Grouped by class · expandable 6-point cards · high-alert flags · antidotes · look-alike pairs
The rules that apply to every drug on this page — the 5 rights, the perfect drug card, med math, and what the body does to a drug.
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| Suffix | Drug class | Key nursing point |
|---|---|---|
| -pril | ACE inhibitors | Monitor for dry cough & angioedema; watch K⁺ (hyperkalemia); 1st-dose hypotension |
| -sartan | ARBs | Like ACE-I but NO cough; still watch K⁺; teratogenic |
| -olol | Beta blockers | ↓HR/BP; hold if HR <60 or SBP <90; don't stop abruptly; masks hypoglycemia |
| -dipine | Ca²⁺ channel blockers (dihydropyridine) | Peripheral edema, reflex tachycardia; avoid grapefruit juice |
| -statin | HMG-CoA reductase inhibitors | Take in evening; report muscle pain (rhabdomyolysis); monitor LFTs |
| -pril/-sartan/-one | RAAS + K⁺-sparing | All raise potassium — teach to avoid salt substitutes |
| -prazole | Proton pump inhibitors | Take before meals; long-term → ↓Ca/Mg/B12, C. diff, fractures |
| -tidine | H₂ receptor blockers | Take at bedtime; famotidine preferred (cimetidine = many interactions) |
| -parin | Heparins / LMWH | Bleeding; monitor aPTT (heparin) / no routine labs (enoxaparin); antidote protamine |
| -ase | Thrombolytics ("clot busters") | Massive bleeding risk; strict time window; many contraindications |
| -floxacin | Fluoroquinolones | Tendon rupture, QT prolongation, photosensitivity; avoid in children |
| -cycline | Tetracyclines | No dairy/antacids; photosensitivity; not in <8 yr or pregnancy (teeth) |
| -mycin/-micin | Aminoglycosides | Nephrotoxic & ototoxic — monitor trough, creatinine, hearing |
| -cillin | Penicillins | Ask about allergy (cross-reacts with cephalosporins); anaphylaxis risk |
| cef-/-cef | Cephalosporins | Cross-allergy with PCN; no alcohol (disulfiram rxn with some) |
| -thromycin | Macrolides | QT prolongation, GI upset; many drug interactions |
| -ide (furosem-) | Loop diuretics | ↓K⁺; ototoxic if pushed fast; monitor K⁺, daily weights, I&O |
| -thiazide | Thiazide diuretics | ↓K⁺, ↑glucose/uric acid/Ca²⁺; sulfa allergy caution |
| -terol | Beta-2 agonists (bronchodilators) | Rescue (albuterol) vs prevention (salmeterol); tachycardia, tremor |
| -sone/-olone | Corticosteroids | ↑glucose, infection risk, ↓immunity; never stop abruptly (taper); take with food |
| -vir | Antivirals | Adherence critical; renal dosing |
| -azole | Antifungals / some PPIs | Hepatotoxic (antifungals); many interactions |
| -dronate | Bisphosphonates | Take with full glass water, sit upright 30 min (esophagitis) |
| -setron | Antiemetics (5-HT₃) | QT prolongation; ondansetron for N/V |
| -pam/-lam | Benzodiazepines | Sedation, fall risk, dependence; antidote flumazenil |
| -caine | Local anesthetics | Watch for systemic toxicity, allergy |
Highest risk of serious harm if given in error — double-check dose, route, and often a second nurse.
⚠️ Insulin⚠️ Heparin / LMWH⚠️ Warfarin⚠️ Opioids (morphine, hydromorphone)⚠️ IV potassium chloride⚠️ Digoxin⚠️ Chemotherapy agents⚠️ Neuromuscular blockers⚠️ Concentrated electrolytes⚠️ Anticoagulant DOACs| Drug | Dosing / duration | Distinguishing feature | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| lisinopril | once daily, long acting | not a prodrug — active as given | dry cough, ↑ K⁺, angioedema | avoid in PREGNANCY (fetal injury) |
| enalapril | 1–2× daily; IV as enalaprilat | only -pril with an IV form | ANGIOEDEMA: lip/tongue swelling → stop drug | monitor BP closely with IV dosing |
| captopril | short t½, 2–3× daily | oldest ACE-I; food ↓ absorption | taste changes, rash, cough, ↑ K⁺ | give on EMPTY stomach, 1 h before meals |
| ramipril | once daily, prodrug | high CV-risk protection | cough, ↑ K⁺, dizziness, ↑ creatinine | ↓ MI/STROKE risk in high-risk pts |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Action / site | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| losartan | blocks angiotensin II at AT1 receptor | HTN, diabetic nephropathy, LVH | ↑ K⁺, dizziness, ↓ BP | shortest acting — may be dosed TWICE daily |
| valsartan | AT1 blocker, once daily | HTN, HF, post-MI | ↑ K⁺, ↓ BP, ↓ renal function | 36-HOUR washout from ACE-I (Entresto) |
| olmesartan | AT1 blocker, long acting | HTN only, no HF indication | ↑ K⁺; rare severe DIARRHEA (sprue-like) | monitor weight loss, chronic diarrhea |
| ARBs vs ACE inhibitors | block receptor — no bradykinin buildup | same uses: HTN, HF, renal protection | ↑ K⁺ both; both teratogenic in pregnancy | NO cough — switch if ACE-I cough |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Receptor selectivity | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| metoprolol | β1 cardioselective | HTN, angina, post-MI, HF (succinate) | bradycardia, fatigue, ↓ BP | HOLD if HR <60; never stop abruptly |
| atenolol | β1 cardioselective | HTN, angina, post-MI | bradycardia, cold extremities, fatigue | RENALLY cleared — adjust if ↓ GFR |
| propranolol | non-selective β1 + β2 | HTN, migraine prophylaxis, tremor, thyroid storm | bronchospasm — AVOID in asthma/COPD | masks tachycardia of hypoglycemia in DM |
| carvedilol | non-selective β + α1 block | HF, HTN, post-MI | orthostatic hypotension, dizziness, fatigue | give WITH food to ↓ orthostatic drop |
| labetalol | α1 + non-selective β block | hypertensive emergency; PREGNANCY/preeclampsia | orthostatic ↓ BP, scalp tingling, bradycardia | keep supine during and after IV dose |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug (subclass) | Site of action | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| amlodipine / nifedipine (dihydropyridine) | arterial smooth muscle, not AV node | HTN, vasospastic and stable angina | ankle EDEMA, flushing, headache, reflex ↑ HR | little HR effect; amlodipine ok in HF |
| diltiazem | AV node + vessels (balanced) | AFib/flutter rate control, SVT, angina | bradycardia, AV block, ↓ BP | HOLD if HR <60 or SBP <90 |
| verapamil | myocardium/AV node — strongest cardiac effect | SVT, AFib rate control, angina, migraine | CONSTIPATION, bradycardia, worsens HF | ↑ digoxin level; avoid with beta blockers |
| all CCBs (class) | block Ca²⁺ influx into cells | HTN, angina, ± rate control | hypotension, dizziness, headache | GRAPEFRUIT juice ↑ level; do not crush ER |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug (class) | Site in nephron | Main use | Electrolyte / acid-base effect | Watch for / key nursing point |
|---|---|---|---|---|
| furosemide (loop) | ascending limb, loop of Henle | pulmonary edema, HF, edema; works at low GFR | ↓ K⁺, ↓ Na⁺, ↓ Mg²⁺, ↓ Ca²⁺ | ototoxic if IV pushed FAST; daily weights |
| hydrochlorothiazide (thiazide) | distal convoluted tubule | first-line HTN, mild edema | ↓ K⁺, ↓ Na⁺, ↑ Ca²⁺ — RETAINS calcium | weak if GFR <30; ↑ uric acid, ↑ glucose |
| spironolactone (K⁺-sparing) | collecting duct — blocks aldosterone | HF, ascites, resistant HTN | ↑ K⁺ — HYPERkalemia risk | no K⁺ supplements or salt substitutes; gynecomastia |
| mannitol (osmotic) | proximal tubule, osmotic pull | ↑ ICP, cerebral edema, ↑ IOP | dilutional ↓ Na⁺, then dehydration | IV FILTER for crystals; hourly output, neuro checks |
| acetazolamide (carbonic anhydrase inhib.) | proximal tubule, blocks HCO₃⁻ reabsorption | glaucoma, altitude sickness, metabolic alkalosis | ↓ K⁺, HCO₃⁻ loss → metabolic ACIDOSIS | sulfa drug; tingling fingers/toes, monitor ABGs |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Action | Effect on HR / BP | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|---|
| digoxin | ↑ contractility, slows AV node conduction | ↓ HR, little direct BP change | chronic HF, AFib rate control | N/V, anorexia, yellow/halo vision, dysrhythmias; ↓K⁺ raises risk | apical pulse 1 FULL MINUTE; hold if HR <60 |
| dobutamine | beta-1 agonist, ↑ contractility | ↑ contractility, mild ↑ HR, BP may fall | acute decompensated HF, cardiogenic shock | tachycardia, ectopy, hypotension, chest pain | INOTROPE not vasopressor; continuous cardiac monitoring |
| dopamine | dose-dependent: dopaminergic → beta-1 → alpha | ↑ HR and ↑ BP at higher doses | shock, symptomatic bradycardia, low output | tachydysrhythmias, extravasation tissue necrosis | CENTRAL LINE preferred; phentolamine for infiltration |
| norepinephrine | potent alpha-1 vasoconstrictor, some beta-1 | ↑↑ BP; HR unchanged or reflex ↓ | septic shock, sustained hypotension | tissue ischemia, extravasation, reflex bradycardia | titrate to MAP; CHECK IV SITE frequently |
| epinephrine | alpha and beta agonist, bronchodilates | ↑↑ HR, ↑ contractility, ↑ BP | anaphylaxis, cardiac arrest, severe asthma | tachycardia, dysrhythmias, anxiety, ↑ glucose | ANAPHYLAXIS: IM into anterolateral thigh |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Class / drug | Action | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| Class I — Na⁺ blockers (lidocaine, procainamide) | block Na⁺ channels, slow impulse conduction | VT, PVCs; procainamide for VT/AFib | CNS changes, seizures; procainamide lupus-like signs, ↑ QT | use CARDIAC LIDOCAINE only — no additives |
| Class II — beta blockers (metoprolol, esmolol) | block beta-1 → ↓ HR and AV conduction | AFib/SVT rate control, post-MI | bradycardia, ↓ BP, fatigue, masks hypoglycemia | NEVER STOP ABRUPTLY; hold for low HR/BP |
| Class III — amiodarone | blocks K⁺ channels, prolongs repolarization | VT/VF, AFib conversion and maintenance | pulmonary fibrosis, thyroid and liver toxicity, ↑ QT | BASELINE CXR, TSH, LFTs, eye exam |
| Class IV — CCB (diltiazem, verapamil) | block Ca²⁺ channels, slow AV node | SVT, AFib/flutter rate control | bradycardia, ↓ BP, edema, constipation (verapamil) | CAUTION WITH BETA BLOCKERS — additive bradycardia |
| adenosine | brief AV node block, resets sinus node | converts stable SVT (PSVT) | flushing, chest tightness, brief asystole on monitor | RAPID IV PUSH 1–2 sec, immediate saline flush |
| atropine | anticholinergic — blocks vagal tone, ↑ HR | symptomatic bradycardia, AV block | dry mouth, blurred vision, urinary retention, confusion | FIRST-LINE for symptomatic bradycardia; 1 mg IV |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Form | Onset | Main use | Watch for (adverse) | Key teaching / nursing point |
|---|---|---|---|---|
| nitroglycerin SL tablet or spray | 1–3 min, lasts ~30 min | acute anginal attack, rescue dosing | headache, dizziness, ↓ BP; avoid sildenafil-type drugs | 1 dose q5 min ×3; CALL 911 if no relief after first |
| NTG transdermal patch | 30–60 min — not for acute pain | around-the-clock angina prevention | headache, orthostatic ↓ BP, skin irritation | remove 10–12 h nightly to PREVENT TOLERANCE; rotate sites |
| NTG IV drip | immediate, 1–2 min | unstable angina, ACS, acute HF/pulmonary edema | hypotension, reflex tachycardia, severe headache | CONTINUOUS BP MONITORING; titrate, non-PVC tubing |
| isosorbide (oral long-acting) | 30–60 min, sustained effect | chronic stable angina prophylaxis | headache, orthostatic hypotension, dizziness | NOT A RESCUE DRUG; keep daily nitrate-free interval |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Action | Main use | Lab to monitor | Antidote / reversal | Key nursing point |
|---|---|---|---|---|---|
| aspirin | blocks COX-1 → ↓ platelet aggregation | MI and stroke prevention, ACS | none routine; CBC and platelets | none; platelet transfusion if major bleed | TINNITUS signals toxicity; give with food |
| clopidogrel | blocks platelet ADP (P2Y12) receptor | post-stent, ACS, ASA intolerance | none routine; CBC and platelets | none specific; platelets if bleeding | HOLD 5–7 DAYS before elective surgery |
| heparin (unfractionated) | activates antithrombin → ↓ thrombin and Xa | DVT/PE, ACS, IV infusion therapy | aPTT 1.5–2× control; platelet count | protamine sulfate IV | WATCH FOR HIT: platelets dropping, new clot |
| enoxaparin (LMWH) | mainly anti-factor Xa activity | DVT prophylaxis and treatment, bridging | no routine aPTT; anti-Xa if indicated | protamine sulfate — partial reversal only | deep SubQ in abdomen; DO NOT EXPEL AIR BUBBLE |
| warfarin | blocks vitamin K factors II, VII, IX, X | AFib, mechanical valves, long-term VTE | PT/INR, goal 2–3 for most | vitamin K (phytonadione); FFP/PCC if bleeding | KEEP VITAMIN K INTAKE CONSISTENT (leafy greens) |
| apixaban / rivaroxaban (DOAC) | direct factor Xa inhibitor | AFib stroke prevention, DVT/PE | NO ROUTINE INR; check renal function, CBC | andexanet alfa if available | same time daily; do not stop without provider |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug / class | Action | Main lipid effect | Watch for (adverse) | Key nursing / teaching point |
|---|---|---|---|---|
| statins (atorvastatin, simvastatin) | block HMG-CoA reductase in liver | ↓↓ LDL, mild ↓ TG, mild ↑ HDL | myopathy and rhabdomyolysis, ↑ liver enzymes | REPORT MUSCLE PAIN or dark urine; avoid grapefruit |
| ezetimibe | blocks cholesterol absorption in small intestine | ↓ LDL, modest effect alone | diarrhea, myalgia, ↑ myopathy risk with statin | OFTEN ADDED TO STATIN; monitor LFTs |
| fibrates (gemfibrozil, fenofibrate) | ↑ lipoprotein lipase, ↓ VLDL production | ↓↓ triglycerides, ↑ HDL | gallstones, myopathy, potentiates warfarin | AVOID GEMFIBROZIL WITH STATIN; monitor INR |
| bile acid sequestrants (cholestyramine) | bind bile acids in gut for excretion | ↓ LDL, may ↑ triglycerides | constipation, bloating, ↓ fat-soluble vitamin absorption | SEPARATE other meds 1 h before, 4 h after |
| niacin (nicotinic acid) | ↓ hepatic VLDL and LDL production | ↑↑ HDL, ↓ LDL, ↓ TG | flushing, pruritus, hyperglycemia, ↑ uric acid | aspirin 30 min prior REDUCES FLUSHING; take with food |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug / class | Type / action | Main use | Onset & duration | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|---|
| albuterol (SABA) | short-acting beta-2 agonist; relaxes airway smooth muscle | acute bronchospasm, asthma attack | 5–15 min; lasts 4–6 h | tachycardia, tremor, nervousness, ↓K⁺ | RESCUE inhaler — keep with patient always |
| levalbuterol | R-isomer of albuterol; SABA | acute bronchospasm, asthma | 5–15 min; lasts 4–6 h | tremor, tachycardia (usually milder) | FEWER cardiac effects than albuterol |
| salmeterol (LABA) | long-acting beta-2 agonist | asthma/COPD maintenance, nocturnal symptoms | 10–20 min; lasts 12 h, dosed q12h | tachycardia, tremor; risk if used alone in asthma | NEVER for acute attack — always paired with ICS |
| ipratropium / tiotropium | anticholinergic; blocks ACh, ↓ secretions | COPD maintenance; ipratropium add-on in acute | ipratropium 15 min; tiotropium once daily | dry mouth, blurred vision, urinary retention; caution glaucoma/BPH | tiotropium capsules INHALED, never swallowed |
| theophylline (methylxanthine) | methylxanthine; relaxes bronchial smooth muscle | rarely used; chronic asthma/COPD | PO maintenance; narrow therapeutic range | N/V, insomnia, tachydysrhythmias, seizures | monitor SERUM LEVELS; limit caffeine |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug / class | Type / action | Main use | Route / onset | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|---|
| fluticasone / budesonide (ICS) | inhaled corticosteroid; ↓ airway inflammation | asthma/COPD daily maintenance — not rescue | inhaled; full effect 1–2 wks | oral thrush, hoarseness, dysphonia | RINSE mouth after; bronchodilator first, use spacer |
| prednisone (PO systemic) | systemic glucocorticoid | exacerbations, short burst; chronic inflammation | PO; effect within hours | ↑glucose, ↑BP, ↑infection risk, ↓K⁺, osteoporosis | TAPER — never stop abruptly; give AM with food |
| methylprednisolone (IV) | systemic glucocorticoid, parenteral | severe acute exacerbation, status asthmaticus | IV; rapid anti-inflammatory effect | hyperglycemia, fluid retention, mood changes | check GLUCOSE even in non-diabetics |
| montelukast | leukotriene receptor antagonist | asthma prophylaxis, allergic rhinitis, exercise-induced | PO once daily, evening | NEUROPSYCHIATRIC effects — mood, agitation | not a rescue med; report behavior changes |
| cromolyn | mast cell stabilizer; blocks histamine release | asthma/allergy prophylaxis | inhaled; 1–2 wks for effect | cough, throat irritation, bad taste | PROPHYLAXIS ONLY — never for acute attack |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Signature adverse effect | Monitor | Don't take with / caution | Key teaching |
|---|---|---|---|---|
| rifampin | RED-ORANGE BODY FLUIDS (harmless) | LFTs, jaundice | oral contraceptives, warfarin — enzyme inducer | stains soft contacts; use backup birth control |
| isoniazid (INH) | peripheral neuropathy, hepatotoxicity | LFTs, numbness/tingling | alcohol, antacids, tyramine foods | give VITAMIN B6 (PYRIDOXINE) |
| pyrazinamide | HYPERURICEMIA — GOUT / JOINT PAIN | uric acid, LFTs | alcohol; caution in gout | increase fluids; report joint pain |
| ethambutol | OPTIC NEURITIS — VISION CHANGES | monthly vision + red-green color testing | caution in young children who can't report vision | report blurred vision immediately |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug / class | Action | Main use | When to take it | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|---|
| PPIs (-prazole) | blocks H⁺/K⁺ ATPase proton pump; ↓↓ acid | GERD, PUD, H. pylori regimen, Zollinger-Ellison | 30–60 min BEFORE breakfast | long-term: ↓Mg²⁺, ↓B12, ↑fracture, C. diff | swallow whole; short-term use preferred |
| H2 blockers (famotidine, cimetidine) | blocks H2 receptors; ↓ acid secretion | GERD, PUD, heartburn, stress ulcer prevention | with or after meals and/or at bedtime | cimetidine: CONFUSION in older adults, gynecomastia, many interactions | separate from antacids by ~1 h |
| antacids (Al³⁺ / Mg²⁺ / Ca²⁺) | neutralize existing acid; fastest symptom relief | quick heartburn/indigestion relief | 1–2 h after meals & at bedtime | Al³⁺ = CONSTIPATION; Mg²⁺ = diarrhea; Ca²⁺ = acid rebound | space other meds 1–2 h; avoid Mg²⁺ in renal failure |
| sucralfate | forms protective barrier over ulcer base | PUD, stress ulcer, esophagitis | 1 h BEFORE meals & at bedtime, empty stomach | constipation, dry mouth | give other meds 2 h apart; ↓ absorption of drugs |
| misoprostol | prostaglandin analog; ↑ mucus/bicarb, ↓ acid | prevents NSAID-induced ulcers | with meals & at bedtime | diarrhea, abdominal cramping | CONTRAINDICATED in pregnancy — abortifacient |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Class / action | Main use | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|
| ondansetron | 5-HT3 (serotonin) blocker, central + gut | chemo, post-op, radiation N/V | headache, constipation, QT prolongation | MONITOR QT; avoid other QT-prolonging drugs |
| promethazine | phenothiazine antihistamine; H1 block | N/V, motion sickness, sedation | heavy sedation, anticholinergic effects, hypotension | IV can cause TISSUE NECROSIS; not under age 2 |
| metoclopramide | prokinetic; D2 blocker, ↑ gastric emptying | gastroparesis, GERD, N/V | restlessness, EPS / TARDIVE DYSKINESIA | give 30 min before meals & bedtime; limit to 12 wks |
| scopolamine | anticholinergic transdermal patch | motion sickness, post-op N/V | dry mouth, blurred vision, confusion in elderly | PATCH BEHIND EAR; wash hands after handling |
| prochlorperazine | phenothiazine; D2 blocker | N/V, vertigo | sedation, hypotension, EPS | watch ACUTE DYSTONIA; treat with diphenhydramine |
| dicyclomine | anticholinergic antispasmodic | IBS cramping, GI spasm | dry mouth, urinary retention, blurred vision | NOT an antiemetic — relieves spasm only |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Type / action | Main use | Onset | Watch for (adverse) | Key nursing point |
|---|---|---|---|---|---|
| docusate | stool softener; ↑ water into stool | prevent straining post-MI, post-op, hemorrhoids | 12–72 h | mild cramping; minimal effects | PREVENTION, not acute relief |
| polyethylene glycol / lactulose | osmotic; pulls water into bowel | constipation; lactulose ↓ ammonia in hepatic encephalopathy | PEG 1–3 days; lactulose 24–48 h | bloating, cramping, dehydration, electrolyte loss | LACTULOSE titrated to 2–3 soft stools/day |
| bisacodyl / senna | stimulant; ↑ peristalsis | opioid-induced constipation, bowel prep | PO 6–12 h; suppository 15–60 min | cramping, ↓K⁺, laxative dependence | DO NOT crush enteric-coated; no milk/antacid within 1 h |
| psyllium | bulk-forming; ↑ stool bulk and water | chronic constipation, IBS, diverticulosis | 12–72 h | obstruction/impaction if fluid inadequate, gas | GIVE WITH FULL GLASS OF WATER |
| loperamide | slows gut motility via gut opioid receptors | acute/chronic noninfectious diarrhea | about 1 h | constipation, ileus, cardiac/QT effects at high doses | NOT IN INFECTIOUS DIARRHEA or C. diff |
| diphenoxylate-atropine | opioid antidiarrheal + atropine to deter abuse | diarrhea unrelieved by other agents | 45–60 min | anticholinergic effects, sedation, dependence | SCHEDULE V; avoid alcohol/CNS depressants |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug / class | Primary use | Action / route | Key adverse & monitoring | Key nursing point |
|---|---|---|---|---|
| mesalamine / 5-ASA | MILD–MODERATE UC; maintains remission | topical anti-inflammatory on bowel mucosa | headache, nausea; monitor renal function | PO, enema, or suppository by disease site |
| sulfasalazine | UC; IBD-related arthritis | 5-ASA + sulfapyridine, split in colon | SULFA allergy, rash, photosensitivity, ↓ folate | give folic acid; ↑ fluids; stains urine orange |
| corticosteroids (prednisone, budesonide) | acute FLARES only — not maintenance | systemic anti-inflammatory; budesonide targets ileum | hyperglycemia, K⁺ ↓, infection, bone loss | taper slowly; short-term use; monitor glucose |
| azathioprine / 6-MP | steroid-sparing maintenance, Crohn's & UC | immunomodulator — suppresses lymphocytes | BONE MARROW suppression; check CBC, LFTs | slow onset 3–6 months; infection precautions |
| infliximab / adalimumab | moderate–severe or fistulizing Crohn's, UC | anti-TNF biologic: infliximab IV, adalimumab SC | serious infection, latent TB reactivation, infusion reaction | SCREEN for TB before first dose; no live vaccines |
| pancrelipase | chronic pancreatitis, CF — fat malabsorption | replaces lipase, protease, amylase | monitor stools, weight, glucose | give WITH every meal and snack; do not crush |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Insulin | Onset | Peak | Duration | Appearance / route | Key nursing point |
|---|---|---|---|---|---|
| lispro / aspart (rapid) | 10–30 min | 30 min–3 hr | 3–5 hr | clear; SC only | eat WITHIN 15 min of dose |
| regular (short) | 30 min–1 hr | 2–5 hr | 5–8 hr | clear; ONLY insulin given IV | used in DKA drips; give 30 min before meal |
| NPH (intermediate) | 1.5–4 hr | 4–12 hr | 12–18 hr | cloudy; SC only, roll to mix | when mixing, draw clear BEFORE cloudy |
| glargine / detemir (long) | 1–2 hr | NO true peak (flat) | up to 24 hr | clear; SC only | never mix or dilute with other insulins |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug / class | Action | Hypoglycemia alone? | Key adverse effect | Key teaching |
|---|---|---|---|---|
| metformin (biguanide) | ↓ hepatic glucose, ↑ insulin sensitivity | no (rare alone) | GI upset; lactic acidosis (rare) | HOLD 48 hr after contrast dye |
| glipizide / glyburide (sulfonylurea) | ↑ insulin release from beta cells | YES — highest risk | hypoglycemia, weight gain | take 30 min before meal; avoid alcohol |
| sitagliptin (DPP-4, -gliptin) | ↑ incretins → ↑ insulin, ↓ glucagon | no alone | pancreatitis risk; headache, joint pain | report SEVERE persistent abdominal pain |
| empagliflozin (SGLT2, -flozin) | ↑ glucose excretion in urine | no alone | YEAST/GU infections, dehydration, euglycemic DKA | perineal hygiene; ↑ fluids; watch orthostatic BP |
| liraglutide / semaglutide (GLP-1, -tide) | ↑ incretin, slows gastric emptying | no alone (↑ risk with SU/insulin) | N/V, weight loss, pancreatitis | MOST given SC, not oral; avoid if medullary thyroid CA history |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug | Class / use | Labs & monitoring | Major adverse effect | Key teaching |
|---|---|---|---|---|
| levothyroxine | T4 replacement — hypothyroid | TSH (goal normal), free T4, HR | s/s hyperthyroid: tachycardia, insomnia, wt loss | take on EMPTY stomach, AM, before food |
| methimazole / PTU | antithyroid — Graves, hyperthyroid | CBC, LFTs, T3/T4 ↓ over weeks | AGRANULOCYTOSIS — report sore throat, fever | lifelong or pre-thyroidectomy; PTU used in 1st trimester |
| prednisone | glucocorticoid — anti-inflammatory | glucose ↑, K⁺ ↓, WBC ↑, weight | infection, hyperglycemia, osteoporosis, Cushingoid | NEVER stop abruptly — taper; take with food |
| fludrocortisone | mineralocorticoid — Addison's | BP, DAILY weight, Na⁺ ↑, K⁺ ↓ | edema, HTN, hypokalemia | report weight gain >2 lb/day or swelling |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug | Class / relative strength | Main use | Signature adverse effect | Antidote | Key nursing point |
|---|---|---|---|---|---|
| morphine | opioid agonist — reference standard | severe acute pain, MI, pulmonary edema | resp depression, constipation, hypotension | naloxone | HOLD IF RR <12 |
| hydromorphone | opioid — ~7× STRONGER THAN MORPHINE | severe pain, opioid-tolerant pts | resp depression, sedation | naloxone | small doses; double-check decimal point |
| fentanyl | opioid — ~100× STRONGER THAN MORPHINE | patch for chronic pain; IV periop | resp depression, sedation | naloxone | patch: avoid heat — heat increases absorption |
| acetaminophen | non-opioid analgesic / antipyretic | mild–mod pain, fever | MAX 4 G/DAY — HEPATOTOXIC | acetylcysteine | check combo products for hidden doses |
| NSAIDs (ibuprofen/ketorolac) | NSAID — blocks prostaglandins | pain + inflammation; ketorolac short-term | GI bleed, renal injury, bleeding risk | none | KETOROLAC MAX 5 DAYS; give with food |
| muscle relaxant (cyclobenzaprine/baclofen) | central-acting — relieves spasm | muscle spasm; baclofen for spasticity | drowsiness, dizziness, dry mouth | none | DO NOT STOP BACLOFEN ABRUPTLY; no alcohol |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
🔍
| Drug | Class / coverage | PCN allergy cross-reactivity | Signature adverse effect | Infusion / admin safety | Monitor |
|---|---|---|---|---|---|
| amoxicillin | penicillin — strep, otitis, dental ppx | TRUE PCN ALLERGY — AVOID ALL PCNs | rash, diarrhea, anaphylaxis | PO; take with food if GI upset | rash, wheeze, throat swelling |
| cefazolin | 1st-gen cephalosporin — gram+, skin | low (~1%); ok if rash-only hx | diarrhea, C. diff | SURGICAL PPX: GIVE WITHIN 60 MIN OF INCISION | renal fx, allergy s/sx |
| ceftriaxone | 3rd-gen cephalosporin — crosses BBB | low; avoid if PCN anaphylaxis hx | biliary sludge, C. diff | NEVER MIX WITH CALCIUM / LR | LFTs, stool changes |
| vancomycin | not a beta-lactam — glycopeptide, MRSA | none — safe in PCN allergy | nephrotoxic, ototoxic | INFUSE OVER 60 MIN OR MORE — RED MAN | trough before 4th dose, BUN/creat, hearing |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
| Drug | Class / main use | Signature adverse effect | Don't take with | Key nursing point |
|---|---|---|---|---|
| ciprofloxacin | fluoroquinolone — UTI, GI, resp | ACHILLES TENDON RUPTURE | antacids, dairy, Ca/Fe/Zn — chelation | separate 2–6 h; QT risk; report tendon pain |
| gentamicin | aminoglycoside — serious gram− infections | OTOTOXIC — tinnitus, hearing loss | loop diuretics, vancomycin, other nephrotoxins | peak & trough levels; watch creatinine |
| doxycycline | tetracycline — Lyme, acne, chlamydia | photosensitivity, esophagitis | dairy, antacids, iron, calcium | AVOID IN PREGNANCY & UNDER 8 YRS — TEETH |
| azithromycin | macrolide — atypical PNA, chlamydia | QT PROLONGATION | antacids, other QT-prolonging drugs | alt for PCN allergy; watch ECG, GI upset |
| metronidazole | anaerobes, C. diff, trich, BV | metallic taste, dark urine, neuropathy | ALCOHOL — DISULFIRAM REACTION | no alcohol during + 3 days after; treat partner |
| nitrofurantoin | urinary anti-infective — uncomplicated UTI | HARMLESS BROWN URINE | magnesium antacids | take with food; avoid in renal impairment |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Onset / duration | Main use | Signature risk | Antidote | Key nursing point |
|---|---|---|---|---|---|
| lorazepam | intermediate onset, moderate duration | status epilepticus, alcohol withdrawal, anxiety | resp depression, oversedation | flumazenil | FIRST-LINE FOR ALCOHOL WITHDRAWAL |
| diazepam | fast onset, long acting (active metabolites) | seizures, muscle spasm, withdrawal | ACCUMULATES IN ELDERLY — FALLS | flumazenil | on Beers list; push slow, do not mix in line |
| midazolam | very fast onset, short duration | procedural sedation, induction | apnea, respiratory arrest | flumazenil | NEVER LEAVE PT UNMONITORED; airway at bedside |
| alprazolam | fast onset, short acting | panic disorder, anxiety | high dependence, rebound anxiety | flumazenil | TAPER — ABRUPT STOP CAUSES SEIZURES |
| buspirone | TAKES 2–4 WEEKS — NOT PRN | chronic generalized anxiety | dizziness, headache; no dependence | none | avoid grapefruit; not for acute anxiety |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
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| Drug | Used for | IV administration rule | Monitor | Key nursing point |
|---|---|---|---|---|
| potassium chloride (K⁺) | hypokalemia | NEVER IV push — dilute, always use pump | ECG, K⁺ level, urine output | PO form with food; never crush ER tabs |
| calcium gluconate (Ca²⁺) | hypocalcemia; stabilizes heart in hyperkalemia | slow IV push/infusion; vesicant — check patency | ECG, Ca²⁺, Chvostek/Trousseau signs | ANTIDOTE for magnesium toxicity; caution with digoxin |
| magnesium sulfate (Mg²⁺) | hypomagnesemia, preeclampsia, torsades | dilute and infuse by pump; never rapid bolus | LOSS of deep tendon reflexes = toxicity | also watch RR <12, ↓ urine output, ↓ LOC |
| sodium bicarbonate | metabolic acidosis; hyperkalemia (shifts K⁺ in) | flush line — INCOMPATIBLE with calcium | ABGs, Na⁺, K⁺, signs of fluid overload | extravasation causes tissue necrosis; watch alkalosis |
| sodium polystyrene sulfonate | hyperkalemia — removes K⁺ via stool | NEVER given IV — PO or retention enema only | K⁺ level, bowel sounds, stooling | hold if ileus or obstruction; expect diarrhea |
💡 Swipe sideways on a phone to see all the columns. The ALL-CAPS bit in each row is the part exams love to test.
🔍
Exams love these as one-liners: “a client is over-sedated on morphine — which medication does the nurse anticipate?” Learn the pair first, then the nursing point.
| Drug / toxin | Antidote | How it works | Key nursing point |
|---|---|---|---|
| Opioids — morphine, hydromorphone, fentanyl, heroin | Naloxone (Narcan) | Knocks the opioid off the mu receptor (competitive antagonist) | SHORT half-life — sedation can come BACK; keep monitoring RR. Precipitates instant withdrawal + severe pain. |
| Benzodiazepines — lorazepam, diazepam, midazolam | Flumazenil | Competitive antagonist at the benzo receptor | Can trigger SEIZURES in chronic users or TCA co-ingestion — airway equipment at bedside. |
| Acetaminophen (Tylenol) | Acetylcysteine (Mucomyst) | Restores glutathione so the liver can detox the toxic metabolite | Best WITHIN 8–10 hr of ingestion. Smells like rotten eggs — dilute in juice, use a straw. Monitor LFTs. |
| Heparin (unfractionated) | Protamine sulfate | Binds heparin and neutralizes it | Give SLOW IV push — fast push → hypotension, bradycardia, anaphylaxis. |
| Enoxaparin (LMWH) | Protamine sulfate — PARTIAL only | Neutralizes some anti-Xa activity | Only about 60% reversal — do NOT expect full correction. |
| Warfarin | Vitamin K (phytonadione) ± FFP or PCC | Restores vitamin-K–dependent clotting factors | Vitamin K takes HOURS. Active bleeding → FFP/PCC for immediate effect. Follow the INR. |
| Digoxin | Digoxin immune Fab (DigiFab) | Antibody that binds circulating digoxin | Given for severe toxicity or K⁺ >5 with symptoms. Digoxin LEVELS become unreliable afterward. |
| Magnesium sulfate | Calcium gluconate | Calcium opposes magnesium at the neuromuscular junction | First sign of Mg toxicity = LOSS OF DEEP TENDON REFLEXES, then RR <12, then ↓ urine output. |
| Insulin / hypoglycemia | Dextrose 50% (D50) IV — or glucagon | Raises blood glucose directly | No IV access → GLUCAGON IM/SC. Recheck glucose in 15 min; give complex carb + protein once awake. |
| Beta blocker overdose | Glucagon | Bypasses the blocked beta receptor and raises cAMP anyway | GLUCAGON is the answer for beta blockers — plus atropine, fluids, and pacing as needed. |
| Calcium channel blocker overdose | Calcium chloride / calcium gluconate | Floods the cell with calcium to overcome the block | CALCIUM for CCB — pair it with the beta blocker/glucagon rule so you don't mix them up. |
| Benzodiazepine vs opioid — which reversal? | Flumazenil = benzo · Naloxone = opioid | Two different receptors, two different drugs | Memory hook: FLUmazenil → FLUnitrazepam/benzos. NALoxone → NARcotics. |
| Drug / toxin | Antidote | How it works | Key nursing point |
|---|---|---|---|
| Malignant hyperthermia (succinylcholine + inhaled anesthetics) | Dantrolene | Blocks calcium release from the sarcoplasmic reticulum → muscle relaxes | Reconstitute with STERILE WATER only. Earliest sign is ↑ end-tidal CO₂ — before the temp spikes. |
| Organophosphate / insecticide / nerve agent (cholinergic crisis) | Atropine + pralidoxime | Atropine blocks muscarinic receptors; pralidoxime reactivates the enzyme | Look for SLUDGE (salivation, lacrimation, urination, defecation, GI cramps, emesis). Titrate atropine until secretions dry up. |
| Anticholinergic overdose — atropine, TCAs, antihistamines | Physostigmine | Raises acetylcholine to overcome the blockade | Classic picture: hot as a hare, dry as a bone, red as a beet, MAD AS A HATTER, blind as a bat. |
| Nondepolarizing neuromuscular blockers — rocuronium, vecuronium | Neostigmine (+ glycopyrrolate) or sugammadex | Raises acetylcholine at the neuromuscular junction | Always paired with an ANTICHOLINERGIC (glycopyrrolate/atropine) to block the bradycardia it would cause. |
| Cyanide — including smoke inhalation from a house fire | Hydroxocobalamin (or nitrites + sodium thiosulfate) | Binds cyanide and lets the kidneys excrete it | Turns urine and skin RED — expected, not an allergic reaction. |
| Tricyclic antidepressants (TCAs) | Sodium bicarbonate | Alkalinizes the blood and narrows the QRS | WIDENED QRS on the ECG is the marker of serious TCA toxicity. |
| Iron | Deferoxamine | Chelates iron so it can be excreted | Urine turns reddish / 'vin rosé' — expected and a sign it's working. |
| Ethylene glycol (antifreeze) / methanol | Fomepizole (or ethanol) | Blocks alcohol dehydrogenase so the toxic metabolite is never made | Dialysis for severe cases. Watch the anion gap and the ABGs. |
| Lead | Succimer, EDTA, or dimercaprol | Chelates lead for excretion | Screen the environment too — the source is usually pre-1978 paint or dust. |
| Methotrexate | Leucovorin ('leucovorin rescue') | Supplies the folate the drug blocked | Timing matters — give exactly on schedule or the rescue fails. |
| Dabigatran (DOAC) | Idarucizumab | Monoclonal antibody that binds dabigatran | Specific to dabigatran — not the -xaban drugs. |
| Apixaban / rivaroxaban (DOAC) | Andexanet alfa | Decoy factor Xa that soaks up the drug | Specific to the -xaban drugs — not dabigatran. |
| Thrombolytic (tPA) bleeding | Aminocaproic acid | Stops the clot breakdown the drug started | STOP THE INFUSION first, then treat. Apply pressure; type and cross. |
| Hyperkalemia (not a drug, but same emergency logic) | Calcium gluconate FIRST | Calcium stabilizes the cardiac membrane — it does NOT lower K⁺ | Order: CALCIUM → insulin + glucose → albuterol → Kayexalate/Lokelma → dialysis. ECG: peaked T waves → wide QRS. |
These show up less often, but Dantrolene, atropine + pralidoxime, and the DOAC reversals are the ones most likely to appear on an ATI or the NCLEX.
| Drug | Don't confuse with | Why it matters |
|---|---|---|
| hydrOXYzine | hydrALAZINE | Antihistamine vs antihypertensive |
| metFORMIN | metroNIDAZOLE | Antidiabetic vs antibiotic |
| HumaLOG | HumuLIN | Rapid insulin vs NPH/regular |
| NovoLOG | NovoLIN | Rapid insulin vs regular/NPH |
| glipiZIDE | glyBURIDE | Both sulfonylureas — different doses |
| cloNIDine | clonazePAM (Klonopin) | Antihypertensive vs benzodiazepine |
| DIGoxin | doxepin | Cardiac glycoside vs antidepressant |
| HEParin | HESpan | Anticoagulant vs volume expander |
| LASix (furosemide) | Losec (omeprazole) | Loop diuretic vs PPI |
| celeBREX | celeXA | NSAID vs antidepressant |
| predniSONE | predniSOLONE | Both steroids — verify formulation |
| morphine | hydromorphone (Dilaudid) | Hydromorphone is ~7× more potent — verify dose |