NCLEX Review Guide: Pharmacology - Hematological, Oncological, Hormonal Medications and Enzymes

Anticoagulants

• Warfarin (Coumadin): Vitamin K antagonist requiring INR monitoring (therapeutic range 2-3). Patient education includes avoiding vitamin K-rich foods and reporting signs of bleeding.
• Heparin: Immediate anticoagulation requiring aPTT monitoring (1.5-2.5 times control). Antidote is protamine sulfate for overdose.
• Low Molecular Weight Heparins (Enoxaparin): Subcutaneous injection with predictable response, no routine monitoring required.

Antiplatelets & Thrombolytics

• Aspirin: Irreversibly inhibits platelet aggregation, used for MI/stroke prevention. Monitor for GI bleeding and tinnitus.
• Clopidogrel (Plavix): ADP receptor antagonist, alternative to aspirin with fewer GI effects.
• Alteplase (tPA): Thrombolytic for acute MI/stroke within therapeutic window. Contraindicated in recent surgery, active bleeding, or hemorrhagic stroke.

Chemotherapy Classifications

• Alkylating Agents (Cyclophosphamide): Cross-link DNA strands. Major side effect: hemorrhagic cystitis. Encourage fluid intake 2-3L/day.
• Antimetabolites (Methotrexate): Interfere with DNA synthesis. Requires leucovorin rescue to prevent toxicity. Monitor for mucositis and bone marrow suppression.
• Anthracyclines (Doxorubicin): DNA intercalation agents. Cardiotoxic - monitor ECHO/MUGA. Lifetime cumulative dose limits apply.

Diabetes Medications

• Insulin Types: Rapid-acting (lispro), short-acting (regular), intermediate (NPH), long-acting (glargine). Only regular insulin can be given IV.
• Metformin: First-line for Type 2 DM, decreases hepatic glucose production. Hold before contrast studies due to lactic acidosis risk.
• Sulfonylureas (Glyburide): Stimulate insulin release from beta cells. Risk of hypoglycemia, especially in elderly.

1. Check blood glucose before insulin administration
2. Rotate injection sites to prevent lipodystrophy
3. Draw regular insulin first when mixing with NPH
4. Monitor for signs of hypoglycemia: diaphoresis, tremors, confusion

Thyroid Medications

• Levothyroxine: Synthetic T4 for hypothyroidism. Take on empty stomach, monitor TSH levels. Therapeutic window is narrow.
• Methimazole: Antithyroid agent for hyperthyroidism. Monitor for agranulocytosis and hepatotoxicity.

Pancreatic Enzymes

• Pancrelipase: Enzyme replacement for pancreatic insufficiency. Take with meals, do not crush enteric-coated capsules.