NCLEX Pharmacology Outline for Nursing Students

Pharm is where a lot of points are won or lost on the NCLEX and nursing school exit exams. This outline goes system by system: the drug classes, examples, key nursing actions, and what to report. Read a system, then test yourself right away. Priority marks the points most likely to show up on exams.

Medication Administration and IV Therapy

Each system lists drug classes, examples, key nursing actions, and what to report.

Safety basics

• Rights of administration: right client, medication, dose, route, time, documentation, plus right to refuse, education, assessment, and evaluation.

• Identify the client with two identifiers (name and date of birth). Never use the room number.

• Three checks against the MAR: when pulling, when preparing, and at the bedside.

• Hold and clarify any order that is unclear, incomplete, or outside the safe dose range.

• High-alert meds (insulin, heparin, opioids, potassium chloride, chemotherapy) need an independent double check.

• Never give IV push potassium chloride.

Routes and techniques

IV complications

IV fluids

• Isotonic (0.9% NaCl, lactated Ringer's): expands vascular volume. Watch for overload.

• Hypotonic (0.45% NaCl): moves water into cells. Avoid with increased intracranial pressure.

• Hypertonic (3% NaCl, D10W): pulls fluid out of cells. Monitor closely for overload.

TPN

• Central line, dedicated line, filter. Monitor blood glucose.

• If a bag is delayed, hang D10W to prevent rebound hypoglycemia.

• Taper; do not stop abruptly.

Calculation formulas

• Desired over have times quantity: (D ÷ H) × Q.

• Drip rate (gtt/min) = total volume × drop factor ÷ time in minutes.

• Pump rate (mL/hr) = total volume ÷ hours.

• Weight conversion: 1 kg = 2.2 lb.

Maternity and Newborn Medications

The priority theme is safety for two clients: watch the mother's vital signs and the fetal heart rate with every drug.

Newborn medications

• Vitamin K (phytonadione): IM in the vastus lateralis to prevent bleeding.

• Erythromycin eye ointment: prevents conjunctivitis from gonorrhea and chlamydia.

• Hepatitis B vaccine: first dose before discharge. Add HBIG within 12 hours if mother is HBsAg positive.

• Naloxone is not routinely used in newborns of opioid-dependent mothers because it can trigger withdrawal.

Pediatric Medication Administration and Calculations

Pediatric dosing is weight based, so every order gets a safe-dose check before it is given.

Safe dose check

1. Convert weight to kg (lb ÷ 2.2).

2. Multiply kg by the recommended mg/kg range.

3. Compare the ordered dose to that range.

4. Within range: give. Outside range: hold and contact the provider.

• Body surface area (BSA) is the most accurate method, used for chemotherapy and high-risk drugs.

Administration by route

High-yield pediatric drugs

• Digoxin: count the apical pulse for 1 full minute. Hold if infant under about 90 to 110, child under 70.

• Liquid iron: use a straw or dropper toward the back of the mouth, brush teeth after. Give with juice, not milk.

• Acetaminophen: 10 to 15 mg/kg per dose. Watch for total daily dose from combination products.

• Avoid aspirin in children (Reye syndrome).

• Atraumatic care: topical anesthetic before needle procedures; give a choice when possible.

Integumentary Medications

Skin drugs are mostly topical, so teaching centers on correct application, sun protection, and infection control.

Oncological and Hematological Medications

Most chemotherapy causes bone marrow suppression, so the priority is infection, bleeding, and anemia precautions.

Bone marrow suppression precautions

• Neutropenia (ANC under 1,000; severe under 500): private room, strict hand hygiene, no fresh flowers or raw fruits and vegetables, no sick visitors, report temp 100.4°F (38°C) or higher.

• Thrombocytopenia (platelets under 50,000): soft toothbrush, electric razor, no IM injections or rectal temps, hold pressure 5 to 10 minutes.

• Anemia: rest periods, oxygen as ordered.

Chemotherapy and related agents

• Vesicant extravasation: stop the infusion first, then follow protocol.

• Handle chemo with gloves and gown; dispose of waste in marked hazardous containers.

Hematological drugs

Endocrine Medications

Insulin timing and the signs of too much or too little hormone drive most endocrine questions.

Insulin

• Rapid acting: give with the meal or within 15 minutes of eating.

• Only regular insulin is given IV.

• Mixing: draw clear (regular) before cloudy (NPH). Never mix glargine.

• Rotate sites within one area; abdomen absorbs fastest.

• Hypoglycemia (under 70 mg/dL): shaky, sweaty, tachycardic, confused. Alert client: 15 g fast carbs, recheck in 15 min. Unconscious: glucagon or IV dextrose.

• Sick days: keep taking insulin, check glucose every 4 hours, drink fluids.

Oral and non-insulin diabetes drugs

Thyroid, adrenal, and pituitary

Gastrointestinal Medications

Timing around meals and spacing from other drugs are the most tested GI points.

Respiratory Medications

Know which inhalers are rescue and which are maintenance, plus the TB drug side effects.

Asthma and COPD

• Inhaler order: bronchodilator first, wait about 5 minutes, then the steroid.

• MDI: shake, exhale fully, inhale slowly and deeply, hold breath 10 seconds. A spacer improves delivery.

Tuberculosis

• Therapy lasts 6 months or longer. Directly observed therapy improves adherence. Noninfectious after 3 negative sputum cultures.

Other respiratory drugs

• Antihistamines (diphenhydramine, loratadine): drowsiness and anticholinergic effects with first generation.

• Decongestants (pseudoephedrine): caution with hypertension and heart disease.

• Expectorant (guaifenesin): drink extra fluids.

• Antitussives (dextromethorphan, codeine): codeine causes constipation and sedation.

• Acetylcysteine: mucolytic and antidote for acetaminophen overdose; smells like rotten eggs.

Cardiovascular Medications

Check the pulse, blood pressure, potassium, and bleeding risk before nearly every cardiac drug.

Anticoagulants, antiplatelets, thrombolytics

Heart failure, rate, and rhythm

Blood pressure

Diuretics

Lipid lowering

• Statins (-statin): report muscle pain (rhabdomyolysis), check liver function, some taken in the evening, avoid grapefruit.

• Niacin: flushing; aspirin 30 minutes before helps.

• Ezetimibe: often combined with a statin.

Vasopressors and inotropes

• Dopamine, norepinephrine, epinephrine, dobutamine: central line preferred, continuous BP and ECG monitoring. Extravasation of norepinephrine: phentolamine.

Renal and Urinary Medications

Urinary tract antiseptics (nitrofurantoin, methenamine, fosfomycin)

• Priority Work only in the urine, not in blood or tissue.

• Fosfomycin: one packet in about 120 mL cold water, drink all.

• Methenamine: chronic UTI. Priority Needs acidic urine (pH 5.5 or lower); avoid extra fluids, alkalinizing antacids, and sulfonamides.

• Nitrofurantoin: with milk or meals; Priority brown urine is harmless; Priority pulmonary reaction (dyspnea, cough, fever); neuropathy; Priority contraindicated in renal impairment.

Fluoroquinolones (ciprofloxacin, levofloxacin)

• Tendon rupture risk (over 60, steroids, transplant). Priority Report dizziness, vision changes, depression (CNS toxicity).

• Priority Avoid sun. Full glass of water; urine output at least 1,200 to 1,500 mL/day. IV over 60 min.

Sulfonamides (TMP-SMX, sulfadiazine)

• Stevens-Johnson syndrome; hold for any rash. Blood dyscrasias: report sore throat or fever.

• Contraindicated: sulfa allergy, pregnancy, breastfeeding, infants under 2 months.

• Raise warfarin, phenytoin, oral hypoglycemic effects. Empty stomach, 8 to 10 glasses of water daily, avoid sun, finish course.

Urinary analgesic (phenazopyridine)

• Priority Pain relief only, given with an antibiotic. Priority Red-orange urine and tears, stains contacts. Interferes with urine glucose tests.

Antispasmodics (oxybutynin, tolterodine, solifenacin)

• Overactive bladder. Priority Dry mouth, constipation, retention, confusion in older adults.

• Priority Avoid in glaucoma; oxybutynin also contraindicated with obstruction, myasthenia gravis. Priority Gum or hard candy.

Cholinergic (bethanechol)

• Nonobstructive urinary retention. Priority Empty stomach; never IM or IV.

• Overdose: salivation, sweating, bradycardia, hypotension. Antidote: atropine. Not with obstruction.

Antirejection drugs

• Priority Cyclosporine: nephrotoxicity, infection, HTN, tremor, hirsutism. No grapefruit juice. Oral liquid in glass, rinse and drink. Mechanical contraception.

• Tacrolimus: like cyclosporine, plus hyperglycemia. Sirolimus: infection, high lipids.

• Everolimus: with cyclosporine every 12 hours.

• Priority Azathioprine and mycophenolate: bone marrow suppression; contraindicated in pregnancy.

• Antithymocyte globulin: Priority skin test first. Basiliximab: IV within 2 hours before transplant.

• Take at the same time every day; report early signs of infection.

Hematopoietic growth factors

• Epoetin, darbepoetin: Priority hypertension, clots; Hct normal in 2 to 3 months.

• Filgrastim, pegfilgrastim, sargramostim: bone pain, splenomegaly with long use.

BPH

• Alpha blockers (tamsulosin, doxazosin): dizziness, retrograde ejaculation.

• Finasteride, dutasteride: shrink prostate, up to 6 months to work.

Eye and Ear Medications

Priority Eye medication guidelines

• Lower conjunctival sac, never on the cornea; do not touch the eye with the tip.

• Punctal occlusion 30 to 60 sec. Drops before ointment; steroids before other eye meds.

• Wait 5 to 10 min between different eye meds (3 to 5 min between drops of the same).

• Ointment: thin ribbon inner to outer canthus; vision blurs; bedtime best.

• Glaucoma is controlled, not cured; do not stop meds.

Mydriatics and cycloplegics (atropine, cyclopentolate, tropicamide, phenylephrine)

• Priority Dilate the pupil for exams and surgery. Contraindicated in glaucoma (raise IOP).

• Atropine toxicity: dry mouth, fever, tachycardia, urinary retention, confusion.

• Priority No driving for 24 hours; sunglasses.

Anti-infective eye drugs (erythromycin, gentamicin, moxifloxacin, trifluridine)

• Priority Clean exudate first; finish course; hand hygiene.

Anti-inflammatory eye drugs (steroids, NSAIDs, mast cell stabilizers)

• Steroids: cataracts, raised IOP, mask infection. Priority Not for abrasions.

Topical anesthetic (tetracaine)

• Priority Never sent home; blink reflex lost, so patch the eye and no rubbing.

Eye lubricants: artificial tears. Priority Burning on instillation, preservative allergy.

Glaucoma drugs

• Miotics (pilocarpine): poor dim-light vision, salivation, sweating. Antidote for cholinergic toxicity: atropine.

• Prostaglandin analogs (latanoprost), alpha agonists (brimonidine), rho kinase inhibitor.

• Avoid OTC atropine-like drugs.

Ophthalmic beta blockers (timolol, betaxolol)

• Contraindicated in asthma and COPD. Priority Bradycardia, hypotension, bronchospasm.

• Priority Hold and call if pulse 60 or less or SBP under 90. Do not stop abruptly.

Carbonic anhydrase inhibitors (dorzolamide, brinzolamide, acetazolamide)

• Contraindicated with sulfa allergy. Hypokalemia, kidney stones, tingling, photosensitivity.

• Remove contacts; wait 15 min after dose.

Ocusert pilocarpine disk: replace every 7 days, insert at bedtime, check placement

• daily.

Osmotic (mannitol): emergency IOP reduction; watch electrolytes and orientation.

Priority Macular degeneration drugs (ranibizumab, bevacizumab, aflibercept)

• Dry form is slow and common; wet form is fast with leaking vessels. Watch for endophthalmitis.

Priority Ear drops and irrigation

• Adult pinna up and back; under 3 years down and back. Tilt head, then move gently.

• Irrigation: needs an order; solution at 98.6°F (37°C); aim at canal wall; fall precautions. Never with a perforated eardrum.

• Ototoxic drugs: aminoglycosides, vancomycin, loop diuretics, aspirin, cisplatin.

Ear anti-infectives: finish course, keep ears dry, report superinfection.

Antihistamines and decongestants: Priority drowsiness, dry mouth; HTN clients check first.

Ceruminolytic (carbamide peroxide)

• Priority Cotton plug after drops; irrigate with warm water 30 min later; do not overuse.

Neurological Medications

Antimyasthenics (pyridostigmine, neostigmine; edrophonium for diagnosis)

• Priority Too much: cholinergic crisis (cramps, miosis, bradycardia, secretions, sweating, bronchospasm). Too little: myasthenic crisis.

• Priority Give on time; eat 45 to 60 min after the dose. Atropine and resuscitation equipment at hand.

Multiple sclerosis

• Disease-modifying: interferons, glatiramer, fingolimod, natalizumab, ocrelizumab, mitoxantrone. Relapses: high-dose IV steroids.

• Priority Interferons: flu-like symptoms, liver toxicity, bone marrow suppression, depression. Mitoxantrone: cardiotoxicity, harm to fetus.

Antiparkinson drugs

• Dopaminergics (carbidopa-levodopa, pramipexole, ropinirole, selegiline, amantadine): Priority dyskinesia, orthostatic hypotension, hallucinations, N/V.

• Hypertensive crisis with MAOIs.

• Priority Spread protein across meals; avoid excess B6; dark urine and sweat harmless; never stop abruptly.

• Anticholinergics (benztropine, trihexyphenidyl): Priority contraindicated in glaucoma; dry mouth, retention, constipation, confusion.

• COMT inhibitors (entacapone) extend levodopa.

Antiseizure drugs

• Priority Seizure precautions; monitor levels, liver and kidney tests. Toxicity: ataxia, drowsiness, nystagmus, vision changes.

• Never stop abruptly; no milk or antacids with doses; MedicAlert; soft toothbrush; report sore throat, bruising, rash.

• Drug Therapeutic range Phenytoin 10 to 20 mcg/mL Carbamazepine 3 to 14 mcg/mL Valproate (divalproex) 50 to 100 mcg/mL Phenobarbital 15 to 40 mcg/mL Ethosuximide 40 to 100 mcg/mL Clonazepam 20 to 80 ng/mL Priority Phenytoin: gingival hyperplasia, nystagmus, high glucose, teratogenic, lowers birth control effect. IV in saline only with a filter, no faster than 25 to 50 mg/min. Space from tube feedings.

• Phenobarbital: Priority sedation, respiratory depression.

• Priority Benzodiazepines (lorazepam, diazepam): status epilepticus; IV slowly. Flumazenil reverses but can trigger seizures.

• Ethosuximide: absence seizures. Valproate: liver toxicity, pancreatitis, Priority neural tube defects.

• Carbamazepine: Priority also trigeminal neuralgia; agranulocytosis.

CNS stimulants (methylphenidate, amphetamines, atomoxetine)

• Priority Insomnia, tachycardia, HTN, appetite loss, growth delay, dependence.

• Priority Track growth; last dose at least 6 hours before bed; no caffeine; tell the school nurse; do not stop abruptly.

Nonopioid analgesics

• Aspirin and NSAIDs: Priority contraindicated in liver or kidney disease and with anticoagulants. GI bleeding, tinnitus. Take with food; upright 20 to 30 min. Stop aspirin 3 to 7 days before surgery. No aspirin for children with viral illness (Reye syndrome).

• Priority Acetaminophen: liver toxicity over 4,000 mg/day; antidote acetylcysteine.

Opioids (morphine, hydromorphone, fentanyl, oxycodone, codeine, methadone)

• Priority Respiratory depression, hypotension, constipation, retention, miosis.

• Priority Hold if adult RR under 12 (unless ventilated or end-of-life). Give 30 to 60 min before painful activity; cough and deep breathe; bowel regimen.

Opioid antagonists (naloxone)

• Priority VS every 5 min, then 15, then 30; never leave the client alone; opioid effects can return.

Osmotic diuretic (mannitol)

• Lowers ICP and IOP. Priority Watch for pulmonary edema and dehydration; do not use a vial with crystals.

Musculoskeletal Medications

Skeletal muscle relaxants

• Priority Contraindicated in severe liver, kidney, or heart disease; no CNS depressants or alcohol.

• Priority Drowsiness, weakness, liver toxicity. Safety first; no driving; check liver tests.

• Priority Baclofen: do not stop abruptly; intrathecal pump refills are critical (withdrawal can be fatal).

• Priority Cyclobenzaprine: not within 14 days of an MAOI; anticholinergic; 2 to 3 weeks only.

• Priority Dantrolene: liver damage most serious; sun protection. Also treats malignant hyperthermia.

• Methocarbamol: brown, black, or green urine; IV slowly. Chlorzoxazone: orange urine, hepatitis.

Antigout drugs (allopurinol, colchicine, probenecid, febuxostat)

• Priority Fluids 2,000 to 3,000 mL/day to prevent stones. Priority Avoid high-purine foods and alcohol. Priority No aspirin.

• Allopurinol: raises warfarin effect; stop for rash; Priority yearly eye exam.

• Priority Colchicine: hold for N/V, diarrhea, abdominal pain.

• Probenecid: aspirin blocks its effect.

Antiarthritic drugs (RA)

• Priority DMARDs: methotrexate (liver fibrosis, marrow suppression, pneumonitis), hydroxychloroquine (retinal damage), leflunomide (liver), sulfasalazine, azathioprine.

• Priority Biologics: etanercept, adalimumab, infliximab, abatacept, anakinra, rituximab.

• Serious infection and TB risk; no live vaccines; injection-site reactions; etanercept HF risk.

• Gold: itching, metallic taste, stomatitis.

Osteoporosis

• Priority Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid): morning, empty stomach, full glass of water, upright 30 min (60 for ibandronate).

• Contraindicated if unable to sit up.

• Priority Calcitonin: alternate nostrils; watch for hypocalcemia.

• Priority Raloxifene: contraindicated with clot history; stop 72 hours before immobility.

• Priority Abaloparatide: orthostatic hypotension within 4 hours. Teriparatide: bone cancer risk.

• Denosumab and romosozumab (heart attack, stroke risk).

Musculoskeletal pain

• First line: NSAIDs and acetaminophen; then relaxants, antidepressants, opioids.

Immune Medications

HIV and AIDS drugs

• Priority Combination therapy (3 to 4 drugs) slows disease but does not cure it.

• Priority NRTIs: abacavir (hypersensitivity: fever, rash, GI upset, SOB), zidovudine (anemia, neutropenia), didanosine and stavudine (neuropathy, pancreatitis), emtricitabine and tenofovir (lactic acidosis, hepatomegaly).

• Priority NNRTIs: efavirenz (vivid dreams, dizziness), nevirapine (Stevens-Johnson, hepatitis).

• Priority Protease inhibitors (-navir): GI upset, high glucose and lipids, fat redistribution; indinavir kidney stones; ritonavir taste changes, hepatitis.

• Integrase inhibitors (dolutegravir, raltegravir). Priority Enfuvirtide: injection-site irritation. Maraviroc: liver injury.

• Priority Opportunistic infections: TMP-SMX or pentamidine for PCP; antifungals for candida and cryptococcus; ganciclovir or foscarnet for CMV.

Priority Immunosuppressants

• Prevent transplant rejection; treat autoimmune disease.

• Cyclosporine and tacrolimus: nephrotoxicity, infection, HTN; tacrolimus also hyperglycemia, hyperkalemia.

• Azathioprine: neutropenia, thrombocytopenia. Cyclophosphamide: hemorrhagic cystitis. Methotrexate: liver fibrosis, stomatitis.

• Mycophenolate: diarrhea, neutropenia, lymphoma risk. Sirolimus: high lipids.

• Basiliximab: anaphylaxis.

• Watch every client closely for infection.

Antimicrobials

• Class Key adverse effects Aminoglycosides (gentamicin, Ototoxicity, nephrotoxicity tobramycin) Cephalosporins (cefazolin, ceftriaxone) C. diff colitis, nephrotoxicity, superinfection Fluoroquinolones (-floxacin) Tendon rupture, photosensitivity, CNS effects Macrolides (azithromycin, GI upset, C. diff colitis erythromycin) Class Key adverse effects Lincosamides (clindamycin) C. diff colitis, marrow suppression Penicillins (amoxicillin, piperacillin) Anaphylaxis, GI upset, superinfection Sulfonamides (TMP-SMX) Skin reactions, marrow suppression, kidney and liver toxicity Tetracyclines (doxycycline) Tooth staining, photosensitivity Antifungals (amphotericin B, Liver toxicity, hearing loss, anemia fluconazole) Priority Ask about allergies; check labs; push fluids; finish the course.

• Severe diarrhea on antibiotics: contact precautions, fluids and electrolytes, ask about probiotics.

Psychotherapeutic Medications

SSRIs, SNRIs, atypicals (fluoxetine, sertraline, escitalopram, venlafaxine, duloxetine,

• bupropion, trazodone) No anticholinergic effects. Ask about St. John's wort. Bleeding risk with ibuprofen.

• Priority Serotonin syndrome: agitation, fever, tachycardia, HTN, rigidity, myoclonus, diarrhea. Never with MAOIs.

• Priority Do not stop abruptly. Watch suicide risk as energy improves. Sexual dysfunction common.

TCAs (amitriptyline, nortriptyline, imipramine, clomipramine for OCD)

• Priority Cardiotoxic: baseline and periodic ECG. Overdose is lethal: airway, cardiac monitoring, charcoal within 2 hours.

• Anticholinergic effects, orthostatic hypotension, sedation. Whole dose at bedtime.

• Antidepressants take 2 to 4 weeks to work.

MAOIs (phenelzine, tranylcypromine, isocarboxazid, selegiline)

• Priority Hypertensive crisis: occipital headache, stiff neck, sweating, palpitations, chest pain. Antidote: phentolamine.

• Priority Avoid tyramine: aged cheese, cured and processed meats, liver, pickled herring, red wine, beer, soy sauce, overripe fruit, avocado, banana, sauerkraut, brewer's yeast, caffeine.

• Avoid decongestants and stimulants. Not in the evening. Taper to stop.

Lithium

• Priority Therapeutic level 0.6 to 1.2 mEq/L; draw 12 hours after the last dose.

• Toxicity rises with low sodium, dehydration, diuretics, NSAIDs.

• Mild (1.5): lethargy, coarse tremor. Moderate (1.5 to 2.0): vomiting, diarrhea, ataxia, slurred speech, tinnitus. Severe (over 2.0): seizures, oliguria, coma.

• Priority Toxicity: hold, notify, check levels, electrolytes, renal function.

• 6 to 8 glasses of water daily, normal salt, with food; baseline ECG, renal, thyroid.

Antianxiety (benzodiazepines, buspirone)

• Contraindicated in narrow-angle glaucoma. Short-term use.

• Priority Overdose: somnolence, confusion, coma. Antidote: flumazenil.

• Priority Fall precautions; no alcohol. Priority Taper over 2 to 6 weeks; abrupt stop can cause seizures.

Sedative-hypnotics (zolpidem, eszopiclone, barbiturates)

• Priority Overdose: respiratory depression, hypotension, shock. Take 30 min before bed; do not stop abruptly.

Antipsychotics

• Typicals (haloperidol, chlorpromazine, fluphenazine): positive symptoms. Atypicals (risperidone, olanzapine, quetiapine, aripiprazole, clozapine): negative symptoms too.

• Priority Anticholinergic effects, weight gain, high glucose, photosensitivity, agranulocytosis.

• Priority EPS: pseudoparkinsonism, dystonia, akathisia, tardive dyskinesia.

• Full effect 3 to 6 weeks. Report sore throat or fever, jaundice. Taper to stop.

Priority Neuroleptic malignant syndrome

• Hyperpyrexia, severe rigidity, unstable BP, tachycardia, altered LOC; high CPK and WBC.

• Stop the drug, cooling, IV fluids, seizure precautions.

Priority Alcohol withdrawal

• Long-acting benzodiazepines first line; beta blockers and clonidine as add-ons.

• Thiamine to prevent Wernicke encephalopathy; folic acid, magnesium.

• Abstinence: naltrexone, acamprosate, disulfiram (no alcohol 12 hours before; avoid mouthwash, cough syrup, aftershave; reaction can occur days after stopping).

Priority Opioid use disorder

• Methadone (close supervision, overdose risk), buprenorphine (lower abuse risk), naltrexone (after detox), clonidine (withdrawal symptoms).

ADHD (methylphenidate, amphetamines, atomoxetine, guanfacine)

• Priority Baseline ECG, BP, height and weight. Last dose 6 hours before bed (14 for extended release). Drug holidays may be ordered.

Priority Alzheimer disease

• Donepezil: bradycardia. Galantamine: caution in asthma and COPD. Rivastigmine: with food.

• Memantine (moderate to severe): avoid with amantadine; caution in renal impairment.

• Quick Reference Therapeutic levels Drug Range Digoxin 0.5 to 2 ng/mL Lithium 0.6 to 1.2 mEq/L Magnesium sulfate (OB) 4 to 7.5 mEq/L Phenytoin 10 to 20 mcg/mL Theophylline 10 to 20 mcg/mL Carbamazepine 3 to 14 mcg/mL Valproate 50 to 100 mcg/mL Phenobarbital 15 to 40 mcg/mL Heparin (aPTT) 1.5 to 2.5 × normal Warfarin (INR) 2 to 3 Antidotes Drug Antidote Heparin, enoxaparin Protamine sulfate Warfarin Vitamin K Thrombolytics Aminocaproic acid Digoxin Digoxin immune Fab Magnesium sulfate Calcium gluconate Opioids Naloxone Benzodiazepines Flumazenil Acetaminophen Acetylcysteine Anticholinesterases, cholinergics Atropine MAOI hypertensive crisis Phentolamine Methotrexate Leucovorin Insulin hypoglycemia (cannot swallow) Glucagon or IV dextrose Hold parameters Digoxin: apical pulse under 60 (adult); infant and child limits are higher.

• Beta blockers: HR or BP outside prescribed limits; ophthalmic beta blockers pulse 60 or less or SBP under 90.

• Opioids: RR under 12.

• Magnesium sulfate: RR 12 or less, absent patellar reflex, urine under 25 to 30 mL/hr.

• Methylergonovine: elevated BP.

• Chemotherapy: ANC under 1,000 or low platelets per policy.

Why read it, then quiz it (the evidence)

For education only. Doses and ranges are standard teaching values. Always follow current drug references, provider orders, and facility policy. For full drug labels, see DailyMed.