NCLEX Pharm: Heparin

Class: Anticoagulant


  • Prevention of clotting in arterial and heart surgery
  • Disseminated Intravascular Coagulation (DIC)
  • Atrial fibrillation with embolization
  • DVT and Pulmonary embolism

Side effects:

  • Hematology: Thrombocytopenia, bleeding, bruising, injection-site reactions,
  • Skin: hair loss,
  • GI: liver enzyme changes

Nursing Tips:

  • Heparin is a High Alert Medication
  • Adjust dose based on lab results.
  • Dosage is considered adequate when the activated partial thromboplastin time (APTT) is 1.5 to 2 times normal
  • Give by deep subcutaneous injections; do not give IM.
  • Have protamine sulfate on hand as antidote.
  • Protect clients from injury, report bleeding gums, black or tarry stools, and severe headache.
  • Avoid intramuscular route of administration because of the frequent occurrence of hematoma at the injection site.
  • Always follow facility’s heparin protocol, whenever working with this medication.

Ref: Roach’s Introductory Clinical Pharmacology

To Your Success!

Rophem 🙂


NCLEX Pharm: Lunesta

Generic Name: Eszopiclone

Brand Name: Lunesta

Class: Sedative, Hypnotic, Nonbenzodiazepine

Indication: Sleeping pill, Lunesta is used to treat insomnia.

Side effects: Confusion, clumsiness or unsteadiness (older adults), daytime anxiety and/or restlessness, difficulty with coordination (older adults), mood or mental changes.

Adverse effects: Headache, chest pain, migraine.

Nursing Tips:

  • Lunesta may be habit-forming.
  • Contraindicated in liver disease; breathing disorder.
  • Contraindicated in History of depression, mental illness, or suicidal thoughts.
  • Contraindicated in history of drug or alcohol addiction.
  • Teach clients to avoid alcohol, it can lead to very serious interactions.

Ref: Roach’s Introductory Clinical Pharmacology

To Your Success!

Rophem 🙂

Pharm: MAOIs and Tyramine Foods

Monoamine Oxidase Inhibitors (MAOI) are

  • Best known to be powerful anti-depressants.
  • They are effective therapeutic agents for panic disorder and social phobia.
  • MAOIs are tried when other antidepressants don’t work, due to side effects.
  • MAOIs can cause dangerous interactions with foods and beverages that contain Tyramine. See table below.


  • Tyramine is an amino acid that regulates blood pressure
  • It occurs naturally in the body, and it’s found in certain foods.

Important: Clients taking MAOIs will need to avoid foods containing high levels of tyramine.

Common side effects of MAOIs include:

  • Dry mouth, Headache, Drowsiness
  • Nausea, diarrhea or constipation
  • Dizziness or light-headedness
  • Skin reaction at the patch site

Nursing Implications:

  • Monitor for occipital headache, nausea, vomiting, sweating, fever, chest pain.
  • Notify the MD quickly, if client complain of any of the signs above.
  • Monitor for other drug interactions e.g. sedatives, hypnotics, & analgesics.
  • Check if client is taking Herbal products – St John’s wort has a potential for adverse reaction when taken with antidepressants.

To Your Success!

Rophem 🙂

NCLEX Pharm: Dilantin

Generic name: Phenytoin Sodium. Brand name: Dilantin

Class: Antiepileptic, Anticonvulsant, Antiarrhythmic

Indication: Seizures, Cardiac Arrhythmias

Side effects:

  • Hematology: aplastic anemia, hematopoietic complications,
  • Neuro: ataxia, dizziness, drowsiness, insomnia
  • Skin: purpuric dermatitis, Steven-Johnson syndrome.
  • GI: gingival hyperplasia, liver damage

Nursing Tips:

  • Therapeutic serum level 10-20 mcg/ml
  • Do not stop abruptly, to prevent status epilepticus.
  • Stop if rash, depressed blood count, enlarged lymph nodes, hypersensitivity reaction, signs of liver damage develop.
  • Not for use in pregnancy, it will cause fetal hydantoin syndrome; mental & physical birth defects.
  • Phenytoin is occasionally used in the treatment of cardiac arrhythmias, those associated with digitalis intoxication
  • Continually monitor cardiac rhythm; check BP frequently.
  • Dilantin capsules should be taken by mouth, swallowed whole. Do not open or crush medication.
  • Patient should take medication with a full glass (8 ounces) of water unless the doctor directs otherwise.
  • Dilantin should be used regularly and all doses taken on time to keep the serum level constant.
  • Products that contain calcium (e.g., antacids, calcium supplements) and nutritional tube-feeding products may decrease the absorption of phenytoin. Separate liquid nutritional products at least 1 hour before and 1 hour after phenytoin dose.

To your Success!

Rophem 🙂

Pharm: Carbidopa-Levodopa (Sinemet)

Sinemet is used to treat Parkinson’s disease.

  • Classifications: Autonomic Nervous System Agent; Anticholinergic; Antiparkinsonism Agent
  • Available in Capsule & Tablet forms


  • Elderly patients may have increase chance of side effects during treatment due to high sensitivity.


  • Narrow-angle glaucoma
  • Pregnancy (category C)

Caution in

  • Kidney disease
  • Diabetes mellitus
  • Chronic lung disease

Side effects

  • Urine, saliva, and sweat become darker in color than usual.
  • May cause a bitter taste, or a burning sensation of the tongue

Interactions – MAOI, Tricyclic antidepressants, Haloperidol

Nursing Implications

  • Observe for therapeutic effects and report adverse reactions promptly.
  • Monitor vital signs & rhythm, particularly during period of dosage adjustment.

Patient teaching

  • Teach to make position changes slowly, particularly from sitting to upright position.

Reference: Roach’s Introductory Clinical Pharmacology. 

To Your Success!

Rophem 🙂

Lisinopril: My Experience!

High Blood Pressure usually has no symptoms.
But as I stared at my enlarged lip in the mirror at 3am yesterday, I have to say I was a bit doubtful. Countless people battle this silent disease on a daily basis, and I’m one of them.

As a cardiac nurse, I can easily state the causes, side effects, and complications that come with high blood pressure and hypertension, but I’m not planning on giving a lecture. For once, I want to look at this problem from the eyes of a woman, not a nurse. The experience I had with treating this ailment can only be regarded as tedious.

They say, “Don’t die before death comes”, but when my son drove me to the emergency room in pitch black darkness, and the triage nurse overdramatized my swollen lip, if I had not been a nurse, a heart attack would’ve been only seconds away.

So how did this problem even start?

Let me just begin by saying that I have not had an easy life, and stress engulfed me far too frequently. This was particularly true about four years ago when I was working a twelve-hour shift and I felt a sudden headache and could hear the blood rushing in my head. To say the least, I knew something wasn’t right. Being a nurse, I could assess my symptoms and so decided to check my blood pressure.

For a minute, I couldn’t believe what I was seeing. I couldn’t believe it. My blood pressure was a high 154/88.

Though blood pressure numbers vary from person to person, I knew those numbers were extremely high for me. Before long, I had talked to my doctor friends and got a prescription for Norvasc. And for a while, it did its job. But as we all know, ALL medications have side effects, some even worse than the problem they’re meant to fix.

Norvasc led a whole other can of worms for me and I developed heartburns less than two months after I started taking it. From there on I switched from medication to medication, each giving me worse side effects than I bargained for, hoping to find something, anything that would fix my problem. Finally, I started taking Lisinopril/HCTZ as prescribed by my doctor.

For a while, it did its job, and I thought I could finally relax and not worry about blood pressure. I had hoped it would be the end of my stressing over blood pressure, but of course I was wrong. Several weeks ago, my daughter bought me an EOS Lip balm ball when I ran out of my usual lip gloss. She was using it well and I figured there was nothing wrong with trying it.

Three hours later, one of my students noticed my upper lip had swelled significantly throughout the day. In the end, I chalked it up to allergies and decided not to use the lip balm again. I didn’t even consider that it might have been my blood pressure medication. Or maybe I just didn’t want to think of the possibilities, after all, the simplest answer is probably correct, right?

It wasn’t. Not in this case. Not having had time to get a new lip gloss still, I tried a Lip Treatment cream to hydrate my lips instead of my usual Vaseline. For a day, everything was fine, and I didn’t think much of the lip balm instance in the past. But then the day after, the swelling began. Slowly but surely, my lip blew up like a balloon at a carnival and I began to get scared.

I tried washing off the balm. I tried icing to reduce the swelling, but it was useless, I decided to take 50 mg of Benadryl to calm down some immune reactions. I was too scared to go to bed, finally, at 3am, I called my son and we went to emergency room.

Through the fear, I began to think of the possible causes. Then it hit me. I had oral Angioedema. A life threatening tissue swelling and fluid accumulation in the lips and throat. As I rode with my son to the emergency room and as the ER doctor gave me Epinephrine and Solu-Medrol intravenously, I knew in my heart that I was really blessed to have not had any swelling in my throat. I remembered all the times I took care of people with the same problem, taking the same medication and I knew I had to change my blood pressure medication again because for all I knew, the next time my lips swell, my throat may swell with it.

I write this a warning to any who may have high blood pressure. Be extremely careful with the medication prescribed to you. Do your research! Just because a doctor says something is good doesn’t mean it’s good for YOU. If you’re not sure, get multiple second opinions. I know it’s hard work and it’s tedious, but I think your health is worth at least that much, don’t you?

Share this, please, you might save someone’s life!
Blessings, RASamuels 🙂