I just took the nclex this past Thursday and I passed with 75 questions, I was getting about the same score on Kaplan tests too. Like everybody else said try to relax, i know it's hard but if you stress too much over it your going to over think every question. As far as drugs go, I had two questions about drugs and they were fairly easy. Just know what class of drugs do. Here is some drug info I found on this website maybe it will help! Good luck! *Pharmacology - Know Indication/Action/Effect ⁃Prefix/Suffix *-ase = thrombolytic *-azepam = benzodiazepine *-azine = antiemetic; phenothiazide *-azole = proton pump inhibitor, antifungal *-barbital = barbiturate *-coxib = cox 2 enzyme blockers *-cep/-cef = anti-infectives *-caine = anesthetics *-cillin = penicillin *-cycline = antibiotic *-dipine = calcium channel blocker *-floxacin = antibiotic *-ipramine = Tricyclic antidepressant *-ine = reverse transcriptase inhibitors, antihistamines *-kinase = thrombolytics *-lone, pred- = corticosteroid *-mab = monoclonal antibiotics *-micin = antibiotic, aminoglycoside *-navir = protease inhibitor *nitr-, -nitr- = nitrate/vasodilator *-olol = beta antagonist *-oxin = cardiac glycoside *-osin = Alpha blocker *-parin = anticoagulant *-prazole = PPI's *-phylline = bronchodilator *-pril = ACE inhibitor *-statin = cholesterol lowering agent *-sartan = angiotensin II blocker *-sone = glucocorticoid, corticosteroid *-stigmine = cholinergics *-terol = Beta 2 Agonist *-thiazide = diuretic *-tidine = antiulcer *-trophin = Pituitary Hormone *-vir = anti-viral, protease inhibitors *-zosin = Alpha 1 Antagonist *-zolam = benzo/sedative *-zine = antihistamine *Pharm Facts *Digoxin- don't give if heart rate *-Don't give non-selective beta-blockers to patients w/respiratory problems (anything ending in olol) *-Vitamin C can cause false +ive occult blood *-Avoid the 'G' herbs (ginsing, ginger, ginko, garlic) when on anti-clotting drugs (coumadin, ASA, Plavix, etc) *-ASA toxicity can cause ringing of the ears *-No narcotics to any head-injury victims (increases chance of respiratory arrest) *-Mg2+ toxicity is treated with Calcium Gluconate *-Do not give Calcium-Channel Blockers with Grapefruit Juice *-Oxytocin is never administered through the primary IV *-Lithium patients must consume extra sodium to prevent toxicity (0.5-1.5) *-MAOI Patients should avoid tyramine: ⁃Aacados, bananas, beef/chicken liver, caffeine, red wine, beer, cheese (except cottage cheese), raisins, sausages, pepperoni, yogurt, sour cream. *-Don't give atropine for glaucoma - it increases IOP (dilates the eye) *-Don't give ant-acids with food -- b/c it delays gastric emptying. *-Don't give Stadol to Methadone/Heroin Preggo's -- cause instant withdrawal symptoms *-Insulin - clear before cloudy *-Don't give meperidine (Demerol) to pancreatitis patients *-Always verify bowel sounds when giving Kayexelate *-Hypercalcemia = hypophosphatemia (and vice versa) *-Radioactive Dye - urine excretion (mucamyst is used to protect the kidneys) *-Signs of toxic ammonia levels is asterixis (hands flapping) *-D10W can be substituted for TPN (temporary use) *-Dopamine and Lasix are incompatible *-Hypoglycemic shivers can be stopped by holding the limb, seizures cannot (infants) *-Common symptom of aluminum hydroxide (antacids)- constipation *-Thiazide diuretics may induce hyperglycemia *-Take iron with Vit C - it enhances absorbtion - Do not take with milk *-B1 - For Alcoholic Patients (to prevent Wernicke's encephalopathy & Korsakoff's synd) *-B6 - For TB Patients *-B9 - For Pregnant Patients *-B12 - Pernicious anemia, Vegetarians. *-Complications of Coumadin - 3H's - Hemorrhage, hematuria & hepatitis *-FFP is administered to DIC b/c of the clotting Fx *-Mannitol (osmtic diuretic [Head injury]) crystallizes at room temp - use a filter needle *-Antianxiety medication is pharmacologically similar to alcohol -used for weaning Tx *-Administrate Glucagon when pt is hypoglycemia and unresponsive *ASA and insulin interact with each other and cause Hypoglycemia *Glucagon decreases the effects of anti-coagulants. *-Phenazopyridine ( Pyridium)--Urine will appear orange *-Rifampicin -- Red-urine, tears, sweat) *-Hot and Dry = sugar high (hyperglycemia) *-Cold and clammy = need some candy (hypoglycemia) *-Med of choice for V-tach is lidocaine *-Med of choice for SVT = adenosine or adenocard *-Med of choice for Asystole = Epinephrine *-Med of choice for CHF is Ace inhibitor. (anything ending in Pril) *-Med of choice for anaphylactic shock is Epinephrine *-Med of choice for Status Epilepticus is Valium. *-Med of choice for bipolar is lithium. (0.5-1.5) *-Give ACE inhibitors w/food to prevent stomach upset *-Administer diuretics in the morning *-Give Lipitor at 1700 since the enzymes work best during the evening *-Common Tricyclic Meds - 3 syllabes (pamelor, elavil) *-Common MAOI's - 2 syllables (nardil, marplan) *Antipsychotic drugs ending in Zine can cause extrapyramidal effects: pseudo parkinsonism, akathisia, dystonia, tardive dykinesia. Tx EPS with Congentin, Benadryl, Ativan, Klonipin and Inderal *-TPN has a dedicated line & cannot be mixed ahead of time *-RHoGAM -- Given at 28 weeks & 72 hrs postpartum *-Do not administer erythromycin to Multiple Sclerosis pt *-Benadryl and Xanax taken together will cause additive effects. *-Can't take Lasix if allergic to Sulfa drugs. *-Acetaminophen can be used for headache when the client is using nitroglycerin. *-Dilantin - can not give with dextrose. Only give with NS. *Antibiotics with sulfa in the generic name: watch for ototoxicity and nephrotoxicity *Addison is skinny ( hypoglycemic, you get weight loss, you got weakness, and you get postural hypotn) Cushing is fat ( hyperglycemic, you get moon face big cheeks, and you retain a lot of Na and fluid) *-Never Give via IVP: *KCL *Heparin *Ibuprofen *Insulin *Dobutamine *ASA *Albumin *Acetaminophen *-Insulin: *Rapid: lispro - onset *Short: Regular - onset ½ - 1 hr. Peak: 2-3hr. Duration: 4-6 hr *Int: NPH or Lente - onset: 2 hr. Peak 6-12 hr. Duration: 16-24hr *Long: Ultralente - onset 4-6 hr. Peak: 12-16 hr. Duration: >24hr *V.Long: Lantus - onset 1 hr. Peak: None. Duration: 24 hr continuous *-Anticholergic Side Effects: *Can't See *Can't Pee *Can't Spit *Can't Sh*t *Hypocalcemia - CATS *Convulsions *Arrythmias *Tetany *Spasms & Stridor *Hyper Kalemia Causes: 'MACHINE' *Medicationa (ace inhibitors, NSAIDS) *Acidosis (metabolic & repiratory) *Cellular destruction (burns, traumatic injuy) *Hypoaldosteronism, Hemolysis *Nephrons, renal failure *Excretion (impaired) *Signs of increased K ' Murder' *Muscle weaknes *Urine - olyguria, anuria *Respiratory distress *Decreaed cardiac contractility *ECG Changes *Reflexes - hyperreflexia, or flaccid *Substance Poisoning and Antidotes *Methanol -- Ethanol *CO2 -- Oxygen *Dopamine -- Phentolamine *Benzo's (Versed) -- Flumazenil *Lead -- Succimer, Calcium Disodium *Iron -- Deferoxamine *Coumadin -- Vitamin K *Heparin -- Protamine Sulfate *Thorazine -- Cogentine *Wild Mushrooms - Atropine *Rat Poison - Vit K *-Parkland Formula: 4cc * Kg * BSA Burned = Total Volume Necessary *1st 8hrs - ½ total volume *2nd 8hrs - ¼ total volume *3rd 8 hrs - ¼ total volumes