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Match insulin types to onset and peak.
Answer: Rapid (lispro): onset 15 min, peak 1 h. Regular: onset 30 min, peak 2–3 h. NPH: onset 1–2 h, peak 4–12 h. Long-acting (glargine): no pronounced peak.
Hypoglycemia risk is highest at peak times.
How should levothyroxine be taken?
Answer: On an empty stomach in the morning, 30–60 minutes before food, at the same time daily.
Signs of excess: tachycardia, weight loss, insomnia.
What is the key counseling point for metformin?
Answer: Hold before and 48 hours after iodinated contrast because of lactic acidosis risk; take with meals to reduce GI upset.
Does not cause hypoglycemia on its own.
What are signs of hypoglycemia and the treatment?
Answer: Shakiness, sweating, confusion, tachycardia; treat with 15 g of fast carbohydrate (or IV dextrose / glucagon if unable to swallow), recheck in 15 minutes.
The 15-15 rule.
What should be monitored with phenytoin?
Answer: Serum levels (10–20 mcg/mL), gingival hyperplasia, and signs of toxicity such as nystagmus and ataxia.
Do not stop abruptly; good oral hygiene helps gums.
What range is therapeutic for lithium and what are signs of toxicity?
Answer: About 0.6–1.2 mEq/L; toxicity shows as coarse tremor, vomiting, diarrhea, confusion, and ataxia.
Maintain steady sodium and fluid intake; dehydration raises levels.
What dietary restriction applies to MAOIs?
Answer: Avoid tyramine-rich foods (aged cheese, cured meats, red wine) to prevent hypertensive crisis.
Includes phenelzine and tranylcypromine.
What is serotonin syndrome and what causes it?
Answer: A dangerous excess of serotonin: agitation, hyperthermia, tremor, diarrhea; caused by combining SSRIs with MAOIs, tramadol, or other serotonergic drugs.
SSRIs can take 4–6 weeks for full effect; monitor for suicidal ideation early.
What should patients avoid while taking metronidazole?
Answer: Alcohol, during and for 48–72 hours after, because of a disulfiram-like reaction.
Metallic taste is a common side effect.
What is 'red man syndrome'?
Answer: Flushing and rash from infusing vancomycin too quickly.
Infuse over at least 60 minutes; monitor troughs for nephrotoxicity.
What is a key risk of aminoglycosides such as gentamicin?
Answer: Nephrotoxicity and ototoxicity; monitor peak and trough levels and kidney function.
Trough is drawn just before the next dose.
Before starting an antibiotic, what should be done?
Answer: Obtain cultures before the first dose, then start therapy.
Ensure patients complete the full course.
What is the priority assessment with opioids and the reversal agent?
Answer: Respiratory rate and sedation level; naloxone reverses opioid overdose.
Also monitor for constipation and start a bowel regimen.
What are the main risks of NSAIDs?
Answer: GI bleeding, kidney injury, and increased cardiovascular risk.
Take with food; avoid in renal impairment and with anticoagulants.
What is the maximum daily dose of acetaminophen for most adults?
Answer: Generally 3–4 g per day (lower with liver disease or alcohol use).
Overdose antidote is acetylcysteine.
What are the 'rights' of medication administration?
Answer: Right patient, drug, dose, route, time, documentation (plus reason, response, and to refuse in many lists).
Check two patient identifiers before giving any medication.
What is the therapeutic index?
Answer: The ratio between the toxic dose and the effective dose; a narrow index means close monitoring is needed.
Digoxin, lithium, warfarin, and phenytoin have narrow indices.
What is a drug's half-life?
Answer: The time for the plasma concentration to fall by half.
Steady state is reached after about 4–5 half-lives.
What is the first-pass effect?
Answer: Oral drugs absorbed from the gut pass through the liver first, where some are metabolized before reaching circulation.
Reason some drugs need higher oral doses or non-oral routes.
Pharmacokinetics vs pharmacodynamics?
Answer: Pharmacokinetics is what the body does to the drug (absorption, distribution, metabolism, excretion); pharmacodynamics is what the drug does to the body.
ADME is the standard mnemonic.
What should a patient do after using an inhaled corticosteroid?
Answer: Rinse the mouth to prevent oral thrush.
Use a spacer with metered-dose inhalers for better delivery.
What is the rescue inhaler for acute asthma symptoms and how does it work?
Answer: Albuterol, a short-acting beta-2 agonist that relaxes bronchial smooth muscle.
Side effects: tremor, tachycardia. Inhaled steroids are for control, not rescue.
What is the main muscle-related adverse effect of statins?
Answer: Myopathy that can progress to rhabdomyolysis; report unexplained muscle pain.
Monitor liver enzymes; avoid grapefruit juice with some statins.
What are the key side effects of loop diuretics such as furosemide?
Answer: Hypokalemia, dehydration, hypotension, and ototoxicity with rapid IV push.
Monitor potassium; give in the morning to avoid nocturia.
How should nitroglycerin be given for chest pain?
Answer: Sublingual tablet every 5 minutes up to 3 doses; call emergency services if pain persists. Avoid with PDE-5 inhibitors (sildenafil).
Headache and hypotension are common; keep tablets in the original dark bottle.
What is monitored with heparin and what is its antidote?
Answer: aPTT (or anti-Xa); the antidote is protamine sulfate.
Watch for heparin-induced thrombocytopenia (falling platelets).
What should be monitored with warfarin and what is its antidote?
Answer: INR (target usually 2–3); the antidote is vitamin K.
Many drug and food interactions; keep vitamin K intake consistent.
What are signs of digoxin toxicity?
Answer: Nausea, vomiting, anorexia, visual changes (yellow-green halos), bradycardia, and arrhythmias.
Check apical pulse for a full minute; low potassium increases toxicity risk.
What do beta blockers do and what should you check before giving one?
Answer: Decrease heart rate and contractility; check apical pulse and hold if below 60 bpm (per policy), and monitor blood pressure.
Names end in -olol. Caution in asthma (non-selective) and masking of hypoglycemia.
What do ACE inhibitors do and what are key side effects?
Answer: Block conversion of angiotensin I to II, lowering blood pressure; side effects include dry cough, hyperkalemia, and angioedema.
Names end in -pril (lisinopril). Contraindicated in pregnancy.
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