthma, presents to the emergency department with acute shortness of breath and wheezing. The healthcare team has prescribed albuterol to relieve her bronchospasm and improve her breathing.

That's it! You made it through 14 must-know meds for nursing school and the NextGen NCLEX!

If you want the entire 140 Must Know Meds book, do not forget to grab your free copy (just pay to ship) today!

Remember, medication administration is a significant responsibility for nurses, and it requires a thorough understanding of each medication's implications. Continuously study and review these medications, as they are commonly encountered in various healthcare settings.

By familiarizing yourself with these essential medications, you will enhance your clinical decision-making skills, improve patient outcomes, and increase your confidence as a nurse.

You Can Do This!

Happy Nursing!

14 Must Know Meds For Nursing School And The NextGen NCLEX

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