Pharmacology
✅ Reviewed by NCLEXDeck Clinical Review Board — Updated June 2026
Comprehensive NCLEX-RN Review — Medication Safety, Drug Classes, Antidotes, and High-Yield Nursing Considerations
1. Medication Safety Foundations
- Rights of medication administration: right patient (2 identifiers), drug, dose, route, time, documentation, reason, response, to refuse
- High-alert medications (greatest harm potential): insulin, heparin/anticoagulants, opioids, potassium, chemotherapy, concentrated electrolytes. Require independent double-checks.
- Verify allergies before every administration.
- Do not administer a med you did not prepare; never leave meds at bedside (exceptions per policy).
2. Common Suffixes → Drug Class (Fast Recognition)
| Suffix | Class | Example |
|---|
| -pril | ACE inhibitors | Lisinopril, enalapril |
| -sartan | ARBs | Losartan, valsartan |
| -olol | Beta blockers | Metoprolol, atenolol |
| -dipine | Calcium channel blockers | Amlodipine, nifedipine |
| -statin | HMG-CoA reductase inhibitors | Atorvastatin |
| -pam / -lam | Benzodiazepines | Lorazepam, alprazolam |
| -cillin | Penicillin antibiotics | Amoxicillin |
| -floxacin | Fluoroquinolones | Ciprofloxacin |
| -cycline | Tetracyclines | Doxycycline |
| -prazole | Proton pump inhibitors | Omeprazole |
| -tidine | H2 blockers | Famotidine |
| -ide | Loop diuretics | Furosemide |
| -mycin/-micin | Aminoglycosides / macrolides | Gentamicin, azithromycin |
3. High-Yield Drug Classes & Nursing Considerations
Anticoagulants / Antiplatelets
| Drug | Monitor | Antidote | Key Points |
|---|
| Heparin | aPTT (1.5–2.5× control) | Protamine sulfate | Watch HIT (heparin-induced thrombocytopenia) |
| Warfarin | PT/INR (therapeutic 2–3) | Vitamin K | Many drug interactions; consistent vitamin K intake |
| LMWH (enoxaparin) | None routinely | Protamine (partial) | SubQ; don't expel air bubble; give in abdomen |
| DOACs | None routinely | Andexanet alfa | Apixaban, rivaroxaban |
⭐ NCLEX TIP
"PT/warfarin" and "aPTT/heparin" — memorize the pairing. INR up = bleeding risk.
Digoxin
- Therapeutic level 0.5–2.0 ng/mL.
- Check apical pulse for 1 full minute; hold if <60 bpm (adult)
- Toxicity: N/V, anorexia, visual changes (yellow-green halos), bradycardia, dysrhythmias
- Hypokalemia potentiates toxicity
- Antidote: digoxin immune Fab (Digibind)
Insulin
- Rapid (lispro, aspart) onset ~15 min — give with food
- Short (regular — only insulin given IV)
- Intermediate (NPH — cloudy, must be mixed correctly)
- Long (glargine — do not mix, no peak)
- When mixing: clear before cloudy (draw regular before NPH — think "RN")
- Hypoglycemia (<70): treat with 15g fast carbs, recheck in 15 min
Opioids
- Monitor respiratory rate/sedation; hold if RR < 12
- Antidote: naloxone
- Constipation prophylaxis needed
Corticosteroids (-sone, -olone)
- Never stop abruptly (taper — adrenal suppression)
- ↑glucose, ↑infection risk, ↓immune response, osteoporosis, fluid retention
- Take with food
Aminoglycosides (gentamicin)
- Nephrotoxic + ototoxic
- Monitor peak/trough and renal function
Beta Blockers (-olol)
- Hold for HR < 60 or low BP
- Mask hypoglycemia signs
- Don't stop abruptly (rebound)
- Caution in asthma (non-selective)
ACE Inhibitors (-pril)
- Dry cough, angioedema (stop drug), hyperkalemia
- First-dose hypotension
- Avoid in pregnancy
4. Antidotes & Reversal Agents
| Drug / Toxin | Antidote |
|---|
| Heparin | Protamine sulfate |
| Warfarin | Vitamin K |
| Opioids | Naloxone (Narcan) |
| Benzodiazepines | Flumazenil |
| Acetaminophen | Acetylcysteine (Mucomyst) |
| Digoxin | Digoxin immune Fab |
| Magnesium sulfate | Calcium gluconate |
| Iron | Deferoxamine |
| Ethylene glycol/methanol | Fomepizole |
| Cyanide | Hydroxocobalamin |
⭐ NCLEX TIP
Antidote pairs are a frequent standalone question. If you only memorize 5: heparin → protamine, warfarin → vitamin K, opioids → naloxone, benzos → flumazenil, acetaminophen → acetylcysteine.
5. Key Food/Drug & Timing Notes
- MAOIs → avoid tyramine (hypertensive crisis)
- Warfarin → consistent vitamin K intake
- Tetracyclines/fluoroquinolones → avoid dairy/antacids; photosensitivity
- Grapefruit juice → ↑levels of many drugs (statins, CCBs)
- Levothyroxine → morning, empty stomach, same time daily
- Bisphosphonates → full glass of water, upright 30 min (esophagitis risk)