Pharm ATI- What to Know- this is not a study guide but a

document to prepare you for the exam! Not everything

 Math: there will be multiple math questions on this exam that will
require multiple steps. Be sure to go over how to do dimensional analysis
and how to do drop factor problems. Know ALL conversions! These will
be easy points towards your score!
 Lab values: know your lab values and therapeutic levels in case they ask
you what one to report or expect with use of a certain medication.
 Aspirin: potential for salicylic toxicity. Tinnitus will be a S/S of this
complication. Other manifestations: sweating, HA, dizzy, respiratory
alkalosis. Remind patient to call HCP and stop med if this occurs.
 Lithium: must maintain adequate sodium and fluid intake, no salt free
diet needed, report swelling to HCP, have strict I/O’s, take with food to
decrease gastric distress. TOXICITY: when the lithium level is over 1.5,
but can be mild, severe or lethal. If above 2.6- prep client for dialysis.
Assess for mild thirst as this can indicate inadequate sodium levels and
potential for toxicity. If lithium is given when the patient have a toxic
level, an incident report must be written.
 Nitroglycerin: if topical ointment- use gloves when applying, rotate sites
to prevent skin irritation, remove topical patches before placement of
the topical ointment, never massage or rub the ointment into the skin,
cover with plastic wrap. Apply nitroglycerin skin patches to a hairless
layer of skin on chest, back or abdomen and rotate sites when placing it.
Always measure nitroglycerin ointment with the applicator paper. Store
the tablets if SL in the container which is dark that it comes in at room
 temperature. If taking SL tablets for chest pain, take one and call 911 if
pain is not relieved.
 IV amphotericin B: acute infusion reactions- fever, chills, rigors, HA for 1-
3 hrs after initiation.
 IV Infiltration: actions- 1st: stop infusion and remove IV, 2nd- elevate arm.
Place moist and warm compress if site is cool and swollen.
 Ondansetron: the medication will help prevent nausea and vomiting, so
an indication that it is working is increased appetite or absence of
nausea or vomiting.
 S/S Allergic reaction: common w/ antibiotics of the penicillin family! S/S:
hives, flushing, redness, itchy, wheezing, closure of airway, impending
doom.
 Morphine/Hydromorphone (opioids): will cause a decrease in all body
systems! Urinary retention, bradycardia, constipation, hypotension. With
any opioid use, because it is controlled substance, another RN must
observe the main RN waste the medication if indicated. If given for
cancer or chronic conditions like sickle cell, give the med on a fixed
schedule to prevent dependence. Respiratory rate should be monitored
and the med held if the rate is less than 12. Naloxone is the antidote. Do
not give with CNS depressant. Never given 2 opioid medications at the
same time with the patient as they are additives! May need a providers
prescription when renewing the medication.
 Administration of antibiotics: must inspect the prescription for
precipitate and expiration, give medication slowly over 2-4 hrs, and
always use a pump.
 Serotonin syndrome: happens with use of SSRI or SNRI within the first 72
hrs of use. S/S must be reported such as: fevers, skin changes, suicidal
ideation, bleeding, seizures, psychomotor disturbances, vital sign
fluctuations.
 Antacids and use of H2 Receptor Blockers or PPI should be spaced out
within 1 hr of taking the medication. Either take antacid 1 hr before the

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 med of 1 hr after the med. Do this as antacids can decrease medication
absorption rate.
 Doxorubicin: chemo agent used to treat ovarian cancers. S/S toxicity are
dysrhythmias (can be toxic).
 Carbamazepine (or other anticonvulsants): will interact with oral
contraceptives. Monitor for any blurred vision. Do not stop this
medication as it will increase risk of seizures.
 Older adult considerations with medications: multiple health problems,
decreased renal function, polypharmacy, decreased absorption rate,
increased body fat. Puts them at risk for adverse drug reactions.
 Acyclovir: antiviral used to treat genital herpes and other viruses.
However, it can help prevent breakouts. Can be taken while pregnant.
 SSRI adverse effects: nausea, fatigue, sweating, bruxism, confusion,
tremor, drowsiness, weight gain. Can cause hyponatremia so sodium
levels should be monitored (135-145).Goal of drug use is to decrease
anxiety and depressive states. Advise patients to eat a well balanced diet
and exercise.
 Digoxin: used in heart failure. Monitor for s/s of toxicity such as nausea,
vomiting, low potassium levels (3.5-5), visual disturbances. Therapeutic
med range is 0.5-0.8. They should not be taking a loop or thiazide
diuretic because it can place the patient at risk for hypokalemia and
digoxin toxicity. Assess the apical HR and BP before use and hold the
drug if the BP is less than 90/60 or HR less than 60 – why? Because it will
bottom out the patient if you give the med with it being too low.
 Tetracycline decreases effect of oral contraceptives. Do not take with
milk. Space med out with use of calcium carbonate
 Furosemide: loop diuretic and rids Na, K, Cl, P. Can be ototoxic- report
hearing loss. Increase foods high in K. Do not give med in evening or at
night as it causes the patient to pee. Daily weights needed while on this
medication. Use with amikacin will further ototoxicity. Bumentanide is

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 also used and is loop diuretic but has same effects. Therapeutic effect is
a decreased weight.
 Iron supplements: do not give with antacids or caffeine- if you have to
take it with antacid space out, take with orange juice, sip it with a straw
to prevent teeth staining, sit upright for 15 minutes after taking, normal
for stool to turn back or tarry like- must inform them! Wash mouth out
after taking the medication.
 Raloxifene: treats osteoporosis postmenopausal.
 Cyanocobalamin: give intranasal in one nostril per week. Will be taken
lifelong for pernicious anemia.
 ACE Inhibitors: adverse reactions include dry cough- they must switch to
ARB. 1st dose hypotension can occur so advise patients to change
position slowly when on the medication.
 Blood transfusion reactions: give epinephrine when a patient has an
allergic reaction to the blood such as hives, itching, flushing, redness,
airway constriction.
 Cromolyn: used for long term asthma control
 Vancomycin: can cause red man syndrome when toxic. Must assess the
patient while on the med for upper body flushing, rashes, tachycardia,
hypotension. Do not give vancomycin if the patient has corn allergy, give
over 1 hour. Must check kidney levels as it can be nephrotoxic.
 Pioglitazone: used in type 2 diabetes. Monitor for adverse effects of
heart failure like fluid retention, edema, weight gain, orthostatic
hypotension.
 Steroids: “sone”. May cause bone loss, osteoporosis if used long term,
hyperglycemia. Advise patients to do weight bearing exercises, have
sufficient dietary vitamin D and calcium intake, low dose with alternate
daily dosing schedule, monitor their blood glucose and may need insulin.
 Infliximab: used in RA and immune conditions. The patient should get a
test for TB and hep B before starting the medication.

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 Warfarin: INR= 2-3- Anything above or below should be reported.
Antidote is Vitamin K. They will need to avoid foods should as green leafy
vegetables, broccoli and cabbage, that have loads of vitamin K in them.
Bleeding precautions are needed. Will interact with naproxen.
 Benzos: used for anxiety, depression, anti-seizures. “am”. These drugs
place patients at risk for falls because they cause CNS depression and S/S
of lightheadedness, drowsiness, and incoordination. Alert patients to not
drive or use heavy machinery until effects are known. Give it to patients
with acute drug or alcohol toxicity.
 If they give you a med question where the RN gave the wrong med,
assess the client will always be the right answer. Whether it be checking
HR, BP, RR, glucose, etc, choose what thing you would assess per what
med was given to the patient mistakenly.
 Statins: help to increase HDL levels and decreased LDL and VLDL. Take at
nighttime. Watch liver tests before giving the medication.
 Enoxaparin administration: insert entire needle into the skin, alternate
and rotate injection sites in the abdomen, pinch skin- this is given
subcutaneous. Never rub site after injection or expel air bubbles from
the syringe.
 If using a SABA and steroid inhaler, Take the SABA first then steroid, wait
1 min between 2 puffs of the same one, rinse mouth out after using the
steroid inhaler to prevent yeast infection in the mouth.
 Buccal medications: goes inside of the cheek
 TB medication regimen will include 2 or more medications such as
rifampin, isoniazid, pyrazinamide, ethambutol. Med effectiveness
evidenced by negative sputum testing.
 Rifampin: makes pee turn red and is normal for the medication. Look at
ALT levels for adverse reactions.
 Always compare the list of medication to the ones the patient will get
after transfer to what is current to prevent any medication mistakes.

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 Cephalexin: adverse effect is diarrhea due to antibiotic associated c.diff
infection with the med. Can cause IM injection pain and hypotension as
well.
 Methimazole: used to treat hyperthyroidism/ Graves disease. S/S of
overmedication and need for lowered dose include those that mimic
hypothyroidism such as bradycardia, drowsiness, depression, weight
gain, anorexia, cold intolerance.
 Levothyroxine: used to treat hypothyroidism. S/S of overmedication
include those that mimic hyperthyroidism such as tachycardia, diarrhrea,
heat intolerance, weight loss, hyperactivity.
 Know 6 rights of med administration: patient, drug, dose, time, route,
documentation
 Heparin: anticoagulant. Monitor aPTT level 60-80 every 4-6 hrs till
therapeutic. and platelet levels. Have patient report any s/s of bleeding
or bruising. Antidote is protamine sulfate
 Oral contraceptives: report any calf swelling, warmth or tenderness as it
sign of DVT.
 Know the difference between fluid volume overload and fluid volume
deficit and what to report (this is MDC 2 stuff)
 Gentamicin: report any tinnitus or ringing in the ears as this is a sign of
toxicity. Monitor for headache, hearing loss, nausea, dizziness, and
vertigo. Can also be nephrotoxic so have to watch BUN and creatinine
levels.
 Filgrastim: should not be given within 24 hours before or after chemo
treatment. Wait 14 days after use to restart the chemo. If this occurs
within that 24 hr window, have to do the incident report. Do not leave
the medication at room temperature before giving. Monitor WBC count
as effectiveness of the medication. Look at granulocytes when seeing
effectiveness of the medications.
 Varenicline: used for smoking cessation. Adverse effects are changes in
behavior, new onset depression, suicidal thoughts, nausea, vomiting.

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 Spironolactone: will increase K levels as the drug causes body to hold
onto K while excreting everything else out. No salt substitutes while on
this medication. No high potassium foods as the levels will be must
higher. At risk for dysrhythmias and heart palpitations while on med.
Hold medication if the K level is above 5.
 Ritonavir: take with food as it can cause nausea and vomiting and will
allow for increased absorption.
 Metformin: can be used to treat a patient who has a HBA1C of 6.5% and
metabolic syndrome
 Diabetic medication effectiveness includes lowered HGBA1C level
(indicative of how well a patient controls diabetes and sugars).
 Acetaminophen: should not be used in patients who have an alcohol use
disorder
 If a patient has an alcohol use disorder and has withdrawal: implement
seizure precautions. Give a benzo to prevent DT’s.
 Atropine: anticholinergic medication: causes one to dry up and be
stopped up and have blurry vision. and their HR to increase. DO not give
with glaucoma patients.
 Epinephrine: can be given under clothing when having an allergic
reaction.
 DVT therapy is effective when platelets are in a therapeutic range.
 Combining 2 insulins: air goes first in the NPH, then regular, then draw
up regular, then draw up NPH.
 If relocating a PIV, place it in the wrist. Never place it in a hard vein,
proximal to site. Avoid dominant arm if possible.
 MAOI: no aged meats, cheeses, smoked meats and fish wine, beer,
avocado, bananas. Can cause hypertensive crisis if given these foods.
 Theophylline: asthma medication. Do not give with caffeine. Monitor
blood levels

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 Muscarinic responses include excessive salivation, ability to see,
pooping, peeing. Common with neostigmine. Response effective when
HR is normal and VS are normal
 Azathioprine: adverse effect is a low WBC count, potential for infection.
Do not use in pregnancy
 Alendronate: must stay sitting up for 30 mins to prevent epiglottitis.
 If a patient vomits blood: discontinue any medication that affects
production of blood cells.
 PPIs: can increase ones risk at having a fracture.
 Epidural anesthesia can cause hypotension, decreased RR, low HR.
 Mag Sulfate: treats preterm labor. Antidote is calcium gluconate. Give
the antidote when the patient has absent DTRs, low urine output,
decreased LOC, low BP.
 Do not use cefuroxime with having a PCN allergy.
 Erythromycin: can be ototoxic
 Always give fondaparinux IV route
 Probenecid: used in long term gout treatment. Report to HCP if the
patient takes salicylic acid.
 Nitroprusside: used in emergency treatment for extremely high BP
(180/120).
 Insulin: when drawing it up- patient should wear glasses to prevent over
or under medication. Check sugar before giving it
 Inipramine: can cause orthostatic hypotension and is a TCA
 Clindamycin: antibiotic and causes diarrhea as adverse effect
 Phenytoin ( anticonvulsant): report any cognitive impairment, suicidal
thoughts, ataxia, agitation ,confusion, drowsiness.
 Before giving a beta blocker: always check pulse rate and hold if the HR
is less than 60. Look for rebound tachycardia and possible hypoglycemia

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 Oxytocin adverse effects: LION- turn Left side first, IV access, o2 10 L,
notify provider.
 Desmopressin: used in diabetes insipidus, will decrease the urine output
for the patient and is an antidiuretic which these patients need.
 Allopurinol: used in gout. Take after a meal to prevent GI distress.
 Clozapine: 2nd generation antipsychotic medication but can cause
agranulocytosis so we must monitor their WBC count weekly. Can
develop lethargy and myalgia.
 Phenazopyridine: used for urinary tract pain, frequency and urgency.
Will relieve urinary burning as medication effectiveness.
 Before doing allergy testing: stop Benadryl as it can interfere with the
results of the test 1 month prior to exam date.
 Antibiotics can cause superinfections if a patient stops them too early or
does not finish entire course. Even with a BSA as it kills both good and
bad.
 Amniodarone: treats ventricular dysrhythmias
 Ergotamine: used in migraine headaches. May cause paresthesia’s or
muscle pain if an OD is found.
 Do not give varicella vaccination to those immunocompromised
 Montelukast: will reduce inflammation, bronchoconstriction, edema, and
mucus production.
 If patient gets succinylcholine for sedation and has malignant
hyperthermia, give dantrolene to reverse it