NCLEX Pharmacology Flashcards
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How to run these cards
Work in one direction first: read the front, say the answer out loud, then open the card. Saying it out loud is not a gimmick — recognising an answer and producing one are different skills, and the exam only rewards the second. Anything you get wrong goes into a pile you repeat at the end of the session, then again the next day.
Do not run a deck front-to-back every time. Order is itself a memory cue, so a deck you always run in sequence will feel mastered and then fall apart inside a mixed practice test.
Pharmacology
Classes, parameters, adverse effects and the antidotes worth memorising.
25 cards — 13 easy, 12 medium.
What must the nurse check before administering digoxin?
Apical pulse for one full minute; hold if under 60 in an adult. Also check the serum potassium.
Hypokalaemia sharply increases the risk of digoxin toxicity, so the potassium is as important as the pulse.
Antidote for heparin?
Protamine sulfate
Heparin is monitored with the aPTT, therapeutic at 1.5 to 2.5 times control.
Antidote for warfarin?
Vitamin K (phytonadione)
Warfarin is monitored with the PT and INR, usually targeting 2 to 3.
Antidote for acetaminophen overdose?
Acetylcysteine
The adult ceiling is 4 g in 24 hours, lower with liver disease or alcohol use.
Antidote for magnesium sulfate toxicity?
Calcium gluconate
Stop the infusion first, then give the antidote. Hold for absent reflexes, respirations under 12, or urine under 30 mL/hour.
Which insulin can be given intravenously?
Regular insulin only
It is also the only one whose onset and peak make it suitable for a titrated infusion in ketoacidosis.
Order for drawing up regular and NPH insulin in one syringe?
Air into cloudy, air into clear, draw clear, draw cloudy.
Clear before cloudy prevents contaminating the regular insulin vial with suspension.
What does the suffix -pril tell you?
ACE inhibitor: dry cough, hyperkalaemia, angioedema, contraindicated in pregnancy.
Angioedema is an emergency and permanently rules out the class.
What does the suffix -olol tell you?
Beta blocker: hold for heart rate under 60 or systolic under 100, never stop abruptly.
In diabetes, beta blockers mask the adrenergic warning signs of hypoglycaemia except sweating.
Key teaching for an inhaled corticosteroid?
Rinse the mouth after every dose to prevent oral candidiasis. It is a controller, never a rescue.
When paired with a bronchodilator, the bronchodilator goes first.
Why is pyridoxine given with isoniazid?
To prevent peripheral neuropathy.
Isoniazid also carries hepatotoxicity risk, so alcohol is avoided and liver enzymes are monitored.
What turns body fluids orange?
Rifampin
It also permanently stains soft contact lenses and reduces oral contraceptive effectiveness.
Therapeutic lithium range, and what raises the level?
0.6 to 1.2 mEq/L. Dehydration, low sodium, NSAIDs and thiazides all raise it.
Toxicity starts with nausea, coarse tremor and diarrhoea, progressing to ataxia and confusion.
Foods to avoid on an MAO inhibitor?
Aged cheese, cured and smoked meats, tap beer, soy sauce, fermented foods, overripe fruit.
Tyramine triggers a hypertensive crisis with severe occipital headache.
Why is potassium never given IV push?
It causes cardiac arrest. It must be diluted and infused on a pump.
Confirm adequate urine output before replacing potassium, since it is renally excreted.
Teaching for alendronate?
Take on rising with a full glass of plain water and stay upright for at least 30 minutes.
This prevents oesophagitis, the main adverse effect of oral bisphosphonates.
When is metformin held around contrast studies?
Before the study and for 48 hours after.
Contrast-related renal impairment raises the risk of lactic acidosis.
Signs of serotonin syndrome?
Agitation, hyperthermia, tremor, diaphoresis, hyperreflexia, diarrhoea.
Usually follows adding a second serotonergic agent. Stop the drugs and support the client.
Why must vancomycin be infused over at least 60 minutes?
To prevent the flushing reaction of the face and torso from rapid histamine release.
This is rate-related, not a true allergy. Monitor troughs and renal function too.
What is the safest intramuscular injection site in an adult?
Ventrogluteal
It is away from major nerves and vessels. Vastus lateralis is preferred for infants.
Which medication forms must never be crushed?
Enteric-coated, extended or sustained release, and sublingual.
Crushing an extended-release tablet delivers the entire dose at once.
Adverse effect that never develops tolerance with opioids?
Constipation
Start a bowel regimen at the same time as the opioid.
Why keep monitoring after giving naloxone?
Naloxone has a shorter half-life than most opioids, so re-sedation can occur.
Be prepared to redose and to support ventilation.
Fluoroquinolone red flags?
Tendon pain or rupture, QT prolongation, photosensitivity, C. difficile.
Separate from antacids, calcium, iron and dairy by at least two hours.
Prefilled enoxaparin syringe technique?
Do not expel the air bubble, do not aspirate, do not massage the site.
The bubble ensures the full dose is delivered and helps seal the tract.
What these cards cover
These 25 cards sit across 6 topics in the test plan. If a whole topic keeps coming back wrong, the problem is the underlying content rather than the recall — go and read that topic before you run the deck again.
| Topic | Focus | Cards | Client need category |
|---|---|---|---|
| Cardiovascular Medications | Digoxin, beta blockers, ACE inhibitors and nitrates | 3 | Pharmacological and Parenteral Therapies |
| Anticoagulants and Antiplatelets | Monitoring, antidotes and bleeding precautions | 3 | Pharmacological and Parenteral Therapies |
| Pain Management and Sedation | Opioids, adjuncts and monitoring | 3 | Pharmacological and Parenteral Therapies |
| Medication Administration | Routes, rights and high-alert handling | 9 | Pharmacological and Parenteral Therapies |
| Anti-Infective Therapy | Antibiotics, antifungals, antivirals and antitubercular drugs | 4 | Pharmacological and Parenteral Therapies |
| Psychotropic Medications | Antidepressants, mood stabilisers and antipsychotics | 3 | Pharmacological and Parenteral Therapies |
Printable answer key
The same 25 cards laid flat, for revision on paper or a last pass the night before. Cover the right-hand columns with a sheet and work down.
| Prompt | Answer | Why it matters |
|---|---|---|
| What must the nurse check before administering digoxin? | Apical pulse for one full minute; hold if under 60 in an adult. Also check the serum potassium. | Hypokalaemia sharply increases the risk of digoxin toxicity, so the potassium is as important as the pulse. |
| Antidote for heparin? | Protamine sulfate | Heparin is monitored with the aPTT, therapeutic at 1.5 to 2.5 times control. |
| Antidote for warfarin? | Vitamin K (phytonadione) | Warfarin is monitored with the PT and INR, usually targeting 2 to 3. |
| Antidote for acetaminophen overdose? | Acetylcysteine | The adult ceiling is 4 g in 24 hours, lower with liver disease or alcohol use. |
| Antidote for magnesium sulfate toxicity? | Calcium gluconate | Stop the infusion first, then give the antidote. Hold for absent reflexes, respirations under 12, or urine under 30 mL/hour. |
| Which insulin can be given intravenously? | Regular insulin only | It is also the only one whose onset and peak make it suitable for a titrated infusion in ketoacidosis. |
| Order for drawing up regular and NPH insulin in one syringe? | Air into cloudy, air into clear, draw clear, draw cloudy. | Clear before cloudy prevents contaminating the regular insulin vial with suspension. |
| What does the suffix -pril tell you? | ACE inhibitor: dry cough, hyperkalaemia, angioedema, contraindicated in pregnancy. | Angioedema is an emergency and permanently rules out the class. |
| What does the suffix -olol tell you? | Beta blocker: hold for heart rate under 60 or systolic under 100, never stop abruptly. | In diabetes, beta blockers mask the adrenergic warning signs of hypoglycaemia except sweating. |
| Key teaching for an inhaled corticosteroid? | Rinse the mouth after every dose to prevent oral candidiasis. It is a controller, never a rescue. | When paired with a bronchodilator, the bronchodilator goes first. |
| Why is pyridoxine given with isoniazid? | To prevent peripheral neuropathy. | Isoniazid also carries hepatotoxicity risk, so alcohol is avoided and liver enzymes are monitored. |
| What turns body fluids orange? | Rifampin | It also permanently stains soft contact lenses and reduces oral contraceptive effectiveness. |
| Therapeutic lithium range, and what raises the level? | 0.6 to 1.2 mEq/L. Dehydration, low sodium, NSAIDs and thiazides all raise it. | Toxicity starts with nausea, coarse tremor and diarrhoea, progressing to ataxia and confusion. |
| Foods to avoid on an MAO inhibitor? | Aged cheese, cured and smoked meats, tap beer, soy sauce, fermented foods, overripe fruit. | Tyramine triggers a hypertensive crisis with severe occipital headache. |
| Why is potassium never given IV push? | It causes cardiac arrest. It must be diluted and infused on a pump. | Confirm adequate urine output before replacing potassium, since it is renally excreted. |
| Teaching for alendronate? | Take on rising with a full glass of plain water and stay upright for at least 30 minutes. | This prevents oesophagitis, the main adverse effect of oral bisphosphonates. |
| When is metformin held around contrast studies? | Before the study and for 48 hours after. | Contrast-related renal impairment raises the risk of lactic acidosis. |
| Signs of serotonin syndrome? | Agitation, hyperthermia, tremor, diaphoresis, hyperreflexia, diarrhoea. | Usually follows adding a second serotonergic agent. Stop the drugs and support the client. |
| Why must vancomycin be infused over at least 60 minutes? | To prevent the flushing reaction of the face and torso from rapid histamine release. | This is rate-related, not a true allergy. Monitor troughs and renal function too. |
| What is the safest intramuscular injection site in an adult? | Ventrogluteal | It is away from major nerves and vessels. Vastus lateralis is preferred for infants. |
| Which medication forms must never be crushed? | Enteric-coated, extended or sustained release, and sublingual. | Crushing an extended-release tablet delivers the entire dose at once. |
| Adverse effect that never develops tolerance with opioids? | Constipation | Start a bowel regimen at the same time as the opioid. |
| Why keep monitoring after giving naloxone? | Naloxone has a shorter half-life than most opioids, so re-sedation can occur. | Be prepared to redose and to support ventilation. |
| Fluoroquinolone red flags? | Tendon pain or rupture, QT prolongation, photosensitivity, C. difficile. | Separate from antacids, calcium, iron and dairy by at least two hours. |
| Prefilled enoxaparin syringe technique? | Do not expel the air bubble, do not aspirate, do not massage the site. | The bubble ensures the full dose is delivered and helps seal the tract. |
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