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Ultimate NCLEX Medications Cheat Sheet 2025: 100 High-Yield Drugs You Must Know to Pass
Brief overview of why pharmacology matters for nursing students and NCLEX prep
Studying for the NCLEX in 2025? You’re not alone in feeling overwhelmed by dosage calculations, side effect mnemonics, and pathophysiology charts. But here’s the good news: this Ultimate NCLEX Medications Cheat Sheet 2025 is designed to simplify everything you need to know — fast.
We’ve gathered 100 of the most high-yield drugs you’re almost guaranteed to see on the exam. This NCLEX Medications Cheat Sheet breaks them down by drug class — from cardiac to psych, antibiotics to anticoagulants — so you can quickly recognize patterns, make confident clinical judgments, and boost your test-day performance.
For each drug, you’ll get:
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Generic and brand names
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Drug class and simple mechanism of action
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Key nursing considerations NCLEX loves to test
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Critical alerts and black box warnings (bolded for easy scanning)
Whether you’re cramming the night before or brushing up weeks out, this NCLEX cheat sheet is your ultimate study partner.
Antihypertensive Medications (High-Yield for NCLEX)
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 1. Lisinopril (Prinivil) | ACE Inhibitor | Inhibits ACE → blocks Ang I to Ang II conversion → vasodilation and ↓ aldosterone. | – Monitor BP, K⁺, renal function. – Watch for persistent dry cough. – Monitor for angioedema — emergency. |
⚠️ Black Box Warning: Contraindicated in pregnancy — may cause fetal harm. |
| 2. Losartan (Cozaar) | ARB | Blocks angiotensin II receptors → ↓ vasoconstriction and aldosterone effects. | – No cough (vs. ACE inhibitors). – Monitor K⁺ and renal labs. – Caution patient to rise slowly to avoid dizziness. |
⚠️ Black Box Warning: Discontinue immediately if pregnant — risk of fetal toxicity. |
| 3.Metoprolol (Lopressor) | Beta-1 Selective Blocker | Blocks β1 receptors in heart → ↓ HR, contractility, and myocardial oxygen demand. | – Hold if apical pulse < 60 bpm. – May mask hypoglycemia symptoms. – Use caution in asthma patients. – Avoid abrupt discontinuation — rebound effects possible. |
⚠️ High Alert: May worsen symptoms in heart failure — monitor for weight gain, dyspnea, and edema. |
| 4. Amlodipine (Norvasc) | Calcium Channel Blocker | Inhibits Ca²⁺ influx in vascular smooth muscle → arterial vasodilation, ↓ BP. | – Monitor for peripheral edema (not HF-related). – Advise slow position changes. – Good oral hygiene to prevent gingival hyperplasia. |
⚠️ Use cautiously in severe aortic stenosis — reduced preload tolerance may exacerbate symptoms. |
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 5. Diltiazem (Cardizem) | Calcium Channel Blocker (non-DHP) | Slows AV node conduction; ↓ HR and myocardial workload. | – Monitor HR & rhythm for bradycardia or blocks. – Watch for hypotension & worsening HF. – Continuous ECG for IV use. – Educate on slow position changes. |
⚠️ Caution: Avoid in heart block or sick sinus syndrome without pacemaker. |
| 6. Clonidine (Catapres) | Central α2-Agonist (Antihypertensive) | ↓ Sympathetic outflow → ↓ vascular resistance & HR. | – Monitor for sedation, dry mouth, orthostatic hypotension. – Support strict dose adherence. – Check renal function in long-term use. |
⚠️ High Alert: Never stop abruptly → can trigger rebound hypertensive crisis. |
| 7.Nitroprusside (Nipride) | Vasodilator (Emergency use) | Releases NO → direct arterial & venous dilation → rapid BP ↓ | – Continuous BP monitoring with arterial line. – Monitor for cyanide toxicity. – Protect from light. – Titrate dose slowly. |
⚠️ High Alert: Stop immediately if signs of cyanide poisoning (AMS, acidosis). Use sodium thiosulfate as antidote if needed. |
Antiarrhythmic Medications
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 8. Digoxin (Lanoxin) | Cardiac Glycoside (Inotrope) | Inhibits Na⁺/K⁺-ATPase → ↑ intracellular Ca²⁺ → ↑ contractility, ↓ AV node conduction | – Check apical pulse (<60 bpm = hold). – Monitor dig level (0.5–2.0 ng/mL) and K⁺. – Watch for toxicity signs: halos, N/V, confusion. – Dose adjust in renal impairment. |
⚠️ High Alert: Stop if signs of toxicity. Prepare for digoxin immune Fab antidote. |
| 9.Amiodarone (Cordarone) | Class III Antiarrhythmic | Blocks K⁺ channels → prolongs repolarization. Also has class I, II, IV effects. | – Monitor ECG, thyroid, liver, and lungs. – Watch for blue-gray skin, visual changes, photosensitivity. – Interacts with many drugs (dig, warfarin). |
⚠️ High Alert: Stop if pulmonary toxicity occurs. May cause thyroid dysfunction (hypo/hyper) — check levels regularly. |
Emergency & Vasopressor Medications
These life-saving drugs are vital to know for the NCLEX Medications Cheat Sheet 2025. Understand their uses, red flags, and clinical pearls.
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 10. denosine (Adenocard) | Antiarrhythmic (nucleoside) | Slows AV node conduction, interrupting re-entrant SVT circuits to restore sinus rhythm. | – Push rapidly via large-bore IV followed by saline flush. – Brief asystole expected. – Educate: chest tightness, flushing are normal. – Avoid in AV block or sick sinus. |
⚠️ High Alert: Avoid in asthma/COPD—can trigger bronchospasm. Contraindicated in 2ⁿᵈ/3ʳᵈ-degree heart block without pacemaker. |
| 11.Atropine (Atropen) | Anticholinergic (muscarinic blocker) | Blocks acetylcholine → ↑ HR & ↓ secretions. | – Use in bradycardia or cholinergic crisis. – Monitor ECG and anticholinergic effects. – Elderly: watch for confusion. – Educate on heat tolerance. |
⚠️ Contraindicated in glaucoma. Signs of toxicity: dry mucosa, flushed skin, delirium. Have physostigmine available as antidote. |
| 12.Epinephrine (Adrenalin) | Adrenergic agonist (catecholamine) | Stimulates α1 (↑ BP), β1 (↑ HR), β2 (bronchodilation). | – First-line for cardiac arrest & anaphylaxis. – Teach EpiPen use. – Monitor for tachycardia, tremors, restlessness. – Monitor for extravasation. |
⚠️ Use caution in heart disease—can trigger MI or arrhythmias. Phentolamine reverses local vasoconstriction if infiltration occurs. |
| 13.Norepinephrine (Levophed) | Adrenergic agonist (vasopressor) | Stimulates α1 → vasoconstriction; minor β1 effects. | – First-line vasopressor for septic shock. – Monitor BP, urine output, and limb perfusion. – Ensure fluid status before starting infusion. Central line preferred. |
⚠️ High Alert: Can cause tissue necrosis if extravasated. Infiltrate with phentolamine immediately. |
| 14.Dopamine (Intropin) | Adrenergic agonist/inotrope | Low dose → ↑ renal perfusion; Mid → β1 (↑ HR); High → α1 (vasoconstriction). | – Monitor ECG, BP, and urine output. – Central line preferred. – Fluid resuscitation required before starting. – Titrate slowly to avoid tachycardia or ischemia. |
⚠️ High Alert: Infiltration causes necrosis. Treat immediately with phentolamine around affected area. |
Antianginals / Vasodilators
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 15.Nitroglycerin (Nitrostat) | Nitrate (Antianginal) | Converts to nitric oxide → venodilation ↓ preload; coronary artery dilation; at high doses, arteriolar dilation ↓ afterload | – Monitor BP before and during therapy; watch for hypotension. – Assess for headache and flushing. – Implement nitrate-free intervals for tolerance prevention. – Teach sublingual admin: sit/lie down, call 911 if pain persists after 1 dose. |
⚠️ Do not combine with PDE5 inhibitors (e.g., sildenafil). Rapid IV admin may cause severe hypotension and shock. |
💊 Antilipemics
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 16.Atorvastatin (Lipitor) | Statin (Antihyperlipidemic) | Inhibits HMG-CoA reductase → decreases cholesterol synthesis → ↓ LDL, ↑ HDL, ↓ triglycerides | – Monitor liver enzymes (AST, ALT) at baseline and during therapy. – Watch for muscle pain, weakness (myopathy). – Take once daily, preferably evening. – Avoid grapefruit and excessive alcohol intake. |
⚠️ Stop if rhabdomyolysis suspected (muscle pain, dark urine). Notify physician immediately. |
Diuretics
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 17.Furosemide (Lasix) | Loop Diuretic | Inhibits Na⁺/K⁺/2Cl⁻ cotransporter in loop of Henle → potent diuresis (Na⁺, K⁺, Cl⁻, water excretion) | – Monitor electrolytes (K⁺, Na⁺, Mg²⁺) and renal function. – Assess for dehydration and hypotension. – Administer early to prevent nocturia. – Watch for ototoxicity with high/rapid IV doses. – Encourage potassium-rich diet or supplements. |
⚠️ Risk of severe hypokalemia and dehydration → can cause arrhythmias and AKI; intervene promptly. |
| 18.Spironolactone (Aldactone) | Potassium-Sparing Diuretic | Aldosterone antagonist → Na⁺/water excretion, K⁺ retention | – Monitor K⁺ and renal function. – Watch for endocrine side effects: gynecomastia, menstrual changes. – Avoid potassium-rich foods and salt substitutes. – Maintain consistent dosing schedule. – Educate about signs of hyperkalemia (weakness, palpitations). |
⚠️ Discontinue if life-threatening hyperkalemia or ECG changes occur. Urgent treatment required. |
| 19.Hydrochlorothiazide (Microzide) | Thiazide Diuretic | Inhibits NaCl reabsorption in distal tubule → moderate diuresis, ↓ blood volume & BP | – Monitor electrolytes (K⁺, Na⁺) and blood glucose. – Assess for dehydration, orthostatic hypotension. – Give in morning to avoid nocturia. – Encourage potassium-rich foods to prevent hypokalemia. – Monitor diabetic patients closely for glucose changes. |
⚠️ Use caution with sulfa allergy. Discontinue if severe electrolyte imbalance (hypokalemia, hyponatremia) occurs. |
Hematopoietic Agents
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 20. Epoetin alfa (Epogen) | Erythropoiesis-stimulant | Synthetic erythropoietin; stimulates RBC production in bone marrow | – Monitor Hgb & Hct; titrate to avoid exceeding target levels. – Watch for hypertension, especially in CKD. – Assess for thromboembolism risks. – Administer SC or IV; do not shake vial. – Follow protocol for dosing schedule. |
⚠️ Black Box: Hold if Hgb rises too fast or >11 g/dL to prevent stroke, MI, death, especially in renal failure. |
| 21. Ferrous Sulfate (Feosol) | Iron Supplement | Replenishes iron needed for hemoglobin synthesis | – Give on empty stomach for best absorption; may give with food if needed. – Monitor for GI upset (nausea, constipation, dark stools). – Avoid calcium, antacids, some antibiotics during dosing. – Take with full glass of water; do not crush extended-release. – Encourage hydration and fiber intake. |
⚠️ High warning: Iron overdose fatal in children—keep out of reach. Monitor for iron overload with long-term use. |
Anticoagulants
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 22. Rivaroxaban (Xarelto) | Factor Xa Inhibitor | Selectively inhibits Factor Xa → reduces thrombin generation → less clotting | – Monitor for bleeding (bruising, hematuria, melena). – Educate to report bleeding immediately. – Avoid abrupt discontinuation to prevent thrombosis. – Use caution with other anticoagulants/antiplatelets. – Adjust dose for renal impairment; monitor renal function. |
⚠️ No specific reversal agent. Abrupt stopping increases risk of stroke, MI, thrombotic events. |
| 23. Warfarin (Coumadin) | Vitamin K antagonist | Inhibits vitamin K-dependent clotting factor synthesis | – Monitor INR regularly; keep within therapeutic range (2-3). – Watch for bleeding signs. – Maintain consistent vitamin K intake. – Assess drug/herbal interactions (antibiotics, NSAIDs). |
⚠️ Black Box: Stop if serious bleeding or INR too high. Reverse with vitamin K or PCC. Contraindicated in pregnancy (teratogenic). |
| 24.Heparin (unfractionated) | Anticoagulant (IV/SQ) | Activates antithrombin III → inactivates thrombin and factor Xa | – Monitor aPTT for therapeutic range. – Watch for bleeding. – Use cautiously with invasive procedures. – Rotate SQ injection sites; avoid massage to prevent hematoma. – Assess for HIT (thrombocytopenia). |
⚠️ High Alert: Monitor for HIT; discontinue if suspected. Have protamine sulfate ready for overdose reversal. |
| 25.Enoxaparin (Lovenox) | Low molecular weight heparin | Enhances antithrombin to inactivate Factor Xa (more selective than heparin) | – Administer deep SQ; rotate sites; avoid massaging. – Monitor for bleeding. – Check platelet count for HIT. – Teach self-injection technique. – Adjust dose in renal impairment. |
⚠️ High Alert: Do not interchange with heparin. Avoid in spinal/epidural procedures due to hematoma risk. Partial reversal by protamine sulphate |
Antiplatelets (Inhibit Platelet Aggregation)
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 26.Clopidogrel (Plavix) | Antiplatelet (ADP receptor blocker) | Irreversibly inhibits P2Y12 ADP receptors → blocks GP IIb/IIIa activation → reduces platelet aggregation | – Monitor bleeding (bruising, epistaxis, hematuria, GI bleeding), especially with anticoagulants or NSAIDs. – Check baseline platelet function and CBC. – Educate on injury avoidance and OTC meds (aspirin, NSAIDs). – Discontinue 5-7 days before surgery if instructed. |
⚠️ Avoid in active bleeding/peptic ulcer disease. Watch for thrombotic thrombocytopenic purpura (TTP). |
| 27.Aspirin (ASA) | NSAID / Antiplatelet (salicylate) | Irreversibly inhibits COX-1 → blocks thromboxane A₂ → prevents platelet aggregation; analgesic & antipyretic | – Monitor for GI irritation and bleeding. – Give with food or use enteric-coated forms. – Avoid combination with other NSAIDs/anticoagulants unless managed carefully. – Educate on low-dose use for CV protection. – Do not stop abruptly without provider advice. |
⚠️ Do not give to children/adolescents with viral illness (Reye syndrome risk). Hold 5-7 days before surgery. |
Thrombolytic / Fibrinolytic Agent (Clot Buster)
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 28.Alteplase (tPA) | Thrombolytic (fibrinolytic) | Converts plasminogen to plasmin → dissolves fibrin clots (“clot buster”) | – Administer within therapeutic window (3-4.5 hours post-stroke symptom onset). – Frequent neuro checks and bleeding assessment during and after infusion. – Assess for recent surgery/trauma; contraindicated if present. – Avoid invasive procedures during and hours after infusion. |
⚠️ High Alert: Do not use in active bleeding or hemorrhagic stroke. Stop immediately if severe bleeding occurs; notify provider. |
Respiratory & Allergy Medications
| Drug Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 29.Albuterol (Ventolin) | Short-acting β2-agonist (SABA) | Stimulates β2 receptors → bronchodilation | – Monitor respiratory status and breath sounds. – Teach correct inhaler/nebulizer use. – Watch for tremors, tachycardia. – Use before corticosteroids for better steroid delivery. |
⚠️ Avoid overuse → paradoxical bronchospasm and increased cardiac side effects. Use cautiously with cardiac disorders. |
| 30. Ipratropium (Atrovent) | Inhaled anticholinergic bronchodilator | Blocks muscarinic receptors → prevents bronchoconstriction and reduces secretions | – Monitor dry mouth/throat irritation. – Teach inhalation technique and mouth rinsing. – Avoid in narrow-angle glaucoma, urinary retention. – Use regularly for maintenance, not rescue. – Check soy/peanut allergy. |
⚠️ Avoid mixing with other inhaled meds unless prescribed. Discontinue if hypersensitivity signs appear (rash, bronchospasm). |
| 31. Fluticasone (Flovent) | Inhaled corticosteroid (ICS) | Reduces airway inflammation and mucus production | – Monitor for oral thrush; instruct to rinse mouth. – Assess respiratory improvement. – Educate on daily use (not for acute attacks). – Use spacer if prescribed. |
⚠️ Not for acute asthma attacks. Watch for adrenal suppression with high doses (fatigue, hypotension). |
| 32. Montelukast (Singulair) | Leukotriene receptor antagonist | Blocks leukotriene receptors → reduces inflammation and bronchoconstriction | – Monitor neuropsychiatric symptoms (mood changes, suicidal thoughts). – Administer in evening. – Educate as maintenance only (not rescue). – Assess symptom control. |
⚠️ High-alert: Discontinue if neuropsychiatric symptoms develop. Report any behavioral changes immediately. |
| 33.Diphenhydramine (Benadryl) | 1st generation H1-antihistamine | Blocks H1 receptors → reduces allergic symptoms; anticholinergic effects | – Monitor sedation and drowsiness. – Watch for anticholinergic effects (dry mouth, urinary retention). – Use caution in elderly (fall risk). – Appropriate timing for insomnia/motion sickness use. |
⚠️ Not for neonates/infants <6 months. Avoid in acute asthma attacks (thickens secretions). High fall risk in elderly. |
| 34. Theophylline (Theo-24) | Methylxanthine bronchodilator | Relaxes bronchial smooth muscle; CNS and cardiac stimulant (via phosphodiesterase inhibition → ↑ cAMP) | – Monitor serum levels (10–20 mcg/mL therapeutic range). – Watch for toxicity signs (nausea, tachycardia, insomnia). – Avoid CYP450 inhibitors. – Advise to avoid caffeine intake. |
⚠️ High alert: Stop if severe toxicity (seizures, arrhythmias) occurs. Caution in cardiac/hepatic impairment due to reduced clearance. |
Antidiabetics / Insulin
| Drug Name | Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 35. Insulin Lispro (Humalog) | Rapid-acting insulin | Quick absorption (onset 15 min, peak ~1 hr, duration 3–4 hr); promotes glucose uptake and glycogen storage | – Give within 15 minutes of meals to prevent spikes. – Rotate injection sites to prevent lipodystrophy. – Monitor for hypoglycemia signs. – Educate on timing and glucose monitoring. |
⚠️ Do NOT delay administration after dosing—risk of severe hypoglycemia if meal delayed. |
| 36. Insulin Regular (Humulin R) | Short-acting insulin | Onset 30 min, peak 2–3 hr, duration 5–8 hr; promotes glucose and potassium uptake | – Draw regular insulin first when mixing with NPH. – Give 30 min before meals. – Monitor blood glucose closely. – Rotate injection sites. – Watch for hypoglycemia symptoms. |
⚠️ Verify units (U-100 vs U-500) to avoid dosing errors. Do not mix with long-acting insulin unless specified. |
| 37. Insulin NPH (Humulin N) | Intermediate-acting insulin | Cloudy suspension; onset 1–2 hr, peak 4–12 hr, duration up to 18 hr; basal insulin coverage | – Administer at same time daily. – Roll vial gently before use. – Monitor for delayed hypoglycemia. – Store properly; rotate sites. |
⚠️ Avoid mixing with glargine/detemir (incompatible). Do NOT use during acute hypoglycemia. |
| 38. Insulin Glargine (Lantus) | Long-acting insulin | Steady 24-hr basal release; no pronounced peak | – Give once daily at same time. – Do NOT mix with other insulins. – Educate on hypoglycemia recognition. – Rotate injection sites. |
⚠️ High risk if confused with other insulins; overdose causes prolonged hypoglycemia. |
| 39.Metformin (Glucophage) | Biguanide (oral antidiabetic) | Decreases hepatic glucose production; increases insulin sensitivity | – First-line for type 2 DM. – Give with meals to reduce GI effects. – No hypoglycemia risk alone. – Hold before/after IV contrast. – Monitor renal function. – Watch for lactic acidosis signs. |
⚠️ Black box warning: Discontinue if lactic acidosis suspected. Use cautiously in renal/hepatic impairment. |
| 40. Glipizide (Glucotrol) | Sulfonylurea (oral hypoglycemic) | Stimulates pancreatic insulin release | – Give 30 min before meals. – Monitor hypoglycemia closely. – Avoid if sulfa allergy. – Check renal/hepatic function. – Warn about alcohol interaction. |
⚠️ Not for type 1 DM or DKA. Increased hypoglycemia risk in elderly/malnourished. Recommend medical ID bracelet. |
| 41. Glucagon (GlucaGen) | Hyperglycemic agent | Promotes hepatic glucose release via glycogenolysis and gluconeogenesis | – Use IM or subcut for severe hypoglycemia when oral/IV glucose not possible. – Turn patient on side after injection. – Teach caregivers proper use. – Follow with oral carbs once awake. |
⚠️ Avoid in pheochromocytoma or insulinoma. Watch for allergic reactions or anaphylaxis. |
Thyroid & Hormonal Agents
| Drug Name | Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 42. Levothyroxine (Synthroid) | Thyroid hormone (T4 replacement) | Synthetic T4 converted to T3; raises metabolic rate | – Give on empty stomach 30–60 min before breakfast. – Avoid iron, calcium, antacids near dosing. – Monitor TSH, free T4. – Watch for overdose/underdose signs. |
⚠️ Overdose risks: A-fib, osteoporosis. Do not use for weight loss in euthyroid patients. |
| 43.Propylthiouracil (PTU) | Thionamide (antithyroid) | Blocks thyroid hormone synthesis & conversion of T4 to T3 | – Administer consistently daily. – Monitor thyroid and liver labs. – Report infection signs (fever, sore throat). – Avoid abrupt discontinuation. |
⚠️ Black box: severe liver injury risk. Use cautiously in pregnancy (fetal hepatotoxicity). |
| 44. Desmopressin (DDAVP) | ADH analog | Increases water reabsorption, concentrates urine | – Route varies: nasal, oral, parenteral. – Monitor sodium & fluid balance. – Advise fluid restriction. – Assess for headache, nausea (hyponatremia signs). |
⚠️ High alert for hyponatremia and seizures. Use cautiously in heart disease or hypertension. |
Corticosteroids
| Drug Name | Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 45. Prednisone (Deltasone) | Glucocorticoid | Suppresses inflammation & immune response; increases gluconeogenesis | – Give with food to avoid GI irritation. – Taper doses gradually. – Monitor glucose, mood, fluid retention. – Teach infection risk. – Encourage bone health. |
⚠️ Risk of adrenal suppression & Cushing’s syndrome. Caution in diabetes, hypertension, ulcers. |
| 46.Fludrocortisone (Florinef) | Mineralocorticoid | Aldosterone analog: promotes Na/water retention & K+ excretion | – Monitor BP and electrolytes. – Watch for fluid overload signs. – Administer with food. – Regular lab follow-up. |
⚠️ Use cautiously with heart/renal disease or hypertension. Abrupt stop may cause adrenal crisis. |
Bone Health & Uric Acid Medications
| Drug Name | Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 47.Alendronate (Fosamax) | Bisphosphonate (bone resorption inhibitor) | Inhibits osteoclasts, increases bone density | – Give on empty stomach with full water. – Remain upright 30 min after dose. – Encourage Ca & vitamin D intake. – Adherence is key. |
⚠️ Contraindicated with esophageal disorders or inability to sit up. Report jaw or thigh pain (fracture risk). |
| 48. Allopurinol (Zyloprim) | Xanthine oxidase inhibitor (antigout) | Lowers uric acid by inhibiting xanthine oxidase | – Start after acute attack resolves. – Monitor renal function & uric acid. – Encourage hydration. – Report rash immediately. |
⚠️ Stop immediately if serious rash or hypersensitivity (Stevens-Johnson syndrome) occurs. Higher risk in some ethnicities. |
Gastrointestinal Medications
| Drug | Class | Mechanism | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 49. Omeprazole (Prilosec) | PPI | Irreversibly inhibits gastric H⁺/K⁺-ATPase → ↓ acid secretion | – Give before meals (morning best). – Monitor Mg²⁺ & B12 levels with long-term use. – Avoid abrupt stop. |
⚠️ May reduce clopidogrel efficacy. Long-term use ↑ risk C. difficile & fractures. |
| 50. Famotidine (Pepcid) | H2 blocker | Blocks H2 receptors on parietal cells → ↓ acid secretion | – Can give with/without food. – Monitor renal function (dose adjust if impaired). – Avoid NSAIDs & irritants. |
⚠️ Rapid IV can cause bradycardia/hypotension. Risk QT prolongation in renal impairment. |
| 51. Docusate (Colace) | Stool softener (emollient laxative) | Surfactant lowers stool surface tension → water/fat penetration softens stool | – Give with full glass water. – Use for prevention, not rapid relief. – Monitor bowel patterns. – Avoid straining. |
⚠️ Overuse may cause dependence. Do not use with mineral oil (↑ risk lipid pneumonia). |
| 52. Lactulose (Kristalose) | Osmotic laxative (disaccharide) | Draws water into colon, acidifies colon converting ammonia to ammonium (hepatic encephalopathy) | – Titrate for 2-3 soft stools/day. – Monitor electrolytes & hydration. – Monitor ammonia & mental status in liver patients. |
⚠️ Rectal use can cause cramping. Caution in diabetics (may ↑ glucose). |
| 53. Loperamide (Imodium) | Antidiarrheal (opioid analog) | Mu-opioid receptor agonist in gut → slows motility & ↑ fluid absorption | – Monitor stool frequency/consistency. – Avoid in infectious diarrhea. – Teach dosing limits. – Hydrate. |
⚠️ Black box: High doses → torsades de pointes, sudden death. Not for <2 years old. |
| 54.Ondansetron (Zofran) | Antiemetic (5-HT3 antagonist) | Blocks serotonin 5-HT3 receptors in CNS & GI tract → ↓ nausea/vomiting | – Give 30 min before chemo. – Monitor QT interval. – Watch for serotonin syndrome. – Monitor bowel & hydration. |
⚠️ Caution QT prolongation & serotonin syndrome. May mask ileus symptoms. |
| 55.Metoclopramide (Reglan) | Prokinetic/Antiemetic | Dopamine-2 antagonist → ↑ GI motility + antiemetic effect | – Give 30 min before meals & bedtime. – Monitor for EPS symptoms. – Avoid in obstruction/perforation. – Assess mental status. |
⚠️ Black box: Risk of tardive dyskinesia >12 weeks. Watch for neuroleptic malignant syndrome. |
| 56. Pancrelipase (Creon) | Pancreatic enzyme supplement | Provides lipase, protease, amylase → aids digestion in pancreatic insufficiency | – Give with meals/snacks. – Do not crush enteric-coated capsules. – Monitor nutrition & allergic reactions. |
⚠️ Avoid if pork allergy. Risk of fibrosing colonopathy with high doses in cystic fibrosis kids. |
| 57. Sulfasalazine (Azulfidine) | Aminosalicylate (5-ASA) | Split by colonic bacteria into 5-ASA (anti-inflammatory) & sulfapyridine | – Check sulfa allergy. – Encourage fluids. – Monitor CBC. – Supplement folic acid. – Educate on orange urine. |
⚠️ Stop if bone marrow suppression or severe rash. Risk Stevens-Johnson syndrome. |
| Drug | Class | Mechanism | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 58. Amoxicillin (Amoxil) | Penicillin (aminopenicillin) | Inhibits bacterial cell wall synthesis → cell lysis and death. | – Assess for penicillin allergy and cross-reactivity. – Administer with food if GI upset occurs. – Monitor for superinfection. – Complete full course to prevent resistance. |
⚠️ Discontinue immediately if hypersensitivity or anaphylaxis occurs. Permanent avoidance of penicillin-class drugs if severe reaction. |
| 59. Ceftriaxone (Rocephin) | Cephalosporin antibiotic (3rd gen) | Disrupts bacterial cell wall synthesis; broad Gram-negative and some Gram-positive coverage. | – Screen for penicillin allergy. – Rotate IM sites; may use lidocaine. – Monitor liver function and bilirubin. – Avoid calcium IV in neonates. – Complete full course. |
⚠️ Avoid calcium IV in neonates due to fatal precipitates. Monitor for C. difficile diarrhea. |
| 60. Vancomycin (Vancocin) | Glycopeptide antibiotic | Binds peptidoglycan precursors → inhibits bacterial cell wall formation (effective against Gram+). | – Monitor trough levels and kidney function. – Watch for ototoxicity. – Administer IV over at least 60 min to prevent red man syndrome. – Use central line for long-term therapy. |
⚠️ Rapid infusion causes red man syndrome. Nephrotoxicity risk—monitor kidney function closely. |
| 61. Doxycycline (Vibramycin) | Tetracycline antibiotic | Binds 30S ribosomal subunit → inhibits bacterial protein synthesis (bacteriostatic). | – Avoid dairy, antacids, iron (space doses 1–2 hrs). – Protect from sunlight. – Take with water; stay upright 30 min. – Avoid in children <8 and pregnancy. – Watch for yeast infections. |
⚠️ Contraindicated in pregnancy and children <8. Discontinue if intracranial hypertension signs occur. |
| 62. Azithromycin (Zithromax) | Macrolide antibiotic | Binds 50S ribosomal subunit → inhibits bacterial protein synthesis. | – Administer with food if GI upset. – Monitor QT interval. – Avoid antacids with aluminum/magnesium. – Teach Z-Pak dosing. – Report palpitations or dizziness. |
⚠️ Discontinue if arrhythmia symptoms develop. Use cautiously with hepatic impairment. |
| 63. Gentamicin (Garamycin) | Aminoglycoside antibiotic | Binds 30S ribosome → causes misreading of mRNA, halting protein synthesis (bactericidal). | – Monitor peak/trough levels. – Assess renal function. – Watch for ototoxicity symptoms. – Avoid mixing with penicillins IV. – Adjust dose in renal impairment. – Complete topical use. |
⚠️ High risk of irreversible hearing loss and nephrotoxicity. Neuromuscular blockade rare but serious. |
| 64.Trimethoprim–Sulfamethoxazole (Bactrim) | Sulfonamide combo antibiotic | Synergistic inhibition of folate synthesis → bactericidal effect. | – Screen for sulfa allergy. – Encourage hydration. – Monitor CBC, potassium, creatinine. – Avoid late pregnancy/neonates. – Use sun protection. |
⚠️ Risk of Stevens-Johnson syndrome; discontinue if rash or mucosal lesions occur. |
| 65. Ciprofloxacin (Cipro) | Fluoroquinolone antibiotic | Inhibits DNA gyrase and topoisomerase IV → prevents bacterial DNA replication (bactericidal). | – Monitor tendon inflammation/rupture. – Encourage hydration. – Avoid antacids/supplements nearby. – Watch for peripheral neuropathy. – Protect from sun exposure. – CNS monitoring. |
⚠️ Black box: Risk QT prolongation and disabling tendon/muscle/joint/CNS effects. Discontinue if symptoms appear. |
| 66.Metronidazole (Flagyl) | Nitroimidazole antibiotic/antiprotozoal | Disrupts DNA structure in anaerobes and protozoa → cell death. | – Monitor neurotoxicity signs. – Avoid alcohol during and 48 hrs post-treatment. – Administer with food if GI upset. – Watch for superinfection. – Explain urine discoloration. |
⚠️ Carcinogenic risk in animals; avoid long-term use. Caution with blood dyscrasias. |
| 66. Isoniazid (INH) | Antitubercular antibiotic | Inhibits mycolic acid synthesis → bactericidal to TB bacilli. | – Monitor liver function. – Supplement pyridoxine (B6). – Avoid alcohol and hepatotoxic drugs. – Teach neuropathy symptoms. – Adhere strictly to regimen. – Check drug interactions. |
⚠️ Black box: Severe/fatal hepatitis risk. Monitor closely first 3 months, especially >35 yrs or liver disease. |
| 67. Rifampin (Rifadin) | Antitubercular antibiotic (Rifamycin) | Inhibits bacterial RNA polymerase → suppresses RNA and protein synthesis. | – Monitor liver function. – Use additional contraception. – Inform about orange-red body fluids. – Avoid alcohol. – Monitor flu-like symptoms. – Strict regimen adherence. |
⚠️ Significant hepatotoxic risk. Many drug interactions; caution advised. |
ANTIFUNGAL AND ANTIVIRAL AGENTS
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 68.Fluconazole (Diflucan) | Azole antifungal | Inhibits fungal ergosterol synthesis by blocking 14-α-demethylase (a CYP450 enzyme), damaging fungal membranes | – Monitor liver function during prolonged use; risk of hepatotoxicity. Check LFTs regularly; teach to report jaundice, fatigue. – Watch for QT prolongation; caution in cardiac patients or with QT drugs. – Avoid in pregnancy unless necessary; risk of birth defects in high doses, especially 1st trimester. – Adjust dose in renal impairment to prevent toxicity. – Monitor for Stevens-Johnson syndrome; discontinue if rash/blistering/mucosal involvement appears. |
None officially designated; severe hepatotoxicity and serious skin reactions (SJS) require close monitoring and immediate intervention. |
| 69. Acyclovir (Zovirax) | Antiviral (anti-herpes) | Guanosine analog activated by viral thymidine kinase; incorporates into viral DNA causing chain termination | – Administer promptly at symptom onset for best efficacy. – Encourage hydration to prevent crystal nephropathy. – Adjust dose in renal impairment. – Monitor for CNS toxicity (confusion, tremors, hallucinations) in elderly/renal impairment. – Use caution with other nephrotoxic drugs; monitor renal function. |
No official black box; critical risks include renal toxicity and neurotoxicity requiring dose adjustment and close monitoring. |
PSYCHIATRY MEDICATIONS
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 70.Fluoxetine (Prozac) | SSRI (antidepressant) | Selectively inhibits serotonin (5-HT) reuptake in the CNS, increasing serotonin availability in synapses. | Monitor closely for suicidal ideation, especially in children, adolescents, and young adults during early treatment. Assess for serotonin syndrome when used with other serotonergic drugs (agitation, hyperreflexia, fever). Avoid abrupt discontinuation—taper gradually to avoid withdrawal symptoms. Administer in the morning to reduce insomnia. Monitor for weight changes and sexual dysfunction. | Black Box: Antidepressants may increase risk of suicidal thinking and behavior in young populations. Monitor closely during initiation and dosage changes. |
| 71.Amitriptyline (Elavil) | Tricyclic antidepressant (TCA) | Inhibits reuptake of serotonin and norepinephrine; also blocks muscarinic, histamine, and α1 receptors, contributing to side effects. | Use caution in patients at suicide risk due to high lethality in overdose. Monitor for anticholinergic side effects (dry mouth, constipation, urinary retention, blurred vision). Assess for orthostatic hypotension and sedation—administer at bedtime. Avoid in elderly with cardiac issues; obtain baseline ECG if needed. Avoid alcohol and CNS depressants. | High Alert: Fatal in overdose (cardiotoxicity, CNS depression). Contraindicated post-MI or in severe heart disease. Black Box: Suicide risk in children and young adults—monitor during early treatment. |
| 72.Phenelzine (Nardil) | MAOI (antidepressant) | Irreversibly inhibits monoamine oxidase, preventing breakdown of serotonin, norepinephrine, and dopamine, increasing their levels in the brain. | Monitor for hypertensive crisis from tyramine-rich foods (aged cheese, meats, wine). Assess drug interactions carefully—contraindicated with SSRIs, TCAs, decongestants, and stimulants. Enforce washout periods of at least 14 days between switching antidepressants. Watch for CNS stimulation or orthostatic hypotension. Educate patients on dietary restrictions and monitor for mood changes or suicidal ideation during early treatment. | Black Box: Increased risk of suicidal thoughts and behaviors in children and young adults. Avoid tyramine-containing foods—risk of fatal hypertensive crisis. |
| 73. Bupropion (Wellbutrin) | Atypical antidepressant | NDRI: Inhibits norepinephrine and dopamine reuptake; does not significantly affect serotonin levels. | Monitor for seizure risk—especially at doses >450 mg/day or in patients with seizure history, eating disorders, or abrupt alcohol/benzo withdrawal. Do not use in bulimia or anorexia. When used for smoking cessation (Zyban), monitor for neuropsychiatric symptoms. Avoid abrupt discontinuation. Use caution with serotonergic or dopaminergic drugs due to CNS stimulation or serotonin syndrome risk. | Caution: Dose-related seizure risk. Increased suicidality in children, adolescents, and young adults. Contraindicated in eating disorders and seizure-prone individuals. |
| 74. Lithium (Lithobid) | Mood stabilizer (anti-manic) | Alters sodium transport and neurotransmitter signaling; exact mechanism unclear. Stabilizes mood in bipolar disorder, particularly manic episodes. | Monitor serum lithium levels (therapeutic range: 0.6–1.2 mEq/L); toxicity risk >1.5 mEq/L. Maintain consistent sodium intake and hydration—low sodium increases toxicity risk. Monitor renal (BUN, creatinine) and thyroid (TSH) function regularly. Teach signs of toxicity: nausea, tremors, confusion, ataxia. Avoid NSAIDs and diuretics unless approved—can raise lithium levels. Use caution with dehydration, illness, or changes in diet. | High Alert: Narrow therapeutic index—can be life-threatening in overdose or toxicity. Contraindicated in pregnancy (risk of fetal heart defects). Monitor labs and educate on toxicity signs. |
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 75. Haloperidol (Haldol) | Typical antipsychotic (butyrophenone) | Blocks dopamine D2 receptors in the brain, particularly in the mesolimbic pathway, reducing positive symptoms of psychosis. Also blocks D2 in nigrostriatal (→ EPS) and tuberoinfundibular pathways (→ ↑ prolactin). | Use to manage acute agitation or psychosis. Monitor for extrapyramidal symptoms (dystonia, akathisia, parkinsonism, tardive dyskinesia)—especially with long-term use. Assess cardiac status—high doses or IV use may prolong QT interval; obtain baseline and periodic ECGs. Avoid in Parkinson’s disease due to worsening of motor symptoms. Use lowest effective dose in elderly patients due to sedation and fall risk. Educate on adherence, recognizing EPS, and avoiding alcohol/CNS depressants. | Black Box: Increased mortality in elderly patients with dementia-related psychosis. Use only if benefits clearly outweigh risks. |
| 76. Clozapine (Clozaril) | Atypical antipsychotic | Blocks dopamine D2 and serotonin 5-HT2A receptors (plus other receptor types). Lower D2 binding in nigrostriatal pathway → fewer EPS; strong mesolimbic effects provide antipsychotic benefit. | Monitor for agranulocytosis—requires regular CBC with ANC (per REMS program). Report any signs of infection (fever, sore throat) immediately. Assess for weight gain, hyperglycemia, and dyslipidemia (metabolic syndrome). Use caution in seizure-prone individuals—clozapine lowers seizure threshold. Monitor for GI hypomotility (e.g., constipation, ileus)—encourage hydration, fiber. Educate on sedation, hypotension, and slow position changes. Avoid alcohol and driving until effects are known. | Black Box: Severe neutropenia risk—requires blood monitoring. Risk of seizures, myocarditis, cardiomyopathy. Increased mortality in elderly with dementia-related psychosis—use is contraindicated in this population. |
| 77. Lorazepam (Ativan) | Benzodiazepine (anxiolytic) | Enhances GABA-A activity by increasing frequency of chloride channel opening → CNS depression (anxiolytic, sedative, muscle relaxant, anticonvulsant effects). | Initiate cautiously in elderly—high fall and sedation risk. Monitor for respiratory depression, especially with concurrent CNS depressants (e.g., opioids). Watch for dependence and withdrawal—taper slowly to avoid seizures or severe anxiety. Use fall precautions. Short-term use only—reevaluate if long-term therapy is needed. Avoid abrupt discontinuation. Educate about tolerance, rebound anxiety, and potential impairment with activities requiring alertness. | High Alert (Caution): Combining with opioids can lead to profound sedation, respiratory depression, coma, or death. Use only when necessary, and monitor closely. |
| 78. Buspirone (Buspar) | Anxiolytic (non-benzodiazepine) | Partial agonist at serotonin 5-HT1A receptors; some dopamine D2 activity. Mechanism for anxiolytic effect not fully understood. | Requires regular dosing—not effective for PRN or acute anxiety. Onset delayed—therapeutic effect takes 2–4 weeks; educate patients to continue therapy despite lack of immediate relief. Monitor for dizziness, headache, GI upset. Avoid combining with CNS depressants. Teach patients to avoid grapefruit juice (increases buspirone levels). Evaluate for serotonin syndrome if used with other serotonergic drugs. Good option for long-term management with minimal sedation or abuse potential. | Caution: Not useful for acute anxiety/panic attacks. Contraindicated with MAOIs. Use cautiously with other serotonergic agents—risk of serotonin syndrome (rare). Educate patients on adherence and delayed onset of action. |
| 79. Zolpidem (Ambien) | Sedative-hypnotic (non-benzo) | Selective agonist at benzodiazepine BZ1 receptors on GABA-A complex (α1 subunit) → sleep induction with minimal anxiolytic or muscle relaxant effect. | Indicated for short-term treatment of insomnia. Use only when 7–8 hours of sleep is possible. Monitor for complex sleep behaviors (e.g., sleepwalking, sleep-driving)—discontinue if these occur. Avoid abrupt discontinuation after prolonged use—taper slowly. Monitor for daytime drowsiness, dizziness, and fall risk (especially in elderly). Avoid alcohol and other CNS depressants—may increase sedation and respiratory depression. Educate patients not to operate heavy machinery if drowsy the next day. | Caution: Complex sleep behaviors may result in serious injury or death—discontinue immediately if such events occur. Risk of overdose, especially with other CNS depressants. Use flumazenil cautiously in overdose—may cause seizures. |
Anticonvulsants/Antiepileptics Medications
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 80. Phenytoin (Dilantin) | Anticonvulsant (Hydantoin) | Blocks voltage-gated sodium channels in neurons, stabilizing the membrane and preventing repetitive firing (use-dependent blockade). | Maintain therapeutic serum levels (10–20 mcg/mL) for seizure control and to avoid toxicity. Educate on oral hygiene—gingival hyperplasia is common; encourage regular brushing and dental visits. Administer IV form slowly (≤50 mg/min) and only with normal saline to prevent hypotension and cardiac arrhythmias. Monitor for CNS effects—ataxia, nystagmus, or confusion may signal toxicity. Avoid abrupt discontinuation—can cause status epilepticus. Review all medications—phenytoin has many drug interactions. | Black Box Warning: Rapid IV administration may cause severe hypotension and cardiac arrhythmias. Continuous cardiac monitoring is required during IV infusion. |
| 81. Carbamazepine (Tegretol) | Anticonvulsant | Inhibits voltage-gated sodium channels, reducing neuronal excitability. Also used as a mood stabilizer and for trigeminal neuralgia. | Monitor serum drug levels (therapeutic: 4–12 mcg/mL) and perform regular CBCs due to risk of bone marrow suppression. Monitor for signs of toxicity—dizziness, diplopia, ataxia. Do not stop abruptly—risk of seizure recurrence. Avoid grapefruit juice—it increases serum levels. Initiate genetic screening (HLA-B*1502) in Asian patients—linked to life-threatening skin reactions. Educate on adherence and early rash recognition. CYP450 inducer—interacts with many other drugs. | Black Box Warning: Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis, especially in patients with HLA-B*1502 allele. May cause aplastic anemia or agranulocytosis—monitor CBC regularly. High Alert: Overdose may cause severe CNS and CV effects. |
| 82. Valproic Acid (Depakote) | Anticonvulsant / Mood Stabilizer | Broad mechanism: increases GABA availability, blocks sodium channels, and inhibits T-type calcium channels. | Monitor therapeutic levels (50–100 mcg/mL) and liver function tests regularly—risk of hepatotoxicity, especially in young children. Assess for signs of pancreatitis—severe abdominal pain, nausea, vomiting. Evaluate for sedation, tremor, dizziness. Strongly teratogenic—avoid in women of childbearing potential unless no alternatives; ensure effective contraception. Avoid abrupt discontinuation. Educate on consistent dosing and follow-up labs. | Black Box Warning: May cause fatal hepatotoxicity (especially in children <2 years), life-threatening pancreatitis, and major congenital malformations (e.g., neural tube defects). Weigh risks in pregnancy carefully. |
Neurologic Medications
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 83. Carbidopa-Levodopa (Sinemet) | Anti-Parkinson Agent | Levodopa is a dopamine precursor that crosses the blood-brain barrier and is converted to dopamine. Carbidopa inhibits peripheral dopa-decarboxylase, allowing more levodopa to reach the brain with fewer side effects. | First-line therapy for Parkinson’s disease—carbidopa reduces peripheral side effects while levodopa replenishes dopamine in the CNS. Start with low doses and titrate slowly to minimize orthostatic hypotension, hallucinations, or dyskinesias. Administer before meals for best absorption—protein can interfere, so advise spacing high-protein meals. Monitor for “wearing-off” effect or motor fluctuations; assess for involuntary movements and behavioral changes. Stress adherence and consistent timing to maintain symptom control. | Caution: Abrupt discontinuation may trigger a Parkinsonian crisis or neuroleptic malignant syndrome-like symptoms; taper slowly. Watch for sudden sleep attacks and impulse control disorders (e.g., gambling, hypersexuality). |
| 84. Benztropine (Cogentin) | Anticholinergic (Antiparkinson) | Blocks central muscarinic receptors, helping rebalance dopamine and acetylcholine in the basal ganglia; reduces tremor and rigidity in Parkinson’s disease or antipsychotic-induced extrapyramidal symptoms (EPS). | Monitor for typical anticholinergic effects—dry mouth, constipation, blurred vision, urinary retention, and confusion—especially in older adults. Use with caution during heat or exercise due to impaired sweating and increased risk of heat stroke. Avoid abrupt withdrawal as it can exacerbate Parkinsonism. If sedation occurs, recommend nighttime dosing. Evaluate for benefit in EPS management and reassess regularly. | Caution: Overdose may result in delirium, hallucinations, paralytic ileus, or urinary retention. Treated with physostigmine. Contraindicated in narrow-angle glaucoma and used cautiously in prostatic hypertrophy due to risk of urinary retention or increased intraocular pressure. |
| 85. Donepezil (Aricept) | Acetylcholinesterase Inhibitor | Reversibly inhibits acetylcholinesterase, increasing acetylcholine availability in the CNS, which may enhance memory and cognition in patients with Alzheimer’s disease. | Watch for gastrointestinal side effects—nausea, vomiting, and diarrhea are common; administer with food to reduce symptoms. Monitor for bradycardia, syncope, or heart block, particularly in patients with cardiac history or those on beta-blockers. Use caution in patients with asthma or COPD due to risk of bronchoconstriction—assess respiratory status regularly. Reinforce adherence for best cognitive support and evaluate periodically for continued benefit. | Caution: May cause bradycardia, syncope, or heart block—use cautiously with cardiac conditions or beta-blockers. In overdose, can cause cholinergic crisis—treated with atropine. Evaluate risks in elderly patients with multiple comorbidities or frailty. |
Osmotic Diuretics
| Drug Name (Brand) | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 86. Mannitol (Osmitrol) | Osmotic Diuretic | Increases plasma and renal filtrate osmolality, drawing fluid from tissues (e.g., brain, eyes) into the bloodstream. It is filtered by the kidneys, pulling water into the urine. | Monitor closely for fluid and electrolyte imbalances—frequent assessment of serum osmolality, sodium, potassium, and hydration status is critical to avoid dehydration or electrolyte disturbances. Observe for signs of pulmonary edema, especially in patients with heart failure—auscultate lungs for crackles or new-onset dyspnea. Always inspect IV solution for crystals and use a filter needle—mannitol crystallizes at cooler temperatures. In renal impairment, adjust dosing and monitor renal function to prevent accumulation and nephrotoxicity. | High Alert: Contraindicated in anuria, active intracranial bleeding (except during neurosurgery), and severe pulmonary edema—mannitol can worsen these conditions through rapid fluid shifts. Rebound intracranial pressure may occur after initial reduction; monitor neurological status frequently following administration for signs of return ICP elevation. |
OBSTETRICS AND GYNECOLOGY MEDICATIONS
| Generic & Brand Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 87. Oxytocin (Pitocin) | Oxytocic / Uterotonic | Stimulates oxytocin receptors in uterine smooth muscle, increasing rhythmic contractions; also promotes milk let-down reflex. | Monitor fetal heart rate and uterine tone closely with continuous monitoring to detect signs of fetal distress or uterine tachysystole. Assess for water intoxication during prolonged infusions due to antidiuretic effects—watch for headache, vomiting, confusion, or seizures indicating hyponatremia. Teach patient about medication purpose and expected effects (labor induction/strengthening or postpartum bleeding control). Use caution in patients with uterine scarring or multiple gestations due to increased risk of uterine rupture. | High Alert: Perinatal ISMP high-alert medication. Improper use can cause uterine rupture, fetal distress, or maternal/fetal death. Requires constant monitoring and rapid response to overdose signs. Black Box Warning (FDA): Use only when medically indicated, not for elective convenience. Watch for water intoxication (confusion, headache, drowsiness) due to antidiuretic effects. |
| 88. Magnesium Sulfate (MgSO₄) | Mineral / Anticonvulsant in OB | Blocks neuromuscular transmission and is a CNS depressant; raises seizure threshold. Also relaxes uterine and vascular smooth muscle. | Monitor for magnesium toxicity by checking deep tendon reflexes, respiratory rate, urine output, and level of consciousness regularly. Use caution in patients with renal impairment as clearance is reduced, increasing toxicity risk. Keep calcium gluconate available for emergency reversal. Educate patient about side effects such as warmth, flushing, muscle weakness, and sedation. | High Alert: Monitor closely for respiratory depression, loss of reflexes, and cardiac arrest at toxic levels. Discontinue immediately and administer calcium gluconate if toxicity occurs. Caution: Potentiates CNS depressants—avoid concurrent high-dose narcotics if possible. |
| 89.Terbutaline (Brethine) | Tocolytic (β2-agonist) | Stimulates beta-2 receptors on uterine smooth muscle causing relaxation; also bronchodilates via β2 receptors in lungs. | Monitor maternal heart rate and blood pressure closely; terbutaline may cause tachycardia, palpitations, or hypotension. Continuously monitor fetal heart rate during and after administration. Use caution in patients with cardiac conditions or poorly controlled diabetes as terbutaline can exacerbate tachyarrhythmias and increase blood glucose. Inform patient about side effects like tremors, nervousness, or restlessness, reassuring these are usually transient. | High Alert (OB): Avoid prolonged use beyond 48–72 hours for preterm labor due to risk of maternal arrhythmias, pulmonary edema, and serious cardiac events. Black Box Warning: Oral terbutaline should not be used for acute or maintenance tocolysis due to risks and lack of proven benefit; limit use to short-term monitored settings only. |
| 90. Rho(D) Immune Globulin (RhoGAM) | Immunoglobulin (IgG anti-D) | Binds and destroys Rh-positive fetal RBCs entering maternal circulation in Rh-negative mother, preventing formation of anti-Rh antibodies. | Administer within 72 hours of sensitizing events (delivery, abortion, trauma, amniocentesis). Confirm maternal Rh-negative status and negative antibody screen before administration. Follow standard dosing guidelines: 300 mcg IM covers up to 15 mL fetal RBCs; microdose (50 mcg) used for early pregnancy losses. Monitor for local injection reactions and hypersensitivity; have emergency support available for rare anaphylaxis. | Caution: Do not give to Rh-positive or sensitized patients; offers no benefit and may obscure antibody titers. Use caution in IgA-deficient individuals due to risk of anaphylaxis. |
| 91. Tamoxifen (Nolvadex) | SERM (Selective Estrogen Receptor Modulator) | Estrogen receptor antagonist in breast tissue (blocks estrogen stimulation of ER+ breast cancer cells); estrogen agonist in uterus and bone (stimulates endometrium, preserves bone density). | Schedule regular gynecologic monitoring for endometrial changes; instruct patients to report abnormal vaginal bleeding. Monitor for thromboembolic events (DVT, PE signs). Educate on menopausal-like side effects (hot flashes, mood swings, vaginal dryness). Periodically assess liver function and watch for visual changes such as blurred vision indicating possible ocular toxicity. | Black Box Warning: Increased risk of uterine malignancies and life-threatening thromboembolic events, including stroke and pulmonary embolism. Carefully weigh risks and benefits in patients with clotting disorders or history of endometrial cancer. |
| 92. Ethinyl Estradiol / Norgestimate (Ortho Tri-Cyclen, Sprintec, MonoNessa) | Combined Oral Contraceptive (Estrogen and Progestin) | Suppresses hypothalamic-pituitary-ovarian axis to prevent ovulation; thickens cervical mucus to block sperm; alters endometrial lining to inhibit implantation. | Assess for thromboembolic risk factors before initiation; monitor for signs of clots (leg pain, chest pain, vision chang |
Pain Management & Anesthesia Medications
| Generic & Brand Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 93. Morphine (MS Contin, etc.) | Opioid analgesic (Schedule II) | Mu-opioid receptor agonist in CNS and periphery; modulates pain perception and emotional response; causes CNS and respiratory depression; decreases GI motility. | – Monitor respiratory rate closely, especially in opioid-naïve patients or during dose increases. – Assess sedation and level of consciousness frequently. – Evaluate pain before and after dosing. – Use caution with head injuries (may raise ICP and mask neuro signs). – Prevent constipation with bowel regimen. – Advise orthostatic hypotension precautions. – Watch for tolerance and dependence signs. | High Alert: Risk of serious respiratory depression. Concomitant CNS depressants increase sedation and respiratory failure risk. |
| 94. Hydromorphone (Dilaudid) | Opioid analgesic (Schedule II) | Potent mu-opioid receptor agonist (~5–7 times more potent than morphine). | – Monitor sedation and cognition for toxicity signs. – Implement bowel regimen proactively. – Use caution with CNS depressants. – Adjust dose for renal/hepatic impairment. – Educate on fall risk and orthostatic hypotension. | Black Box Warning: Fatal respiratory depression risk. Increased sedation and coma risk with benzodiazepines or CNS depressants. |
| 95. Oxycodone (OxyContin, Roxicodone) | Opioid analgesic (Schedule II) | Semi-synthetic mu-opioid receptor agonist; analgesia and CNS depression similar to morphine. | – Monitor respiratory status and sedation. – Manage constipation proactively. – Avoid alcohol and sedatives unless approved. – Educate on secure storage and misuse prevention. | Black Box Warnings: Fatal respiratory depression risk. High abuse and addiction potential. Dangerous with concurrent CNS depressants. |
| 96. Fentanyl (Sublimaze, Duragesic) | Opioid analgesic (Schedule II) | Highly potent mu-opioid receptor agonist (~100x morphine potency); causes analgesia, sedation, and respiratory depression. | – Continuous respiratory and cardiovascular monitoring. – Avoid heat over patches (increases absorption). – Teach proper patch handling and disposal. – Frequent sedation assessment. – Use cautiously in opioid-naïve patients (start low). | High Alert: Life-threatening respiratory depression risk. High misuse and addiction potential. Avoid concurrent CNS depressants. Risk of fatal pediatric exposure from patches. |
| 97. Naloxone (Narcan) | Opioid antagonist | Competitive opioid receptor blocker; reverses opioid effects including respiratory depression and sedation. | – Monitor respiratory rate and consciousness closely. – Prepare for withdrawal symptoms. – May require repeated dosing or continuous infusion. – Administer via appropriate route and titrate carefully. | Caution: No black box warning, but close monitoring needed to avoid rebound respiratory depression. |
| 98. Succinylcholine (Anectine) | Depolarizing neuromuscular blocker | Binds acetylcholine receptors causing persistent depolarization and paralysis. | – Anticipate need for immediate respiratory support. – Avoid in hyperkalemia risk patients. – Monitor for malignant hyperthermia; treat immediately. – Confirm full neuromuscular recovery before extubation. | Reserved for emergency intubation in children/adolescents due to cardiac arrest risk from undiagnosed myopathies/electrolyte imbalances. Use only when necessary. |
| Generic & Brand Name | Drug Class | Mechanism of Action | Key Nursing Considerations | Critical Alerts |
|---|---|---|---|---|
| 99.Morphine (MS Contin, etc.) | Opioid Analgesic (Schedule II) | Mu-opioid receptor agonist in CNS and periphery; modulates pain perception and emotional response; causes CNS and respiratory depression, decreases GI motility. | Monitor respiratory rate and oxygen saturation closely for respiratory depression, especially in opioid-naïve patients or higher doses. Assess sedation and level of consciousness frequently. Evaluate pain before and after dosing to guide effectiveness. Use caution in patients with head injury due to increased intracranial pressure risk. Prevent constipation with bowel regimen. Warn about orthostatic hypotension risk. Monitor for tolerance, dependence, and signs of misuse. | High Alert: Risk of life-threatening respiratory depression, especially at initiation or dose increase. Concomitant use with benzodiazepines or CNS depressants can cause profound sedation, respiratory depression, coma, or death. |
| 100. Hydromorphone (Dilaudid) | Opioid Analgesic (Schedule II) | Mu-opioid receptor agonist; similar to morphine but approximately 5–7 times more potent. | Assess sedation and cognitive changes closely to detect toxicity. Implement bowel regimen to prevent constipation. Use caution with CNS depressants due to increased sedation and respiratory risk. Adjust dose for renal or hepatic impairment to avoid accumulation. Educate patient on fall risk and orthostatic hypotension; assist with ambulation. | Black Box Warning: Risk of fatal respiratory depression, especially during initiation or dose escalation. Concurrent use with benzodiazepines or CNS depressants may cause profound sedation, coma, or death. |
/nursing/pharmacology-essential-medications
https://dailymed.nlm.nih.gov/dailymed/
Whenever you have a moment of downtime, quickly review a few medications and connect each one to a patient you’ve cared for. Before long, the drug mechanisms will start to make sense, your confidence will grow, and the pharmacology section of the NCLEX will feel like second nature.
