Top Meds You Can't Forget

Jessie

Hey everyone, welcome to the Pharmacology Study Guide Podcast! I’m Jessie, nursing student and your guide to keeping calm during finals. With me are Mrs. Smith and Damon Salvator, our favorite pharmacist. Let’s dig right into the stuff you literally cannot afford to forget for your exam. Mrs. Smith, can we start with that classic: medication metabolism and excretion—especially how kids and elderly folks are just… different?

Mrs. Smith

Absolutely, Jessie. It's one of those basics that throws students off! Remember, infant and the elderly don’t always metabolize or eliminate medications like healthy adults do. Infants often have immature liver enzymes and kidneys, so their bodies process drugs more slowly. For the elderly, it’s usually the kidneys—reduced renal function means drugs can stick around longer, sometimes causing toxicity. That’s why we’re so careful with dosing, especially with medications cleared renally.

Damon Salvator

Right on, Mrs. Smith. And here’s where half-life really becomes important. I know people get tripped up, but half-life just tells you how long until half that drug’s out of your system. Short half-life? More frequent dosing. Long half-life? Less often. But if someone’s kidneys are on the fritz—or still maturing—what would normally clear in six hours might take a lot longer. So, always check renal and liver function before dosing!

Jessie

That makes sense. Okay, Damon, you once gave a bakery analogy for peak and trough levels that made me laugh. Could you do it again?

Damon Salvator

Oh, ha—my go-to! So, imagine you’re at a bakery. Peak is like when the buns are just out of the oven—warm, perfect, at their highest point, yeah? That’s when the drug’s at its max concentration in the blood. Trough is like the buns that have sat all day—lowest quality, lowest level before the next batch. We draw peak levels to check for toxicity, troughs to ensure we don’t go subtherapeutic. Simple, but so many students overthink this.

Mrs. Smith

Yes, and timing those labs is everything. If a protocol says, “draw trough just before the next dose,” there’s a reason—so the pharmacy can adjust dosing if it’s too high or too low.

Jessie

Totally. Speaking of protocols. There was this day I was giving medications during my Med/Surg clinicals and almost missed the timing of my patient's trough draw. Luckily, a nurse commented just in time. That one near-miss taught me: always double-check the clock and orders with peaks and troughs. Seriously, those checks are there for a reason—mistakes can really harm your patients.

Mrs. Smith

Thank you for sharing, Jessie. Be vigilant, follow protocols, and never let anyone rush you with proper timing—especially on your exam questions.

Jessie

So, let’s jump into the meds and drug classes that everyone seems to blank on—usually the ones with the weirdest mnemonics! Mrs. Smith, anticholinergics always trip me up. What are those classic side effects again?

Mrs. Smith

I’m glad you asked—everyone mixes this up! Remember the phrase “Can't see, can't pee, can't spit, and can't poop." That covers blurry vision, dry mouth, urinary retention, and constipation. And don’t forget, anticholinergics can’t be used in patients with glaucoma or BPH—they make those conditions worse. Cholinergic crisis, on the other hand, looks like too much acetylcholine: think bronchoconstriction, bradycardia, diarrhea, salivation. Know the difference for your exam!

Damon Salvator

Spot on, Mrs. Smith. My trick for anticholinergics: if it dries up everything or makes your body slow down, it’s probably anticholinergic. Now, with SSRIs and MAOIs, students always forget which foods can interact. MAOIs, like phenylzine: stay away from aged cheeses, cured meats, and anything with tyramine—or you risk a hypertensive crisis. SSRIs, like escitalopram, meanwhile, watch for serotonin syndrome if mixing with other serotonergic drugs. And don’t forget that lithium has a tiny therapeutic window—too much, and your patient gets tremors, nausea, vomiting, or confusion. Lithium toxicity can lead to seizures, coma, and even death.

Mrs. Smith

Don't forget—lithium toxicity risk goes up with dehydration or sodium loss, so encourage patients to stay hydrated.

Jessie

Solid. Ok, let’s talk respiratory meds. I totally acted out using my inhaler in the wrong order on my first check-off. (laughs) Bronchodilator first, then corticosteroid, right?

Damon Salvator

You got it, Jessie Bronchodilator—usually albuterol—opens up the airways so the corticosteroid can get deeper into the lungs and work better. And a quick rinse afterwards for the steroid, or else you risk oral thrush. Don’t forget, albuterol can cause jitters or a racing heart—tell your patients!

Mrs. Smith

Exactly, and the timing matters—wait a minute or so between inhalers. Also, know which inhaler’s for rescue and which is for prevention, your board exam will ask you this in some tricky way.

Jessie

Alright, time for those notorious “high-yield pearls”—the little facts every test sneakily includes. Let’s kick off with antibiotics. Damon, you always make quinolone side effects memorable—what’s the big one?

Damon Salvator

Tendon rupture! Quinolones, like ciprofloxacin and levofloxacin, can actually cause tendon damage—especially in older adults or patients on steroids. This is a black box warning! No heavy lifting or marathons while on these! And tetracyclines—oof, sunburn city. Remind patients to use sunscreen, and never take them with milk; calcium binds the drug and blocks absorption. I say, “Never mix milk and doxy”—sing it to yourself!

Mrs. Smith

Can’t forget vancomycin, either—watch for red man syndrome if infused too quickly and check trough levels because it can become toxic quickly. Vancomycin also has several medications that it interacts with. It is so important to check drug interactions when administering Vancomycin. For instance, vancomycin and penicillin are incompatible with each other via IV and the medication will actually crystalize in the line. Vancomycin can also cause kidney damage and hearing damage, so assess renal function and monitor for signs of hearing damage such as tinnitus. Now for blood thinners. Warfarin and heparin get everyone confused. Warfarin’s monitored with INR, heparin with aPTT. Vitamin K reverses warfarin, protamine sulfate for heparin. Pro tip: Patient's taking Warfarin need to keep their Vitamin K intake consistent and should not eat lots of green leafy vegetables all at once. It can reverse the action of warfarin.

Jessie

Right, so friendly reminder: don’t binge eat a spinach salad right before you get your labs checked. And Mrs. Smith, what’s that digoxin toxicity sign students always forget?

Mrs. Smith

Yellow/Green halos! If a patient reports seeing green or yellow halos around lights, plus GI upset or arrhythmias, think digoxin toxicity. Also, check potassium—low potassium increases the risk of digoxin toxicity.

Damon Salvator

With diuretics, students always confuse which are potassium-sparing. Here’s your rhyme: “Potassium stays when Spiro stays.” Spironolactone spares potassium; however, loop diuretics like furosemide or thiazide diuretics waste potassium. Always check labs, and watch out for muscle cramps or heart issues from imbalances.

Jessie

This was such a rapid-fire episode, but I learned a ton—again! Mrs. Smith, Damon, thanks for making the tough stuff feel, like, actually doable. To everyone listening, review your notes, practice those pearls, and you’ll do great.

Mrs. Smith

Good luck with your finals—and remember, you know more than you think.

Damon Salvator

Cheers, all. Stay safe, and study smart!