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 28 drugs at a glance

Drug by drug

Digoxin

Cardiac glycoside

Used for. Heart failure, atrial fibrillation rate control

Adverse effects. Bradycardia, nausea, anorexia, yellow-green or halo vision, dysrhythmias

Nursing considerations. Count apical pulse for a full minute and hold if under 60 in an adult. Low potassium potentiates toxicity, so check the level before giving.

Furosemide

Loop diuretic

Used for. Pulmonary oedema, heart failure, oedema

Adverse effects. Hypokalaemia, hypotension, ototoxicity, dehydration

Nursing considerations. Give IV push slowly, weigh daily, monitor potassium and hearing. Dose in the morning to protect sleep.

Spironolactone

Potassium-sparing diuretic

Used for. Heart failure, ascites, hyperaldosteronism

Adverse effects. Hyperkalaemia, gynaecomastia, menstrual irregularity

Nursing considerations. Teach the client to avoid salt substitutes, which are potassium chloride.

Metoprolol

Beta-1 selective blocker

Used for. Hypertension, angina, post-myocardial infarction, heart failure

Adverse effects. Bradycardia, fatigue, hypotension, masked hypoglycaemia signs

Nursing considerations. Hold for a heart rate under 60 or systolic under 100. Never stop abruptly, as rebound angina can follow.

Lisinopril

ACE inhibitor

Used for. Hypertension, heart failure, renal protection in diabetes

Adverse effects. Dry persistent cough, hyperkalaemia, angioedema, first-dose hypotension

Nursing considerations. Angioedema is an emergency and means the drug is stopped permanently. Contraindicated in pregnancy.

Losartan

Angiotensin II receptor blocker

Used for. Hypertension when an ACE inhibitor causes cough

Adverse effects. Hyperkalaemia, dizziness

Nursing considerations. Same pregnancy contraindication as ACE inhibitors, but far less cough.

Amlodipine

Calcium channel blocker (dihydropyridine)

Used for. Hypertension, angina

Adverse effects. Peripheral oedema, headache, flushing, reflex tachycardia

Nursing considerations. Teach the client to avoid grapefruit juice and to rise slowly.

Nitroglycerin

Nitrate vasodilator

Used for. Angina, acute coronary syndrome

Adverse effects. Headache, hypotension, dizziness

Nursing considerations. Sublingual every five minutes up to three doses; call emergency services if pain persists after the first dose. Never combine with erectile dysfunction drugs.

Atorvastatin

HMG-CoA reductase inhibitor

Used for. Hyperlipidaemia, cardiovascular risk reduction

Adverse effects. Myalgia, rhabdomyolysis, raised liver enzymes

Nursing considerations. Report unexplained muscle pain with dark urine at once. Monitor liver function.

Amiodarone

Class III antidysrhythmic

Used for. Ventricular and atrial dysrhythmias

Adverse effects. Pulmonary fibrosis, thyroid dysfunction, corneal deposits, blue-grey skin, bradycardia

Nursing considerations. Baseline and periodic chest imaging, thyroid and liver studies. Use a filter for IV infusion.

Adenosine

Antidysrhythmic

Used for. Terminating supraventricular tachycardia

Adverse effects. Brief asystole, flushing, chest tightness

Nursing considerations. Rapid IV push over 1 – 2 seconds into a proximal site followed by a fast saline flush. Warn the client about a few seconds of chest discomfort.

Heparin

Anticoagulant

Used for. Venous thromboembolism, acute coronary syndrome, dialysis circuits

Adverse effects. Bleeding, heparin-induced thrombocytopenia

Nursing considerations. Follow aPTT with a therapeutic range of 1.5 – 2.5 times control. Watch the platelet count. Do not aspirate or massage subcutaneous injections.

Enoxaparin

Low molecular weight heparin

Used for. Deep vein thrombosis prevention and treatment

Adverse effects. Bleeding, injection site haematoma

Nursing considerations. Give deep subcutaneously in the abdomen and do not expel the air bubble in the prefilled syringe. Routine aPTT monitoring is not required.

Warfarin

Vitamin K antagonist

Used for. Atrial fibrillation, mechanical valves, recurrent thromboembolism

Adverse effects. Bleeding, purple toe syndrome

Nursing considerations. Follow the INR. Teach a consistent, not zero, vitamin K intake. Many drug interactions.

Clopidogrel

Antiplatelet

Used for. Post-stent, stroke and myocardial infarction prevention

Adverse effects. Bleeding, bruising

Nursing considerations. Hold before surgery as directed and teach the client to report black stools.

Alteplase

Thrombolytic

Used for. Ischaemic stroke, massive pulmonary embolism, myocardial infarction

Adverse effects. Major haemorrhage, intracranial bleeding

Nursing considerations. Screen the bleeding-risk exclusions carefully and confirm the symptom onset time before giving.

Regular insulin

Short-acting insulin

Used for. Hyperglycaemia, diabetic ketoacidosis (IV)

Adverse effects. Hypoglycaemia, hypokalaemia

Nursing considerations. The only insulin given IV. Onset around 30 minutes, peak 2 – 4 hours. When mixing, draw clear before cloudy.

Insulin glargine

Long-acting insulin

Used for. Basal glycaemic control

Adverse effects. Hypoglycaemia, injection site changes

Nursing considerations. No pronounced peak, so it is never mixed with another insulin in the same syringe.

Metformin

Biguanide

Used for. Type 2 diabetes

Adverse effects. GI upset, lactic acidosis (rare), B12 deficiency

Nursing considerations. Hold before and for 48 hours after iodinated contrast. Contraindicated in significant renal impairment.

Levothyroxine

Thyroid hormone

Used for. Hypothyroidism

Adverse effects. Tachycardia, weight loss, insomnia, tremor if overdosed

Nursing considerations. Take in the morning on an empty stomach, separated from calcium, iron and antacids. Lifelong therapy.

Propylthiouracil

Antithyroid agent

Used for. Hyperthyroidism, thyroid storm

Adverse effects. Agranulocytosis, hepatotoxicity, rash

Nursing considerations. Report sore throat or fever immediately, as these may signal agranulocytosis.

Prednisone

Corticosteroid

Used for. Inflammation, autoimmune disease, transplant, asthma exacerbation

Adverse effects. Hyperglycaemia, infection risk, osteoporosis, mood change, Cushingoid features

Nursing considerations. Give with food, never stop abruptly, and monitor glucose and weight. Masks signs of infection.

Desmopressin

Vasopressin analogue

Used for. Diabetes insipidus, nocturnal enuresis

Adverse effects. Water intoxication, hyponatraemia, headache

Nursing considerations. Monitor sodium, daily weight and urine output.

Morphine

Opioid agonist

Used for. Severe pain, myocardial infarction, pulmonary oedema

Adverse effects. Respiratory depression, sedation, constipation, urinary retention, pruritus

Nursing considerations. Assess respiratory rate before and after. Constipation is the one effect that never develops tolerance, so start a bowel regimen early.

Hydromorphone

Opioid agonist

Used for. Severe pain

Adverse effects. Respiratory depression, sedation, constipation

Nursing considerations. Considerably more potent per milligram than morphine, so double-check the dose.

Acetaminophen

Non-opioid analgesic and antipyretic

Used for. Mild to moderate pain, fever

Adverse effects. Hepatotoxicity in overdose

Nursing considerations. Cap the total adult intake at 4 g in 24 hours, and lower with liver disease or alcohol use. Check combination products for hidden acetaminophen.

Ibuprofen

NSAID

Used for. Pain, inflammation, fever

Adverse effects. GI bleeding, renal impairment, raised blood pressure

Nursing considerations. Give with food, monitor renal function, and avoid combining with other NSAIDs or anticoagulants.

Naloxone

Opioid antagonist

Used for. Opioid-induced respiratory depression

Adverse effects. Acute withdrawal, pain rebound, agitation

Nursing considerations. Shorter half-life than most opioids, so keep monitoring for re-sedation and be ready to redose.

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