This episode CONTAINS NO EDUCATIONAL MATERIAL. This episode details how the subjects are set up.

Season 1= Health Assessment

Season 2- Medical Surgical

Season 3- Pharmacology

💊 HIGH-YIELD PHARM REVIEW: LEVOTHYROXINE (Synthroid, Levoxyl, Euthyrox)

Levothyroxine sodium is a synthetic T4 thyroid hormone—the body’s inactive form that converts to T3, the active hormone responsible for regulating metabolism, energy use, cardiac output, and CNS development. 🧠❤️

🔹 Mechanism of Action (MoA): Mimics natural thyroxine (T4) → converted to triiodothyronine (T3) in tissues → restores normal metabolism and energy balance.

🔹 Primary Uses: • Hypothyroidism (all causes) • Myxedema coma (IV form – emergency use)

🔹 Therapeutic Goal: Normalize TSH and T4 → relieve fatigue, weight gain, bradycardia, cold intolerance, and cognitive slowing.

⚠️ Toxicity / Overdose = Hyperthyroidism Symptoms: • Cardiac: Tachycardia, palpitations, arrhythmias, angina, HF, cardiac arrest 🚨 • Neuro: Tremor, insomnia, seizures, anxiety, pseudotumor cerebri • Metabolic: Heat intolerance, weight loss, hyperthermia • Other: Emotional lability, diaphoresis, weakness

👩‍⚕️ Nursing Management & Dosing Pearls • Start low, go slow—especially in older adults or cardiac pts (12.5–25 mcg/day) 💗 • Myxedema coma: IV 200–400 mcg bolus + glucocorticoids to prevent adrenal crisis • Pediatrics: Start with 25% of full dose and titrate weekly to avoid hyperactivity • Never use for weight loss in euthyroid pts ❌

🍽️ Administration Tips (Oral): • Take on an empty stomach, 30–60 min before breakfast ☀️ • Avoid taking with coffee, fiber, soy, calcium, iron, or antacids—space 4 hours apart • Swallow capsules whole; crush tablets only if allowed and give immediately • Give separately from enteral feedings

💉 IV Administration: • Preferred over IM; reconstitute only with 0.9% NaCl • Stable 4 hours—discard remainder • Push slowly (≤100 mcg/min) via Y-site • IV → PO conversion: increase PO dose by 20–25%

⚠️ Major Drug Interactions (Must-Know!) • Warfarin: ↑ anticoagulant effect → monitor INR closely 🩸 • PPIs, Antacids, Calcium, Iron: ↓ absorption → separate by 4 hrs • Antidiabetics: ↓ glucose control → monitor blood sugars • Amiodarone: may cause hypo- or hyperthyroidism → monitor TSH/T4 • Semaglutide (oral): ↑ T4 exposure by 33% → monitor for hyperthyroid sx

📚 Clinical Pearls: • Absorption: 40–80% (best fasting). • Half-life: ~9–10 days → steady-state 4–6 weeks; re-check TSH after any dose change. • Pregnancy: Safe and essential—dose often ↑ 30–50%; revert postpartum 👶 • Growth: Overuse + GH → early epiphyseal closure in kids. • Gastric Acidity: Required for absorption—watch PPI users!

💡 NCLEX Tip: If a hypothyroid patient reports nervousness, palpitations, or heat intolerance → sign of overdose! Hold dose and notify provider immediately.

🧩 Summary Mnemonic: L-E-V-O = Low → start low dose Early AM on empty stomach Vitals (esp HR) monitor Overdose = hyperthyroid signs 🚨

This is everything 1st Gen Ceph Drugs. For my RN Program this class includes Cephalexin.

First-Generation Cephalosporins

Examples: Cefadroxil, Cefazolin, Cephalexin Class: Anti-infective | Pharmacologic: Cephalosporin (1st Gen) MOA: Binds to bacterial cell-wall membrane → cell death (bactericidal).

Top Indications

1️⃣ Skin & soft-tissue infections. 2️⃣ UTIs. 💉 Cefazolin: peri-operative surgical prophylaxis.

Therapeutic Effect

Resolution of infection — ↓ redness, swelling, discharge, pain, fever.

Contraindications / Cautions

• Allergy: Cephalosporin or serious PCN reaction → risk of anaphylaxis.
• Renal impairment: Drug is renally cleared → dose-adjust to avoid toxicity.
• GI disease / Colitis: ↑ risk for C. diff-associated diarrhea (CDAD).

Red-Flag Adverse Effects

🚨 Anaphylaxis / Severe Allergy: Stop drug → maintain airway → notify provider → prepare for epi/O₂/resus. 🚨 C. diff Diarrhea: Watery, foul stool (can occur weeks later) → discontinue, report immediately. ⚠️ Stevens-Johnson / TEN: Blistering rash ± fever → stop drug → seek emergency care. Common: Nausea, vomiting, diarrhea → give with food/milk. IV: Phlebitis → monitor site; rotate every 48–72 h.

Nursing Priorities

1️⃣ Always check allergy history (ceph ↔ PCN cross-sensitivity). 2️⃣ Monitor renal function (BUN/Cr). 3️⃣ Watch bowel pattern for CDAD. 4️⃣ Observe for rash or respiratory distress during first doses. 5️⃣ Teach: report rash, diarrhea, or SOB immediately.

💊 Quick Recall: “1st Gen = 1st Line for Skin & Surgery.” Kills by breaking the wall; watch for Allergy, Abdomen, and Airway.

This is everything Ceftriaxone.

Third-Generation Cephalosporins

Examples: Cefdinir, Cefditoren, Cefixime, Cefotaxime, Cefpodoxime, Ceftazidime, Ceftriaxone (Rocephin) MOA: Bactericidal—Inhibits bacterial cell wall synthesis. Spectrum: Stronger gram-negative coverage (E. coli, H. influenzae, K. pneumoniae, N. gonorrhoeae).

Indications

Respiratory, skin, GU, bone/joint, abdominal infections; meningitis; septicemia; otitis media.

Major Contraindications

• Allergy: Cephalosporin or serious penicillin hypersensitivity.
• Neonates: Ceftriaxone contraindicated (<28 days, jaundiced, or on Ca²⁺ IV).
• Caution: Renal impairment, GI disease, urolithiasis (Ceftriaxone).

Red-Flag Adverse Effects

🚨 Anaphylaxis: Stop drug, treat immediately. 🚨 C. diff Diarrhea: Report fever, bloody stool; avoid antidiarrheals. ⚡ Seizures: High doses or renal failure → monitor neuro status, adjust dose. 🩸 Bleeding: Ceftriaxone + Warfarin = ↑ INR; monitor. 💧 Nephrotoxicity: Watch BUN/Cr, ensure hydration. 🧬 Hematologic: Agranulocytosis, thrombocytopenia → monitor CBC. Common: N/V, cramps, rash, IM pain, phlebitis.

Interactions

• Probenecid: ↑ levels/toxicity.
• Loop diuretics/Aminoglycosides/NSAIDs: ↑ renal risk.
• Antacids/H2 blockers: ↓ absorption (Cefdinir, Cefpodoxime).
• Warfarin: ↑ bleeding.
• OCPs: ↓ efficacy (Cefixime).
• Alcohol: Disulfiram-like reaction → avoid.

PK Highlights

Mostly renally excreted; dose-adjust in renal impairment. Half-life: Cefotaxime 1–1.5 hr ⟶ Ceftriaxone 5–9 hr (once daily).

Top 5 NCLEX Pearls

1️⃣ Anaphylaxis & CDAD = life-threatening. 2️⃣ Ceftriaxone = no neonates or Ca²⁺ IV. 3️⃣ Adjust dose if Cr ↓. 4️⃣ Monitor INR w/ Warfarin. 5️⃣ Bactericidal cell-wall inhibitor → great Gram-negative coverage.

💊 Quick Recap: “Ceph-3 = Caution: CNS, C. diff, CrCl ↓.” 🩺 Watch for allergy, renal toxicity, and bleeding.

Everything Azithromycin.

1️⃣ Azithromycin (Zithromax, Zmax)

Class: Macrolide antibiotic (50S inhibitor). MOA: Inhibits bacterial protein synthesis → bacteriostatic/cidal by concentration. Use: Respiratory infections (strep pharyngitis, pneumonia), STIs (gonorrhea, chancroid), and MAC prophylaxis in advanced HIV. Contra: Hypersensitivity, prior cholestatic jaundice, QT prolongation, hypokalemia, or bradycardia → risk of Torsades de Pointes. Adverse / Interventions:

• QT Prolongation / Arrhythmia: Monitor cardiac status; avoid QT-prolonging drugs (quinidine, amiodarone).
• Hepatotoxicity / Cholestasis: Monitor LFTs (AST, ALT, LDH).
• SJS / TEN / Anaphylaxis: Stop immediately at first rash or swelling.
• C. Diff Diarrhea: Monitor stool frequency and hydration. Priority: Stop for severe skin reaction or anaphylaxis; watch for dysrhythmias.

2️⃣ Aztreonam (Azactam, Cayston)

Class: Monobactam β-lactam antibiotic. MOA: Bactericidal; binds cell-wall membrane → cell lysis. Use: Serious gram-negative infections (including Pseudomonas and multi-resistant strains). Contra: Hypersensitivity to aztreonam. Adverse / Interventions:

• Hypersensitivity / Anaphylaxis: Assess rash, wheezing, edema; notify HCP immediately.
• Superinfection (oral/vaginal candidiasis): Educate patient to report itching or discharge.
• Drowsiness/Dizziness: Caution with driving or machinery. Priority: Stop drug and treat if anaphylaxis occurs (fever, chills, dyspnea).

3️⃣ Azathioprine

Class: Immunosuppressant / DMARD. MOA: Antimetabolite that suppresses T-cell activity → ↓ immune response (prevents graft rejection). Use: Prevention of transplant rejection; treatment of rheumatoid arthritis. Contra: Severe infection or known hypersensitivity (others not specified). Adverse / Interventions:

• Bone Marrow Suppression: Monitor CBC and platelets; dose ↓ if < 3000 platelets.
• Hepatotoxicity: Monitor LFTs and bilirubin; report jaundice.
• GI Upset: Take with food to reduce nausea. Priority: Bone-marrow suppression = life-threatening → monitor labs and infection signs (fever, fatigue, bleeding, chills).

🔥 Rapid Recall Summary

• Azithromycin: Watch for QT prolongation & liver toxicity. Stop if rash or arrhythmia.
• Aztreonam: Kills Gram-negatives hard; monitor for anaphylaxis & superinfection.
• Azathioprine: Suppresses immune system; monitor CBC & LFTs—bone marrow and liver are targets.

Mnemonic: 💊 Three A’s — Airway, Allergy, Anemia → Cardiac for Azithro, Anaphylaxis for Aztreo, Anemia for Azathioprine.

This is everything Aminoglycosides.

PHARMACOLOGY STUDY GUIDE: AMINOGLYCOSIDES

Drugs: Amikacin, Gentamicin, Tobramycin, Neomycin, Streptomycin Class: Anti-infective; bactericidal via 30S ribosomal inhibition.

Key Mechanism & Uses

MOA: Inhibits bacterial protein synthesis (30S ribosome) → kills bacteria. Use: Serious gram-negative infections (Pseudomonas, E. coli, Klebsiella, Proteus, Serratia). Often combined with penicillins or other agents for staph, endocarditis, or TB. Special Uses:

• Neomycin: Pre-op bowel prep, hepatic encephalopathy.
• Tobramycin (Inhaled): CF with Pseudomonas. PK: Well absorbed IM, full bioavailability IV. Poor PO absorption (except Neomycin). >90% excreted by kidneys. Half-life: 2–4 hr; prolonged in renal impairment → dose adjust.

Contraindications & Major Interactions

Avoid:

• Hypersensitivity, pregnancy (fetal nephro/ototoxicity), known ototoxicity, severe renal impairment. Deadly Combos:
• Loop diuretics (Furosemide): ↑ ototoxicity
• Nephrotoxic drugs (Vancomycin, NSAIDs): ↑ kidney injury
• Neuromuscular blockers: Respiratory paralysis risk
• Penicillins/Cephalosporins: Inactivation in renal insufficiency
• Warfarin + Neomycin: ↑ anticoagulant effect

Red-Flag Adverse Effects

🚨 Nephrotoxicity — ↓ urine, ↑ BUN/Cr. → Priority: Monitor renal labs + output, ensure hydration (1.5–2L/day).

🚨 Ototoxicity — tinnitus, hearing loss, vertigo. → Priority: Assess hearing pre- and during therapy. Report ringing, dizziness, or balance issues immediately.

🚨 Respiratory Paralysis — esp. w/ rapid IV or neuromuscular blockers. → Priority: Stop infusion, support airway if apnea develops.

Other Common: Headache, ataxia, nausea, vomiting, rash, hypersensitivity.

Nursing Priorities & Monitoring

• Therapeutic Drug Monitoring (TDM):
  • Peak: 30–90 min post-dose.
  • Trough: Just before next dose (most critical to avoid toxicity).
• Maintain hydration, monitor renal & auditory function.
• Avoid in pregnancy unless life-threatening infection.
• Teach patients to report ringing in ears, decreased urine, or dizziness.

Top 5 NCLEX Points

1️⃣ MOA: Bactericidal → inhibits protein synthesis (30S). 2️⃣ Toxicities: Ototoxicity + Nephrotoxicity (dose-related). 3️⃣ Monitor Peaks/Troughs: Narrow therapeutic window—mandatory. 4️⃣ Renal Caution: Half-life ↑ drastically in renal impairment → adjust dose. 5️⃣ Major DDI: Loop diuretics = hearing loss, nephrotoxics = kidney damage.

Rapid Recall: 💊 Gentamicin & friends kill bacteria hard—but kill kidneys & ears faster if you’re not watching. 🩺 Monitor labs, monitor hearing, hydrate, and never skip those trough levels.

This episode is everything Anti-Diabetic and Insulins. All of this material is being pulled from PDR (Physician's Desk Reference)

PHARMACOLOGY STUDY GUIDE: ANTIDIABETIC AGENTS

Covers Insulin, Glipizide (Sulfonylurea), Metformin (Biguanide), and Glucagon — focusing on MOA, red-flag effects, nursing priorities, and top NCLEX points.

I. INSULIN (Lispro, Aspart, Humulin R, Novolin N)

MOA: Promotes glucose uptake → stored as glycogen. Use: Type 1 DM, sometimes Type 2. Major Risk: Hypoglycemia — trembling, sweating, confusion, tachycardia. Priority: If conscious, give 4 oz OJ; if mild, check glucose first. Other Concerns: Somogyi (night hypoglycemia → AM rebound), Dawn Phenomenon (AM hyperglycemia), Lipodystrophy (rotate sites). Teach: Recognize hypo/hyper signs, store insulin refrigerated, avoid heat/light. Interactions: ↑BG—steroids, thiazides. ↓BG—MAOIs, aspirin, TCAs. NCLEX Tips: 1️⃣ Hypoglycemia = Priority. 2️⃣ Somogyi vs Dawn. 3️⃣ Store properly.

II. SULFONYLUREAS (GLIPIZIDE)

MOA: Stimulates pancreas → ↑ insulin. Use: Type 2 DM with functioning β-cells. Risk: Hypoglycemia (especially if no meal), weight gain, GI upset. Teach: Take 30 min before meals; always eat right after. Avoid: Renal/hepatic impairment. NCLEX Tips: 1️⃣ Take before meal. 2️⃣ Never skip eating. 3️⃣ Watch for hypoglycemia.

III. BIGUANIDES (METFORMIN)

MOA: ↓ hepatic glucose production, ↑ insulin sensitivity. Use: Type 2 DM (normal renal/hepatic function). Risk: Metallic taste; lactic acidosis in renal/hepatic impairment. Priority: Monitor renal/hepatic labs; hold before contrast dye studies. NCLEX Tips: 1️⃣ Liver = Target. 2️⃣ Monitor kidney. 3️⃣ Hold before procedures.

IV. HYPERGLYCEMIC AGENT (GLUCAGON)

MOA: ↑ BG via glycogenolysis (liver). Use: Severe hypoglycemia when oral glucose unavailable. Priority: Emergency only—administer IM/IV; follow with carbs when awake. NCLEX Tips: 1️⃣ Use when patient can’t take PO. 2️⃣ Fast-acting, life-saving.

Rapid Recall: 💉 Insulin: Pushes glucose in. 💊 Glipizide: Squeezes pancreas. ⚙️ Metformin: Stops liver sugar dump. 🚨 Glucagon: Brings glucose out.

PHARM Amox” is an audio lesson zeroing in on amoxicillin pharmacology. It delivers a structured, no-nonsense review of therapeutic uses, contraindications, side effects, administration, and nursing management. Designed for nursing students and clinicians, this fast-paced, high-yield refresher sharpens the essentials you need for safe patient care and exam success.