How to read a drug for the exam

Almost nobody fails pharmacology items for not knowing what a drug is for. They fail on the nursing column — the parameter you check before you give it, the number that makes you hold it, and the finding that means stop and call. Learn drugs in that order and a class you have never seen becomes answerable from its family resemblance.

Where a drug has an antidote, learn the pair as a pair. Reversal agents are cheap marks and they come up in emergency items where you have no time to reason from first principles.

All 32 drugs at a glance

Drug by drug

Vancomycin

Glycopeptide antibiotic

Used for. MRSA and other resistant gram-positive infection

Adverse effects. Nephrotoxicity, ototoxicity, infusion reaction with flushing

Nursing considerations. Infuse over at least 60 minutes to avoid the flushing reaction. Follow trough levels and renal function.

Gentamicin

Aminoglycoside

Used for. Serious gram-negative infection

Adverse effects. Nephrotoxicity, ototoxicity, neuromuscular blockade

Nursing considerations. Monitor peak and trough levels, creatinine and hearing. Ensure good hydration.

Ceftriaxone

Third-generation cephalosporin

Used for. Pneumonia, meningitis, pyelonephritis, gonorrhoea

Adverse effects. Diarrhoea, rash, rare cross-reaction in penicillin allergy

Nursing considerations. Do not mix with calcium-containing solutions in neonates.

Ciprofloxacin

Fluoroquinolone

Used for. Urinary tract and GI infection

Adverse effects. Tendon rupture, QT prolongation, photosensitivity, C. difficile

Nursing considerations. Separate from antacids, calcium, iron and dairy by at least two hours. Report new tendon pain.

Isoniazid

Antitubercular

Used for. Active and latent tuberculosis

Adverse effects. Peripheral neuropathy, hepatotoxicity

Nursing considerations. Give pyridoxine (vitamin B6) to prevent neuropathy. Avoid alcohol and monitor liver enzymes.

Rifampin

Antitubercular

Used for. Tuberculosis regimens

Adverse effects. Orange discoloration of body fluids, hepatotoxicity, many drug interactions

Nursing considerations. Warn about permanently stained soft contact lenses and reduced oral contraceptive effectiveness.

Metronidazole

Antiprotozoal and antibacterial

Used for. C. difficile, trichomoniasis, anaerobic infection

Adverse effects. Metallic taste, nausea, disulfiram-like reaction with alcohol

Nursing considerations. No alcohol during therapy and for three days after the last dose.

Albuterol

Short-acting beta-2 agonist

Used for. Acute bronchospasm, asthma rescue

Adverse effects. Tachycardia, tremor, nervousness, hypokalaemia

Nursing considerations. Rescue inhaler; use before the corticosteroid inhaler when both are due.

Fluticasone (inhaled)

Inhaled corticosteroid

Used for. Asthma and COPD maintenance

Adverse effects. Oral candidiasis, hoarseness

Nursing considerations. Rinse the mouth after every dose. This is a controller, never a rescue medication.

Ipratropium

Anticholinergic bronchodilator

Used for. COPD maintenance

Adverse effects. Dry mouth, blurred vision

Nursing considerations. Caution in narrow-angle glaucoma and prostatic enlargement.

Montelukast

Leukotriene receptor antagonist

Used for. Asthma and allergic rhinitis prevention

Adverse effects. Neuropsychiatric events, headache

Nursing considerations. Take in the evening. Report mood or behaviour change.

Phenytoin

Anticonvulsant

Used for. Tonic-clonic and focal seizures

Adverse effects. Gingival hyperplasia, ataxia, nystagmus, rash

Nursing considerations. Mix IV only with normal saline and infuse slowly. Emphasise meticulous oral care. Narrow therapeutic level of 10 – 20 mcg/mL.

Levetiracetam

Anticonvulsant

Used for. Focal and generalised seizures

Adverse effects. Somnolence, irritability, behaviour change

Nursing considerations. Renal dose adjustment; minimal drug interactions.

Lithium carbonate

Mood stabiliser

Used for. Bipolar disorder

Adverse effects. Tremor, polyuria, thirst, weight gain, hypothyroidism; toxicity brings vomiting, ataxia and confusion

Nursing considerations. Keep sodium and fluid intake steady. Dehydration, low sodium and NSAIDs raise the level. Therapeutic range 0.6 – 1.2 mEq/L.

Haloperidol

First-generation antipsychotic

Used for. Acute psychosis, severe agitation

Adverse effects. Extrapyramidal symptoms, tardive dyskinesia, QT prolongation, neuroleptic malignant syndrome

Nursing considerations. Fever with rigidity and altered mental status is neuroleptic malignant syndrome and is a medical emergency.

Clozapine

Second-generation antipsychotic

Used for. Treatment-resistant schizophrenia

Adverse effects. Agranulocytosis, myocarditis, seizures, sedation, weight gain

Nursing considerations. Mandatory absolute neutrophil count monitoring. Report fever or sore throat immediately.

Sertraline

SSRI antidepressant

Used for. Depression, anxiety disorders, PTSD

Adverse effects. GI upset, sexual dysfunction, hyponatraemia, serotonin syndrome

Nursing considerations. Full effect takes 4 – 6 weeks. Watch for increased suicidal thinking early in treatment in young clients.

Phenelzine

MAO inhibitor antidepressant

Used for. Treatment-resistant depression

Adverse effects. Hypertensive crisis with tyramine, orthostatic hypotension

Nursing considerations. Strict tyramine-free diet: no aged cheese, cured meats, tap beer, soy sauce or overripe fruit.

Lorazepam

Benzodiazepine

Used for. Anxiety, status epilepticus, alcohol withdrawal

Adverse effects. Sedation, respiratory depression, dependence, falls in older adults

Nursing considerations. Avoid combining with alcohol or opioids. Taper rather than stopping abruptly.

Omeprazole

Proton pump inhibitor

Used for. GERD, peptic ulcer, stress ulcer prophylaxis

Adverse effects. Headache, B12 and magnesium depletion, raised fracture and C. difficile risk with long use

Nursing considerations. Take before the first meal of the day and swallow the capsule whole.

Ondansetron

5-HT3 antagonist antiemetic

Used for. Chemotherapy and post-operative nausea

Adverse effects. Headache, constipation, QT prolongation

Nursing considerations. Check the QT interval when combined with other QT-prolonging drugs.

Lactulose

Osmotic laxative

Used for. Constipation, hepatic encephalopathy

Adverse effects. Flatulence, cramping, dehydration

Nursing considerations. In encephalopathy the goal is two to three soft stools a day; falling ammonia and clearer thinking show it is working.

Docusate sodium

Stool softener

Used for. Preventing straining after myocardial infarction or surgery

Adverse effects. Mild cramping

Nursing considerations. Encourage fluid intake for it to work.

Magnesium sulfate

Anticonvulsant and tocolytic

Used for. Preeclampsia seizure prophylaxis, preterm labour

Adverse effects. Loss of deep tendon reflexes, respiratory depression, flushing

Nursing considerations. Stop the infusion for absent reflexes, respirations under 12 or urine output under 30 mL/hour.

Oxytocin

Uterotonic

Used for. Labour augmentation, postpartum haemorrhage

Adverse effects. Uterine tachysystole, water intoxication, fetal distress

Nursing considerations. Always give as a secondary infusion on a pump. Stop for contractions closer than every two minutes or lasting over 90 seconds.

Methylergonovine

Uterotonic

Used for. Postpartum haemorrhage

Adverse effects. Hypertension, headache, cramping

Nursing considerations. Check blood pressure before each dose; it is contraindicated in hypertension.

Betamethasone

Antenatal corticosteroid

Used for. Accelerating fetal lung maturity in preterm labour

Adverse effects. Maternal hyperglycaemia

Nursing considerations. Two doses 24 hours apart; benefit peaks 24 – 48 hours after the first dose.

Allopurinol

Xanthine oxidase inhibitor

Used for. Chronic gout, tumour lysis prevention

Adverse effects. Rash including severe hypersensitivity, GI upset

Nursing considerations. Encourage 2 – 3 L of fluid daily. Not for an acute gout attack.

Alendronate

Bisphosphonate

Used for. Osteoporosis

Adverse effects. Oesophagitis, osteonecrosis of the jaw

Nursing considerations. Take on rising with a full glass of plain water and stay upright for at least 30 minutes.

Cyclosporine

Calcineurin inhibitor immunosuppressant

Used for. Transplant rejection prevention

Adverse effects. Nephrotoxicity, hypertension, gum hyperplasia, infection risk

Nursing considerations. Monitor trough levels and creatinine. Avoid grapefruit juice and live vaccines.

Methotrexate

Antimetabolite

Used for. Rheumatoid arthritis, psoriasis, some cancers

Adverse effects. Bone marrow suppression, mucositis, hepatotoxicity, teratogenic

Nursing considerations. Given weekly, not daily, for arthritis. Folic acid reduces toxicity. Strict contraception is required.

Potassium chloride

Electrolyte replacement

Used for. Hypokalaemia

Adverse effects. Cardiac arrest if given too fast, vein irritation, GI upset

Nursing considerations. Never give IV push and never give undiluted. Dilute and infuse on a pump, generally no faster than 10 mEq/hour on a general unit.

Antidote pairs

Every drug on this page that has a named reversal agent, pulled into one list. These are worth knowing cold in both directions — the exam asks “what reverses X” and “why is Y at the bedside”.

More NCLEX practice and review

Everything on this site tagged NCLEX lives in the NCLEX category.

Sources

• NCSBN — NCLEX Test Plans (official blueprint and category weights)
• NCSBN — The NCLEX examination (official candidate information)
• DailyMed (US National Library of Medicine) — current drug labelling