50 Most Important Medications to Know for Nursing School -

50 Most Important Medications to Know for Nursing School

This list includes high-yield medications commonly emphasized in nursing school because they connect directly to pathophysiology, clinical judgment, patient safety, and NCLEX-style prioritization. This list is not all inclusive.

What is not included in this post are key points related to medication administration, get that here!

50 Most Important Medications to Know for Nursing School

Cardiac

1. Metoprolol

Class: Beta-blocker
Pharmacologic effect: Cardioselective beta-1 adrenergic blockade.
Mechanism: Selectively inhibits beta-1 receptors in cardiac tissue, decreasing sympathetic stimulation of the heart.
Therapeutic effect: Decreased heart rate, decreased contractility, decreased myocardial oxygen demand, and decreased blood pressure.
Predominant side effects: Bradycardia, hypotension, dizziness, fatigue, orthostatic hypotension.
Contraindications: Severe bradycardia, heart block without pacemaker, cardiogenic shock, acute decompensated heart failure.
Considerations: Has a more influential impact on heart rate than blood pressure, so it is commonly used for rate control in atrial fibrillation, angina, post-MI management, and heart failure therapy once stable. Assess apical pulse and blood pressure before administration. Beta-blockers may mask the traditional signs of hypoglycemia, as such additional consideration should be taken in patients with diabetes.
Nursing exam PEARL: Hold and notify the provider for significant bradycardia or hypotension according to facility parameters. Never abruptly stop chronic beta-blocker therapy because rebound tachycardia, hypertension, and ischemia can occur. [ncbi.nlm.nih.gov]

2. Labetalol

Class: Beta-blocker with alpha-1 blocking activity.
Pharmacologic effect: Nonselective beta-blockade plus peripheral alpha-1 blockade.
Mechanism: Blocks beta-1, beta-2, and alpha-1 receptors, decreasing heart rate and contractility while producing vasodilation.
Therapeutic effect: Decreased blood pressure with modest heart-rate reduction.
Predominant side effects: Hypotension, orthostatic hypotension, dizziness, fatigue, bradycardia, bronchospasm risk in susceptible patients.
Contraindications: Asthma or severe reactive airway disease, severe bradycardia, heart block, cardiogenic shock, acute decompensated heart failure.
Considerations: Has a more influential impact on blood pressure than heart rate. Frequently used in hypertensive urgency/emergency and pregnancy-related hypertension depending on clinical context. Monitor for orthostatic changes and avoid rapid position changes. Beta-blockers may mask the traditional signs of hypoglycemia, as such additional consideration should be taken in patients with diabetes.
Nursing exam PEARL: Think “labetalol lowers pressure.” It is commonly tested as a preferred medication for severe hypertension in pregnancy, but still monitor for fetal/neonatal bradycardia and maternal hypotension. [ncbi.nlm.nih.gov]

3. Lisinopril

Class: ACE inhibitor.
Pharmacologic effect: Inhibits conversion of angiotensin I to angiotensin II.
Therapeutic effect: Vasodilation, decreased aldosterone secretion, decreased blood pressure, renal protection in diabetes, mortality benefit in heart failure and post-MI patients.
Predominant side effects: Dry cough, hyperkalemia, hypotension, dizziness, acute kidney injury, angioedema.
Contraindications: Pregnancy, history of ACE-inhibitor angioedema, bilateral renal artery stenosis, severe hyperkalemia., acute kidney injury/CKD
Considerations: Monitor potassium and renal function. A mild creatinine increase may occur after initiation, but significant renal decline requires provider evaluation.
Nursing exam PEARL: ACE inhibitors end in “-pril.” A persistent dry cough or angioedema should make you think ACE inhibitor immediately. [ncbi.nlm.nih.gov]

4. Losartan

Class: Angiotensin II receptor blocker, ARB.
Pharmacologic effect: Blocks angiotensin II receptor binding.
Therapeutic effect: Vasodilation, reduced aldosterone secretion, decreased blood pressure, renal protection in diabetic kidney disease.
Predominant side effects: Hyperkalemia, hypotension, dizziness, renal function changes.
Contraindications: Pregnancy, severe hyperkalemia, caution with renal artery stenosis, acute kidney injury/CKD.
Considerations: Often used when a patient cannot tolerate ACE inhibitors due to cough. It does not usually cause the bradykinin-mediated cough seen with ACE inhibitors.
Nursing exam PEARL: ARBs end in “-sartan.” Do not combine ACE inhibitors and ARBs routinely because of increased risk of angioedema, renal injury, and hyperkalemia. [ncbi.nlm.nih.gov],

5. Valsartan-Sacubitril

Class: ARNI, angiotensin receptor neprilysin inhibitor.
Pharmacologic effect: Valsartan blocks angiotensin II receptors; sacubitril inhibits neprilysin, increasing natriuretic peptides.
Therapeutic effect: Decreased afterload, decreased aldosterone-mediated sodium retention, improved heart failure outcomes in appropriate patients.
Predominant side effects: Hypotension, hyperkalemia, renal impairment, dizziness, angioedema.
Contraindications: Pregnancy, history of angioedema, concomitant ACE inhibitor use, severe hyperkalemia, acute kidney injury/CKD
Considerations: Requires a 36-hour washout after stopping an ACE inhibitor before initiation to reduce angioedema risk. Monitor blood pressure, potassium, and renal function.
Nursing exam PEARL: Sacubitril/valsartan is a major heart failure medication. The NCLEX-style safety point is: never give with an ACE inhibitor or within 36 hours of one. [ncbi.nlm.nih.gov],

6. Diltiazem

Class: Non-dihydropyridine calcium channel blocker.
Pharmacologic effect: Inhibits calcium influx in cardiac and vascular smooth muscle.
Therapeutic effect: Decreased heart rate, slowed AV nodal conduction, decreased blood pressure, decreased myocardial oxygen demand.
Predominant side effects: Bradycardia, hypotension, dizziness, constipation, peripheral edema.
Contraindications: Severe bradycardia, heart block, hypotension, decompensated heart failure with reduced ejection fraction (EF < 35%).
Considerations: Used for rate control in atrial fibrillation/flutter and for angina or hypertension. Please note that Diltiazem (and other NDHP calcium channel blockers) have a mild effect on blood pressure. When given IV it may cause hypotension, however, is a low risk due to its primary action affecting heart rate and rhythm. Monitor telemetry when IV.
Nursing exam PEARL: Diltiazem and verapamil slow the AV node. Avoid combining with beta-blockers unless specifically ordered and closely monitored because severe bradycardia or heart block can occur. [ncbi.nlm.nih.gov]

7. Amlodipine

Class: Dihydropyridine calcium channel blocker.
Pharmacologic effect: Peripheral arterial vasodilation.
Therapeutic effect: Decreased systemic vascular resistance and decreased blood pressure.
Predominant side effects: Peripheral edema, flushing, headache, dizziness, hypotension.
Contraindications: Severe hypotension; caution in significant aortic stenosis.
Considerations: Has minimal direct impact on heart rate compared with diltiazem. Edema is common and is not necessarily caused by fluid overload. May result in compensatory or “reflex” tachycardia, although it is less common than its IV counterparts.
Nursing exam PEARL: Amlodipine is more “blood pressure” than “heart rate.” Do not confuse it with diltiazem, which is frequently used for rate control. [ncbi.nlm.nih.gov]

8. Nicardipine

Class: Dihydropyridine calcium channel blocker.
Pharmacologic effect: Potent arterial vasodilation.
Therapeutic effect: Rapid, titratable blood pressure reduction.
Predominant side effects: Hypotension, reflex tachycardia, headache, flushing, dizziness.
Contraindications: Advanced aortic stenosis; caution in heart failure or acute coronary syndromes depending on clinical context.
Considerations: Often administered as an IV infusion for hypertensive emergencies, stroke-related BP management, and perioperative hypertension. Requires frequent blood pressure monitoring.
Nursing exam PEARL: Nicardipine drip equals “titrate the pressure carefully.” Avoid dropping BP too quickly in chronic hypertension or neurologic emergencies unless ordered, because organ perfusion can worsen. [ncbi.nlm.nih.gov]

9. Furosemide

Class: Loop diuretic.
Pharmacologic effect: Inhibits sodium and chloride reabsorption in the loop of Henle.
Therapeutic effect: Diuresis, decreased preload, decreased pulmonary/peripheral edema, blood pressure reduction.
Predominant side effects: Hypokalemia, dehydration, hypotension, hyponatremia, ototoxicity at high doses or rapid IV administration.
Contraindications: Anuria; caution with severe electrolyte depletion, namely hypokalemia.
Considerations: Monitor intake/output, daily weights, potassium, magnesium, renal function, and blood pressure.
Nursing exam PEARL: Loop diuretics “lose K.” Watch for hypokalemia, which increases digoxin toxicity risk and dysrhythmia risk. [ncbi.nlm.nih.gov]

10. Spironolactone

Class: Potassium-sparing diuretic; aldosterone antagonist.
Pharmacologic effect: Blocks aldosterone receptors in the distal nephron.
Therapeutic effect: Mild diuresis, potassium retention, reduced remodeling and mortality benefit in select heart failure patients.
Predominant side effects: Hyperkalemia, hypotension, dizziness, gynecomastia, menstrual irregularities.
Contraindications: Hyperkalemia, significant renal impairment, Addison disease.
Considerations: Monitor potassium and renal function closely, especially if combined with ACE inhibitors, ARBs, or ARNIs.
Nursing exam PEARL: Spironolactone “spares potassium.” Avoid salt substitutes because many contain potassium. [ncbi.nlm.nih.gov],

11. Hydralazine

Class: Direct arterial vasodilator.
Pharmacologic effect: Relaxes arteriolar smooth muscle.
Therapeutic effect: Decreased systemic vascular resistance and decreased blood pressure.
Predominant side effects: Reflex tachycardia, headache, flushing, hypotension, fluid retention, drug-induced lupus-like syndrome with prolonged use.
Contraindications: Coronary artery disease caution, mitral valve rheumatic disease, hypersensitivity.
Considerations: Can increase heart rate due to reflex sympathetic response. Often paired with nitrates in certain heart failure patients or used for BP management.
Nursing exam PEARL: Hydralazine lowers afterload but may cause reflex tachycardia. If chest pain occurs after administration, think increased myocardial oxygen demand. [ncbi.nlm.nih.gov],

12. Digoxin

Class: Cardiac glycoside.
Pharmacologic effect: Inhibits sodium-potassium ATPase, increasing intracellular calcium.
Therapeutic effect: Increased contractility and decreased AV nodal conduction (Decreased heart rate).
Predominant side effects: Bradycardia, nausea, vomiting, visual disturbances, confusion, dysrhythmias.
Contraindications: Ventricular fibrillation, significant AV block without pacemaker, caution in renal impairment and hypokalemia.
Considerations: Narrow therapeutic index. Monitor apical pulse, renal function, potassium, magnesium, and digoxin levels when ordered.
Nursing exam PEARL: Digoxin toxicity is more likely with hypokalemia. Classic clues include GI symptoms, vision changes such as yellow halos, and new dysrhythmias.

Antimicrobial

13. Penicillin

Class: Beta-lactam antibiotic.
Pharmacologic effect: Inhibits bacterial cell wall synthesis.
Therapeutic effect: Bactericidal activity against susceptible organisms.
Predominant side effects: Rash, GI upset, diarrhea, hypersensitivity reactions, anaphylaxis.
Contraindications: Serious penicillin allergy.
Considerations: Always assess allergy history carefully, including reaction type. “I got nauseated” is different from anaphylaxis.
Nursing exam PEARL: If a patient develops wheezing, angioedema, hypotension, or urticaria after penicillin, stop the medication and prioritize airway/anaphylaxis response.

14. Cefazolin

Class: First-generation cephalosporin.
Pharmacologic effect: Inhibits bacterial cell wall synthesis.
Therapeutic effect: Bactericidal activity, especially against many gram-positive organisms; commonly used for surgical prophylaxis.
Predominant side effects: GI upset, diarrhea, rash, hypersensitivity reaction, possible C. difficile-associated diarrhea.
Contraindications: Serious cephalosporin allergy; caution with severe beta-lactam allergy.
Considerations: Timing matters for surgical prophylaxis. Nurses often administer cefazolin preoperatively within the ordered prophylaxis window.
Nursing exam PEARL: Cefazolin is a common “pre-op antibiotic.” Verify allergy history and administration timing before incision. Rare chance of patients with a Penicillin allergy to have a cross reaction with cephalosporin antibiotics.

15. Cefepime

Class: Fourth-generation cephalosporin.
Pharmacologic effect: Inhibits bacterial cell wall synthesis.
Therapeutic effect: Broad gram-negative coverage, including Pseudomonas, plus gram-positive coverage.
Predominant side effects: Diarrhea, rash, hypersensitivity reactions, neurotoxicity risk especially with renal impairment.
Contraindications: Serious cephalosporin allergy.
Considerations: Requires renal dose adjustment. New confusion, encephalopathy, myoclonus, or seizures should raise concern for cefepime neurotoxicity.
Nursing exam PEARL: Cefepime plus altered mental status in a patient with kidney dysfunction is a classic safety concern. Rare chance of patients with a Penicillin allergy to have a cross reaction with cephalosporin antibiotics.

16. Vancomycin

Class: Glycopeptide antibiotic.
Pharmacologic effect: Inhibits bacterial cell wall formation.
Therapeutic effect: Treats serious gram-positive infections, including MRSA.
Predominant side effects: Nephrotoxicity, infusion reaction, ototoxicity risk, rash.
Contraindications: Hypersensitivity; caution in renal impairment.
Considerations: Monitor renal function and drug levels according to protocol. Infuse at the ordered rate to reduce vancomycin infusion reaction, formerly called “red man syndrome.”
Nursing exam PEARL: If flushing, itching, or erythema occurs during infusion, slow or stop the infusion per protocol and notify the provider. This is usually rate-related, not necessarily a true allergy.

17. Metronidazole

Class: Nitroimidazole antimicrobial.
Pharmacologic effect: Disrupts DNA synthesis in anaerobic organisms and certain protozoa.
Therapeutic effect: Treats anaerobic infections, bacterial vaginosis, trichomoniasis, and C. difficile in selected situations.
Predominant side effects: Metallic taste, nausea, GI upset, headache, peripheral neuropathy with prolonged use.
Contraindications: Hypersensitivity; avoid alcohol during therapy and shortly after completion due to disulfiram-like reaction risk.
Considerations: Educate patients to avoid alcohol-containing products and report numbness or tingling. Can cause photosensitivity, patients should be educated about reducing sunlight exposure while on medication.
Nursing exam PEARL: Metronidazole equals “no alcohol.” Metallic taste is common and expected. [mcforms.mayo.edu], [stanfordch…ldrens.org]

18. Sulfamethoxazole-Trimethoprim

Class: Sulfonamide antibiotic combination.
Pharmacologic effect: Sequential inhibition of bacterial folate synthesis.
Therapeutic effect: Bactericidal activity against susceptible infections, including UTIs, some MRSA skin infections, and Pneumocystis jirovecii pneumonia treatment/prophylaxis.
Predominant side effects: Rash, photosensitivity, GI upset, hyperkalemia, bone marrow suppression, Stevens-Johnson syndrome risk.
Contraindications: Sulfonamide allergy, significant liver disease, severe renal impairment without monitoring, certain pregnancy contexts.
Considerations: Encourage hydration unless contraindicated. Monitor CBC, potassium, renal function, and rash.
Nursing exam PEARL: A new rash on TMP-SMX is not something to ignore because severe cutaneous reactions can occur. Also remember TMP-SMX can increase INR in patients taking warfarin. [ncbi.nlm.nih.gov], [pmc.ncbi.nlm.nih.gov]

19. Acyclovir

Class: Antiviral, nucleoside analog.
Pharmacologic effect: Inhibits viral DNA polymerase.
Therapeutic effect: Treats HSV and VZV infections.
Predominant side effects: Nausea, headache, renal toxicity, crystalluria with IV administration.
Contraindications: Hypersensitivity; caution with renal impairment.
Considerations: Ensure adequate hydration, especially with IV therapy. Monitor renal function.
Nursing exam PEARL: IV acyclovir can injure the kidneys. Hydration and renal monitoring are the nursing priorities.

20. Amphotericin B

Class: Polyene antifungal.
Pharmacologic effect: Binds ergosterol in fungal cell membranes, causing cell death.
Therapeutic effect: Treats severe systemic fungal infections.
Predominant side effects: Nephrotoxicity, hypokalemia, hypomagnesemia, fever/chills during infusion, anemia.
Contraindications: Hypersensitivity; use requires careful risk-benefit evaluation due to toxicity.
Considerations: Monitor renal function, electrolytes, infusion reactions, and CBC. Premedication may be ordered to reduce infusion reactions.
Nursing exam PEARL: Amphotericin B is sometimes remembered as “ampho-terrible” because of nephrotoxicity and infusion reactions. Potassium and magnesium monitoring are high-yield.

21. Fluconazole

Class: Azole antifungal.
Pharmacologic effect: Inhibits fungal ergosterol synthesis.
Therapeutic effect: Treats Candida infections and selected fungal infections.
Predominant side effects: GI upset, headache, hepatotoxicity, QT prolongation risk, drug interactions.
Contraindications: Hypersensitivity; caution with liver disease and QT-prolonging medications.
Considerations: Monitor liver enzymes when prolonged therapy is used. Review medication list for interactions.
Nursing exam PEARL: -Azole antifungals commonly interact with other drugs. Think liver monitoring and QT prolongation risk.

Anti-Epileptic

22. Levetiracetam

Class: Antiseizure medication.
Pharmacologic effect: Modulates synaptic vesicle protein SV2A, reducing neuronal excitability.
Therapeutic effect: Seizure prevention and treatment adjunct/monotherapy depending on seizure type.
Predominant side effects: Drowsiness, dizziness, weakness, behavioral changes, irritability, mood symptoms.
Contraindications: Hypersensitivity; caution with renal impairment.
Considerations: Renal dosing may be needed. Assess mood and behavior changes, especially new agitation or suicidal ideation.
Nursing exam PEARL: Levetiracetam has fewer drug interactions than many older seizure meds, but mood/behavior changes are the key safety issue.

23. Phenytoin

Class: Antiseizure medication; sodium channel blocker.
Pharmacologic effect: Stabilizes neuronal membranes by prolonging sodium channel inactivation.
Therapeutic effect: Prevents seizure propagation.
Predominant side effects: Gingival hyperplasia, nystagmus, ataxia, sedation, rash, hepatotoxicity, blood dyscrasias.
Contraindications: Sinus bradycardia, heart block, Adams-Stokes syndrome for IV use; hypersensitivity.
Considerations: Narrow therapeutic index. IV phenytoin can cause hypotension and dysrhythmias, so cardiac monitoring is important during administration.
Nursing exam PEARL: Teach oral hygiene because gingival hyperplasia is classic. Do not confuse phenytoin toxicity with worsening neurologic disease.

24. Valproic Acid

Class: Antiseizure medication; mood stabilizer.
Pharmacologic effect: Increases GABA activity and affects sodium/calcium channels.
Therapeutic effect: Seizure control, migraine prophylaxis, bipolar disorder management.
Predominant side effects: GI upset, tremor, weight gain, thrombocytopenia, hepatotoxicity, pancreatitis, teratogenicity.
Contraindications: Pregnancy for many indications, significant liver disease, urea cycle disorders.
Considerations: Monitor liver function, platelets, and signs of pancreatitis.
Nursing exam PEARL: Valproic acid is highly teratogenic. Abdominal pain, nausea, and vomiting may signal pancreatitis and should be escalated.

Anti-Depressant

25. Sertraline

Class: SSRI.
Pharmacologic effect: Inhibits serotonin reuptake.
Therapeutic effect: Improves depression, anxiety, PTSD, OCD, and other serotonergic conditions.
Predominant side effects: GI upset, insomnia or somnolence, sexual dysfunction, headache, serotonin syndrome risk.
Contraindications: MAOI use within required washout period, linezolid/methylene blue interaction risk.
Considerations: Therapeutic effect may take several weeks. Monitor for suicidal ideation early in therapy or after dose changes, especially in younger patients.
Nursing exam PEARL: SSRIs increase serotonin. Watch for serotonin syndrome: agitation, diaphoresis, fever, diarrhea, tremor, hyperreflexia. [pubmed.ncb…lm.nih.gov]

26. Escitalopram

Class: SSRI.
Pharmacologic effect: Inhibits serotonin reuptake.
Therapeutic effect: Treats depression and anxiety disorders.
Predominant side effects: Nausea, sexual dysfunction, insomnia, fatigue, QT prolongation at higher risk/dose settings.
Contraindications: MAOI use within required washout period; caution with QT prolongation.
Considerations: Assess mood, sleep, anxiety, adherence, and suicidal ideation.
Nursing exam PEARL: Do not stop SSRIs abruptly because discontinuation symptoms can occur. Teach patients that improvement is gradual, not immediate. [pubmed.ncb…lm.nih.gov]

27. Bupropion

Class: Norepinephrine-dopamine reuptake inhibitor, NDRI.
Pharmacologic effect: Inhibits norepinephrine and dopamine reuptake.
Therapeutic effect: Treats depression and supports smoking cessation.
Predominant side effects: Insomnia, dry mouth, anxiety, weight loss, hypertension, seizure risk.
Contraindications: Seizure disorder, eating disorders such as bulimia/anorexia, abrupt alcohol or benzodiazepine withdrawal.
Considerations: Often less sexual dysfunction than SSRIs. Avoid giving near bedtime due to insomnia.
Nursing exam PEARL: Bupropion lowers seizure threshold, very high risk of seizures with abrupt withdrawal of medication. Eating disorder history is a major contraindication. [pubmed.ncb…lm.nih.gov]

28. Selegiline

Class: MAOI; also used in Parkinson disease.
Pharmacologic effect: Inhibits monoamine oxidase, increasing monoamine neurotransmitters.
Therapeutic effect: Increases dopamine availability in Parkinson disease and may treat depression depending on formulation.
Predominant side effects: Insomnia, dizziness, orthostatic hypotension, hypertensive crisis with tyramine interaction, serotonin syndrome risk with serotonergic drugs.
Contraindications: Concomitant serotonergic antidepressants, certain opioids, sympathomimetics, and tyramine-rich diet concerns depending on dose/formulation.
Considerations: Medication reconciliation is critical because interactions can be severe.
Nursing exam PEARL: MAOI equals tyramine warning. Avoid aged cheeses, cured meats, fermented foods, and many interacting medications. [pubmed.ncb…lm.nih.gov]

Anti-Psychotic

29. Olanzapine

Class: Second-generation atypical antipsychotic.
Pharmacologic effect: Dopamine and serotonin receptor antagonism.
Therapeutic effect: Treats schizophrenia, bipolar disorder, acute agitation in appropriate settings.
Predominant side effects: Weight gain, metabolic syndrome, sedation, orthostatic hypotension, anticholinergic effects.
Contraindications: Hypersensitivity; caution in dementia-related psychosis due to increased mortality warning.
Considerations: Monitor weight, glucose, lipids, sedation, and orthostatic blood pressure.
Nursing exam PEARL: Olanzapine is strongly associated with metabolic effects. Think glucose, cholesterol, and weight monitoring. [ncbi.nlm.nih.gov], [ncbi.nlm.nih.gov]

30. Quetiapine

Class: Second-generation atypical antipsychotic.
Pharmacologic effect: Serotonin-dopamine antagonism with significant antihistamine effects.
Therapeutic effect: Treats schizophrenia, bipolar disorder, and adjunct depression depending on formulation/indication.
Predominant side effects: Sedation, orthostatic hypotension, weight gain, metabolic changes, QT prolongation risk.
Contraindications: Hypersensitivity; caution with dementia-related psychosis.
Considerations: Fall precautions are important, especially after initiation or dose escalation.
Nursing exam PEARL: Quetiapine is sedating. A safety-focused NCLEX answer often includes fall precautions and orthostatic BP assessment. May prolong QT interval [ncbi.nlm.nih.gov], [ncbi.nlm.nih.gov]

31. Haloperidol

Class: First-generation typical antipsychotic.
Pharmacologic effect: Dopamine D2 receptor antagonism.
Therapeutic effect: Treats psychosis, agitation, delirium symptoms in selected situations, Tourette syndrome.
Predominant side effects: Extrapyramidal symptoms, QT prolongation, neuroleptic malignant syndrome, sedation, anticholinergic effects.
Contraindications: Parkinson disease caution, severe CNS depression, dementia-related psychosis warning.
Considerations: Monitor for dystonia, akathisia, parkinsonism, tardive dyskinesia, fever, rigidity, and autonomic instability.
Nursing exam PEARL: High-potency typical antipsychotics like haloperidol have high EPS risk. Fever plus muscle rigidity plus autonomic instability equals possible neuroleptic malignant syndrome. [ncbi.nlm.nih.gov], [ncbi.nlm.nih.gov]

32. Risperidone

Class: Second-generation atypical antipsychotic.
Pharmacologic effect: Dopamine and serotonin antagonism.
Therapeutic effect: Treats schizophrenia, bipolar mania, irritability associated with autism in selected patients.
Predominant side effects: EPS at higher doses, hyperprolactinemia, weight gain, metabolic changes, orthostatic hypotension.
Contraindications: Hypersensitivity; caution in dementia-related psychosis.
Considerations: Monitor for menstrual changes, galactorrhea, sexual dysfunction, movement symptoms, and metabolic effects.
Nursing exam PEARL: Risperidone can increase prolactin. Think galactorrhea, gynecomastia, and menstrual changes. [ncbi.nlm.nih.gov], [ncbi.nlm.nih.gov]

Analgesic

33. Morphine

Class: Opioid analgesic.
Pharmacologic effect: Mu-opioid receptor agonist.
Therapeutic effect: Moderate to severe pain relief, decreased preload in some acute pulmonary edema contexts.
Predominant side effects: Respiratory depression, sedation, hypotension, constipation, nausea, urinary retention, pruritus.
Contraindications: Significant respiratory depression, acute/severe asthma without monitoring, paralytic ileus.
Considerations: Assess respiratory rate, sedation level, pain score, blood pressure, and bowel function.
Nursing exam PEARL: Respiratory depression is the priority adverse effect. Always reassess pain and respiratory status after administration. [ncbi.nlm.nih.gov], [nida.nih.gov]

34. Acetaminophen

Class: Non-opioid analgesic and antipyretic.
Pharmacologic effect: Central inhibition of prostaglandin synthesis.
Therapeutic effect: Decreased pain and fever.
Predominant side effects: Hepatotoxicity with overdose or excessive cumulative dosing.
Contraindications: Severe hepatic impairment, active severe liver disease.
Considerations: Track total daily dose from all sources, including combination opioid products and OTC cold medications. Requires dose adjustment based on age and liver function.
Nursing exam PEARL: Acetaminophen overdose damages the liver. The antidote is N-acetylcysteine, and early treatment matters. Number 1 cause of fulminant hepatic failure

35. Ibuprofen

Class: NSAID.
Pharmacologic effect: Nonselective COX inhibition, reducing prostaglandin synthesis.
Therapeutic effect: Decreased pain, fever, and inflammation.
Predominant side effects: GI bleeding, renal injury, hypertension, fluid retention, platelet inhibition.
Contraindications: Active GI bleeding, severe renal impairment, peri-CABG pain, NSAID hypersensitivity.
Considerations: Use caution in kidney disease, heart failure, anticoagulant use, and peptic ulcer disease.
Nursing exam PEARL: NSAIDs can injure kidneys and cause GI bleeding. Avoid in high-risk renal patients unless specifically ordered.

36. Fentanyl

Class: Synthetic opioid analgesic.
Pharmacologic effect: Potent mu-opioid receptor agonist.
Therapeutic effect: Severe pain relief and procedural/critical care analgesia.
Predominant side effects: Respiratory depression, sedation, bradycardia, hypotension, constipation, chest wall rigidity with rapid/high-dose IV administration.
Contraindications: Significant respiratory depression without appropriate monitoring.
Considerations: Very potent; dosing errors can be catastrophic. Transdermal patches are for opioid-tolerant patients, not acute opioid-naive pain.
Nursing exam PEARL: Fentanyl patch plus heating pad can increase absorption and cause overdose. Remove old patches before applying a new one. [ncbi.nlm.nih.gov], [nida.nih.gov]

37. Hydromorphone

Class: Opioid analgesic.
Pharmacologic effect: Mu-opioid receptor agonist.
Therapeutic effect: Moderate to severe pain relief.
Predominant side effects: Respiratory depression, sedation, hypotension, constipation, nausea.
Contraindications: Significant respiratory depression, acute/severe asthma without monitoring, paralytic ileus.
Considerations: More potent than morphine milligram-for-milligram. Use caution during transitions between opioids.
Nursing exam PEARL: Hydromorphone and morphine are not equivalent doses. Dose conversion errors are a major patient safety concern. [ncbi.nlm.nih.gov], [nida.nih.gov]

Anxiolytic

38. Alprazolam

Class: Benzodiazepine.
Pharmacologic effect: Enhances GABA-A receptor activity.
Therapeutic effect: Anxiolysis, sedation, panic symptom reduction.
Predominant side effects: Sedation, dizziness, impaired coordination, respiratory depression when combined with other depressants, dependence/withdrawal.
Contraindications: Severe respiratory impairment caution, acute narrow-angle glaucoma, concurrent opioid/CNS depressant use requires extreme caution.
Considerations: Shorter acting with higher withdrawal/rebound anxiety potential than some benzodiazepines.
Nursing exam PEARL: Benzodiazepines plus opioids can suppress respirations and increase overdose risk. Avoid alcohol. [nida.nih.gov]

39. Midazolam

Class: Benzodiazepine.
Pharmacologic effect: Enhances GABA-A receptor activity.
Therapeutic effect: Sedation, anxiolysis, amnesia, procedural sedation, seizure termination in certain routes.
Predominant side effects: Respiratory depression, hypotension, oversedation, paradoxical agitation.
Contraindications: Severe respiratory depression without airway support; caution with opioids and other sedatives.
Considerations: Requires close monitoring of respiratory status, oxygen saturation, blood pressure, and level of consciousness. Fat soluble medication, in high doses or continuous infusions will leech into fat cells and slowly be metabolized which may result in prolonged sedation.
Nursing exam PEARL: Midazolam is commonly used for procedures. Airway equipment and reversal agent availability are key safety concepts. [nida.nih.gov]

40. Lorazepam

Class: Benzodiazepine.
Pharmacologic effect: Enhances GABA-A receptor activity.
Therapeutic effect: Anxiolysis, sedation, seizure control, alcohol withdrawal symptom control.
Predominant side effects: Sedation, respiratory depression, hypotension, confusion, falls.
Contraindications: Severe respiratory insufficiency caution, hypersensitivity, concurrent CNS depressants require caution.
Considerations: Often preferred in alcohol withdrawal and seizures. Monitor respiratory status and fall risk.
Nursing exam PEARL: Lorazepam is a common first-line medication for active seizures/status epilepticus and alcohol withdrawal protocols. [nida.nih.gov]

41. Diazepam

Class: Benzodiazepine.
Pharmacologic effect: Enhances GABA-A receptor activity.
Therapeutic effect: Anxiolysis, muscle relaxation, seizure control, alcohol withdrawal management.
Predominant side effects: Sedation, respiratory depression, hypotension, impaired coordination, falls.
Contraindications: Severe respiratory depression, severe hepatic impairment caution, myasthenia gravis caution.
Considerations: Long half-life and active metabolites can accumulate, especially in older adults.
Nursing exam PEARL: Diazepam lasts longer than lorazepam. Older adults are especially vulnerable to falls, confusion, and over sedation. [nida.nih.gov]

Reversal Agents

42. Naloxone

Class: Opioid antagonist.
Pharmacologic effect: Competitively blocks opioid receptors.
Therapeutic effect: Reverses opioid-induced respiratory depression and sedation.
Predominant side effects: Acute withdrawal, agitation, nausea/vomiting, tachycardia, hypertension, recurrent sedation after short duration.
Contraindications: No absolute contraindication in emergency opioid toxicity.
Considerations: Airway and ventilation remain the priority. Repeated dosing or infusion may be needed for long-acting opioids.
Nursing exam PEARL: Naloxone wakes the patient up, but it can wear off before the opioid does. Continue monitoring respirations after reversal. [ncbi.nlm.nih.gov], [nida.nih.gov]

43. Protamine Sulfate

Class: Heparin reversal agent.
Pharmacologic effect: Positively charged molecule binds negatively charged heparin.
Therapeutic effect: Reverses unfractionated heparin and partially reverses low molecular weight heparins.
Predominant side effects: Hypotension, bradycardia, anaphylactoid reaction, pulmonary hypertension.
Contraindications: Hypersensitivity; caution in fish allergy, prior protamine exposure, vasectomy history, and NPH insulin exposure.
Considerations: Administer slowly as ordered because rapid infusion increases hypotension and reaction risk.
Nursing exam PEARL: Protamine reverses heparin. Vitamin K reverses warfarin. Do not mix these up. [ncbi.nlm.nih.gov]

44. Flumazenil

Class: Benzodiazepine antagonist.
Pharmacologic effect: Competitively inhibits benzodiazepine binding at GABA-A receptors.
Therapeutic effect: Reverses benzodiazepine sedation.
Predominant side effects: Seizures, agitation, withdrawal, recurrent sedation.
Contraindications: Chronic benzodiazepine dependence, seizure disorder treated with benzodiazepines, suspected mixed overdose with seizure-provoking agents such as TCAs.
Considerations: Use is cautious because reversal can precipitate seizures in dependent patients.
Nursing exam PEARL: Flumazenil is not “benzo Narcan” in a simple sense. It can cause seizures, especially in chronic benzodiazepine users or mixed overdoses. [nida.nih.gov]

Anticoagulants / Antiplatelets

45. Apixaban

Class: Direct oral anticoagulant, factor Xa inhibitor.
Pharmacologic effect: Inhibits factor Xa, decreasing thrombin generation.
Therapeutic effect: Prevents/treats thromboembolism, including atrial fibrillation stroke prevention and VTE treatment/prevention.
Predominant side effects: Bleeding, bruising, anemia.
Contraindications: Active pathological bleeding; caution with severe renal/hepatic impairment and interacting drugs.
Considerations: Does not require routine INR monitoring. Assess renal function, bleeding, adherence, and peri-procedural hold instructions.
Nursing exam PEARL: DOACs have short half-lives compared with warfarin, so missed doses matter. Do not assume “no INR” means “no monitoring.” [ncbi.nlm.nih.gov]

46. Aspirin

Class: Antiplatelet; salicylate NSAID.
Pharmacologic effect: Irreversibly inhibits COX-1 and COX-2, reducing thromboxane A2-mediated platelet aggregation.
Therapeutic effect: Reduces platelet aggregation and thrombotic risk in selected cardiovascular conditions.
Predominant side effects: GI irritation, GI bleeding, bruising, tinnitus with toxicity, bronchospasm in sensitive patients.
Contraindications: Active bleeding, aspirin allergy, certain pediatric viral illness contexts due to Reye syndrome risk.
Considerations: Assess bleeding risk, stool appearance, concurrent anticoagulants/NSAIDs, and upcoming procedures.
Nursing exam PEARL: Aspirin is an antiplatelet, not an anticoagulant. Irreversible platelet inhibition means bleeding risk persists for the platelet lifespan. [ncbi.nlm.nih.gov]

47. Clopidogrel

Class: Antiplatelet; P2Y12 inhibitor.
Pharmacologic effect: Inhibits ADP-mediated platelet activation and aggregation.
Therapeutic effect: Prevents arterial thrombosis after ACS, stroke/TIA, or stent placement depending on indication.
Predominant side effects: Bleeding, bruising, GI upset, rare thrombotic thrombocytopenic purpura.
Contraindications: Active bleeding.
Considerations: Assess adherence after coronary stent placement because premature discontinuation can cause stent thrombosis.
Nursing exam PEARL: After stent placement, missed antiplatelet therapy can be life-threatening. Teach patients not to stop without cardiology/provider direction. [ncbi.nlm.nih.gov]

48. Heparin

Class: Parenteral anticoagulant.
Pharmacologic effect: Enhances antithrombin activity, inhibiting thrombin and factor Xa.
Therapeutic effect: Prevents clot extension and treats/prevents venous or arterial thromboembolism.
Predominant side effects: Bleeding, thrombocytopenia, heparin-induced thrombocytopenia, osteoporosis with long-term use.
Contraindications: Active bleeding, history of HIT, severe thrombocytopenia.
Considerations: Monitor aPTT or anti-Xa per protocol, platelet counts, bleeding, and infusion pump accuracy.
Nursing exam PEARL: HIT is a paradoxical clotting disorder with low platelets. If platelets drop significantly after heparin exposure, notify the provider and anticipate stopping heparin. [ncbi.nlm.nih.gov]

49. Warfarin / Coumadin

Class: Vitamin K antagonist anticoagulant.
Pharmacologic effect: Inhibits vitamin K-dependent clotting factors II, VII, IX, and X.
Therapeutic effect: Prevents and treats thromboembolic disease.
Predominant side effects: Bleeding, bruising, skin necrosis, many drug and food interactions.
Contraindications: Pregnancy, active bleeding, high bleeding risk without safe monitoring.
Considerations: Requires INR monitoring. Keep vitamin K intake consistent, not necessarily absent. Antibiotics, amiodarone, diet changes, and illness can change INR.
Nursing exam PEARL: Warfarin antidote is vitamin K. INR is the key lab. Green leafy vegetables are not banned, but intake should be consistent. [ncbi.nlm.nih.gov], [pmc.ncbi.nlm.nih.gov]

50. Enoxaparin

Class: Low molecular weight heparin.
Pharmacologic effect: Primarily inhibits factor Xa through antithrombin activation.
Therapeutic effect: Prevents and treats venous thromboembolism and is used in selected ACS protocols.
Predominant side effects: Bleeding, injection-site hematoma, thrombocytopenia, HIT risk lower than unfractionated heparin but still possible.
Contraindications: Active bleeding, history of HIT, severe renal impairment requires caution/dose adjustment.
Considerations: Usually administered subcutaneously in the abdomen. Do not expel the air bubble unless facility policy says otherwise, and do not massage after injection. Monitor renal function and bleeding.
Nursing exam PEARL: Enoxaparin is renally cleared. In kidney dysfunction, bleeding risk increases. Protamine only partially reverses LMWH. [ncbi.nlm.nih.gov]

Universal Nursing Safety PEARLs

Before cardiac meds: Check blood pressure, heart rate, rhythm, electrolytes, and clinical status. A medication that is safe in stable heart failure may be unsafe in acute decompensation. [ncbi.nlm.nih.gov]
Before antimicrobials: Assess allergy history, culture collection status, renal function, hepatic function, and prior reactions. [mcforms.mayo.edu]
Before opioids or benzodiazepines: Assess respiratory rate, sedation level, oxygenation, fall risk, and concurrent CNS depressants. [ncbi.nlm.nih.gov], [nida.nih.gov]
Before anticoagulants: Assess bleeding, platelet count when relevant, renal function, fall risk, procedure schedule, and concurrent antiplatelet/NSAID use. [ncbi.nlm.nih.gov]
Exam mindset: When asked what to do first, prioritize airway, breathing, circulation, severe allergic reaction, severe hypotension, severe bradycardia, active bleeding, and acute mental status change.