Memory tricks for nursing pharmacology

All beta blockers end in -olol (metoprolol, atenolol, propranolol, carvedilol). Block beta-1 (heart) and beta-2 (lungs) receptors. Side effects — BASH: Bradycardia (hold if HR <60), AV block, Bronchospasm (avoid in asthma/COPD), Sexual dysfunction, Hypotension. Never stop abruptly — taper to avoid rebound hypertension and angina. Check apical pulse before giving. Used for: HTN, heart failure, angina, dysrhythmias, post-MI.

Anticholinergic drugs block acetylcholine — the "rest and digest" neurotransmitter. ANTI means NOT, so these are all the things your patient CAN'T do. Classic drugs: atropine, diphenhydramine, scopolamine, oxybutynin, tricyclic antidepressants.

Hypothyroidism occurs when the thyroid doesn't produce enough hormones, slowing the entire metabolism. Think of MOM'S SO TIRED as the perfect picture of someone whose body has completely slowed down. Treatment: levothyroxine (synthetic T4).

Hyperkalemia is one of the most dangerous electrolyte imbalances — it can cause fatal cardiac arrhythmias. Normal K+ is 3.5–5.0 mEq/L. Causes: renal failure, acidosis, potassium-sparing diuretics, ACE inhibitors. Treatment: calcium gluconate (cardiac protection), insulin + glucose (shift K+ into cells), kayexalate, dialysis.

LEAN helps you remember the key emergency drugs nurses must know cold. Each targets a specific crisis situation and must be available for rapid administration.

Lidocaine is generally safe but has a narrow therapeutic window. SAMS helps you recognize toxicity early — symptoms progress from mild neurological changes to seizures if not caught quickly.

TRAMP is your checklist for safe and accurate medication administration. Each step must be verified before giving any medication to any patient, every single time.

SEA CASH helps nurses and patients recognize the serious side effects that oral contraceptives can occasionally cause. These symptoms require immediate medical attention and may indicate clotting complications.

IDEA helps you recall the four drugs used when heart rate and blood pressure drop dangerously low. Each works through a different mechanism — knowing which to reach for first is critical in emergencies.

Thiazides are the most commonly prescribed oral diuretics. CHIC helps you remember the four conditions they are used to treat — a high-yield NCLEX topic especially for hypertension management.

PALS helps you remember the four antiarrhythmic drugs used to treat ventricular arrhythmias. Amiodarone is currently the most widely used, but all four may appear on NCLEX and in clinical practice.

All ACE inhibitors end in -pril (lisinopril, enalapril, captopril, ramipril). Block conversion of angiotensin I → II → less vasoconstriction, less aldosterone → lower BP + less sodium/water retention. Key side effects: Dry hacking cough (most common reason stopped — switch to ARB). Angioedema: life-threatening swelling of airway — STOP immediately, epinephrine. Hyperkalemia (blocks aldosterone). Teratogenic (category D/X) — never in pregnancy. First-dose hypotension. Check K+ and creatinine.

Digoxin: cardiac glycoside — slows HR (negative chronotrope), strengthens contraction (positive inotrope). Therapeutic level: 0.5–2 ng/mL. Toxicity signs — early GI: nausea, vomiting, anorexia. Visual: yellow-green halos around lights (classic). Cardiac: bradycardia, heart block, dysrhythmias. Hypokalemia potentiates toxicity (K+ competes at same receptor). Antidote: Digibind (digoxin immune fab). Hold if apical pulse <60. Assess K+ before giving. Toxicity treated with: hold drug, K+ replacement, Digibind for severe.

Vitamin K antagonist — inhibits clotting factors II, VII, IX, X. Monitor INR (not PTT — that's heparin). Therapeutic INR: 2–3 (most indications), 2.5–3.5 (mechanical heart valves). Foods high in Vitamin K (green leafy vegetables) DECREASE warfarin effect — consistent intake, not elimination. Drug interactions: enormous — antibiotics, NSAIDs, many others. Antidote: Vitamin K (slow, oral/IV) or FFP (fast, emergency). Bleeding precautions: soft toothbrush, electric razor. Hold for procedures. Takes 3–5 days to reach therapeutic level.

Heparin activates antithrombin III → inhibits thrombin and factor Xa. Monitor aPTT (activated partial thromboplastin time) — therapeutic: 60–100 seconds (1.5–2.5× normal of ~40 sec). NOT INR (that's warfarin). Antidote: protamine sulfate. HIT (Heparin-Induced Thrombocytopenia): paradoxical clotting — check platelets. If platelets drop >50% → STOP heparin, switch to argatroban. LMWH (enoxaparin/Lovenox): does NOT require monitoring, give SubQ, do not rub. Overdose signs: bleeding — gums, urine (hematuria), stools (melena).

Opioids (morphine, oxycodone, hydromorphone, fentanyl): bind mu receptors. Side effects — COAT: Constipation (always give stool softener), Over-sedation, Aspiration risk (nausea/vomiting), respiratory depression (most dangerous). Respiratory depression: RR <12, O2 sat dropping → administer naloxone (Narcan). Tolerance: need more for same effect. Physical dependence: withdrawal if stopped abruptly. Assess pain BEFORE giving, reassess 30–60 min after. Naloxone: short-acting — may need repeat doses. Hold if RR <12.

Corticosteroids (prednisone, methylprednisolone, dexamethasone): anti-inflammatory, immunosuppressive. Long-term CUSHINGS side effects: Cataracts, Ulcers (PUD — give with food/antacid), Skin thinning/bruising, Hypertension, Immunosuppression (infection risk — no live vaccines), Necrosis (avascular femoral head), Growth suppression (children), Sugar increase (hyperglycemia — monitor blood glucose). Never stop abruptly → adrenal crisis. Taper over weeks. Give in morning (mimics cortisol rhythm). Moon face, buffalo hump, central obesity = Cushing's syndrome.

Loop diuretics (furosemide/Lasix, bumetanide): most potent. Act in loop of Henle. Lose K+, Na+, Mg2+, Ca2+. Monitor K+ — hypokalemia potentiates digoxin toxicity. Ototoxicity (hearing loss) — avoid with other ototoxic drugs. Thiazides (HCTZ, chlorthalidone): act in DCT. Also lose K+. Used for HTN. Potassium-sparing (spironolactone, triamterene): act in collecting duct. KEEP K+ — monitor for hyperkalemia. Spironolactone: anti-aldosterone, used in heart failure. Osmotic (mannitol): draws fluid out of brain — used for cerebral edema. Monitor I&O and daily weights for all diuretics.

Culture before antibiotics — 'culture before cure.' Allergy history: penicillin allergy — 1–10% cross-reactivity with cephalosporins. Anaphylaxis kit at bedside after first dose. Aminoglycosides (gentamicin, tobramycin): nephrotoxic + ototoxic — monitor BUN/creatinine, peak/trough levels. Fluoroquinolones: tendon rupture risk, avoid in children. Tetracyclines: avoid in pregnancy, children <8 (discolors teeth), take with full glass of water, no dairy. Superinfection: C. diff (watery diarrhea after antibiotics — contact precautions), oral thrush. Complete the full course.

Rapid-acting (lispro/Humalog, aspart/NovoLog): onset 15 min, give WITH meal or right after. Short-acting (Regular/Humulin R): onset 30–60 min, only insulin given IV. Intermediate (NPH/Humulin N): onset 2–4 hr, cloudy — gently roll, never shake. Long-acting (glargine/Lantus, detemir/Levemir): no peak, 24 hr. NEVER mix glargine. Draw clear before cloudy (Regular before NPH). Hypoglycemia: BS <70, diaphoresis, tremor, confusion — give 15g fast carbs, recheck in 15 min (15-15 rule). Insulin sites: rotate — abdomen absorbs fastest.

Naloxone (Narcan): opioid overdose — short-acting, may need repeat. Flumazenil (Romazicon): benzodiazepine reversal — short-acting, seizure risk in benzo-dependent. Protamine sulfate: heparin reversal — 1 mg per 100 units heparin. Vitamin K: warfarin reversal — slow (hours-days). FFP: fast warfarin reversal. Digibind (digoxin immune fab): digoxin toxicity. N-acetylcysteine (Mucomyst): acetaminophen (Tylenol) overdose — give within 8–10 hr, most effective. Atropine: organophosphate poisoning / bradycardia. Glucagon: beta-blocker or calcium channel blocker overdose.

Antipsychotics EPS (extrapyramidal symptoms) — ADAPT: Akathisia (restlessness), Dystonia (muscle spasm — treat with Benadryl), Akinesia (reduced movement), Parkinsonism, Tardive dyskinesia (late, irreversible — tongue/lip smacking). Neuroleptic Malignant Syndrome (NMS): fever, rigidity, altered LOC — STOP drug. Lithium: therapeutic 0.6–1.2 mEq/L. Toxicity: early — fine tremor, N/V, diarrhea. Toxic — coarse tremor, ataxia, confusion, seizure. Low Na+ increases lithium toxicity (dehydration). Adequate fluid and Na+ intake essential. SSRIs: serotonin syndrome — hyperthermia, agitation, clonus.

Rapid-acting (inject just before meals): Lispro (Humalog), Aspart (NovoLog), Glulisine (Apidra) — Onset 15 min, Peak 1–2h, Duration 3–4h. Short-acting (inject 30 min before meals): Regular (Humulin R, Novolin R) — Onset 30–60 min, Peak 2–4h, Duration 6–8h. ONLY insulin given IV. Intermediate-acting: NPH (Humulin N) — Onset 1–2h, Peak 6–14h, Duration up to 24h. Cloudy — mix last when combining. Long-acting (basal — once daily, no peak): Glargine (Lantus), Detemir (Levemir), Degludec (Tresiba) — Onset 1–2h, No peak, Duration 20–24h. Never mix long-acting with other insulins. Never shake insulin — roll gently. Clear before cloudy when mixing (Regular before NPH). Hypoglycemia: peak time is when hypoglycemia risk is highest — assess at peak. NCLEX: only Regular insulin IV, long-acting has no peak, clear before cloudy.

SSRIs (selective serotonin reuptake inhibitors): fluoxetine, sertraline, escitalopram, paroxetine, citalopram. SNRIs: venlafaxine, duloxetine. Common side effects: GI upset (nausea — take with food), sexual dysfunction (most common reason for non-compliance), insomnia or sedation, weight changes. Black Box Warning: increased risk of suicidal ideation in children and young adults under 25 — monitor closely in first weeks. Serotonin Syndrome (too much serotonin): HALT — Hyperthermia, Agitation/anxiety, Labile vitals (BP, HR), Tremor/myoclonus/clonus. Triggered by: combining SSRIs + MAOIs (fatal — 14-day washout required), tramadol, triptans, St. John's Wort, linezolid. Treatment: stop offending drug, cyproheptadine, supportive care. Discontinuation syndrome: do NOT stop abruptly — taper. SSRI onset: 2–4 weeks for full effect — teach patient to continue even when not feeling better yet.

Metformin (Glucophage) is first-line for Type 2 DM. Mechanism: decreases hepatic glucose production, improves insulin sensitivity — does NOT cause hypoglycemia alone. Advantages: weight neutral/loss, cardioprotective, inexpensive. Side effects: GI (nausea, diarrhea, metallic taste — take with food), Vitamin B12 deficiency (long-term use). Critical nursing consideration: hold metformin before IV contrast dye (CT, angiography) and before surgery — risk of lactic acidosis if kidneys impaired (contrast can temporarily impair renal function). Restart 48 hours after contrast if renal function normal. Contraindications: eGFR <30 (renal failure), hepatic disease, excessive alcohol use, heart failure (risk of lactic acidosis). Lactic acidosis signs: muscle pain, weakness, GI symptoms, difficulty breathing, dizziness — medical emergency. NCLEX: scheduled for CT with contrast → hold metformin.

High-alert medications have a high risk of causing significant patient harm when used in error. ISMP High-Alert list highlights: IV Potassium chloride (concentrated KCl — NEVER give IV push — cardiac arrest). Insulin (high hypoglycemia risk, dose errors common). Narcotics/opioids (respiratory depression). Chemotherapy (narrow therapeutic index, extravasation risk, dosing errors). Heparin (bleeding, HIT — Heparin-Induced Thrombocytopenia). Also: concentrated electrolytes (hypertonic NaCl), neuromuscular blocking agents (paralysis — must be ventilated), oral methotrexate, anticoagulants (warfarin, DOACs). Safety practices: independent double-check with second nurse, pharmacy verification, standard concentrations, SMART pumps with dose limits, clear labeling, separate storage of concentrated electrolytes. NCLEX: concentrated KCl IV push = fatal, insulin requires second nurse check at most facilities.

Chemotherapy affects all rapidly dividing cells — cancer AND normal. Universal side effects: myelosuppression (neutropenia, anemia, thrombocytopenia — nadir 7–14 days post-chemo), nausea/vomiting (antiemetics before chemo), mucositis (oral/GI ulceration — mouth care), alopecia (reversible), fatigue. Neutropenia precautions (ANC <500): protective/reverse isolation, no fresh flowers/plants, low-bacteria diet, no rectal temps or suppositories, visitors screened. Thrombocytopenia (<50,000): bleeding precautions — soft toothbrush, electric razor, no NSAIDs, fall precautions. Extravasation (vesicant leaks into tissue): stop infusion immediately, leave needle in, aspirate residual drug, apply antidote per protocol, elevate extremity, document, notify provider and pharmacy. Vesicants (most dangerous): vincristine, doxorubicin, taxol. PPE required for nurses handling chemo: gown, gloves (double), eye protection, closed-toe shoes.

Medication errors are the most common cause of preventable patient harm. Medication reconciliation = comparing patient's current medications against new orders at every transition of care. Required at: admission (complete medication history), transfer (unit to unit, OR to floor), discharge (reconcile home meds with new prescriptions). Obtain complete list: prescription drugs, OTC medications, herbals/supplements, vitamins, patches, eye drops, inhalers — patients often forget non-prescriptions. High-risk interactions to catch: herbal + anticoagulants (St. John's Wort decreases warfarin effectiveness), grapefruit juice + statins/calcium channel blockers (increases drug levels), NSAIDs + anticoagulants (GI bleed). The "Five Rights" of medication administration: Right patient (2 identifiers), Right drug, Right dose, Right route, Right time. Expanded: Right documentation, Right reason, Right response. NCLEX: always verify allergies before ANY medication, always use 2 patient identifiers.

Beta blockers block beta-adrenergic receptors → decrease HR, BP, myocardial oxygen demand. Drugs: metoprolol, atenolol, carvedilol, propranolol, labetalol. Uses: HTN, angina, HF (carvedilol, metoprolol — counterintuitive but proven), post-MI, arrhythmias, hyperthyroidism, performance anxiety (propranolol). Side effects: bradycardia (hold if HR <60), hypotension (hold if SBP <90), fatigue, depression, sexual dysfunction, bronchospasm (avoid in asthma/COPD — non-selective beta blockers block beta-2 → bronchoconstriction; use cardioselective -olol if needed), hypoglycemia masking (blocks tachycardia response to hypoglycemia — diabetics won't feel it coming). Critical rules: NEVER stop abruptly — rebound hypertension, angina, MI risk. Taper over 1–2 weeks. Metoprolol tartrate (immediate) vs succinate (extended release) — do not crush succinate. Labetalol: alpha + beta blocker — used in hypertensive emergency in pregnancy.

Always ask about herbals/supplements — patients don't think of them as "medications." High-yield herbal interactions: The Four G's (all increase bleeding — dangerous with anticoagulants/NSAIDs): Garlic, Ginger, Ginkgo biloba, Ginseng. St. John's Wort: induces CYP450 enzymes → decreases effectiveness of: warfarin, oral contraceptives, digoxin, HIV medications, cyclosporine. Also serotonin syndrome risk with SSRIs. Echinacea: immunostimulant — avoid in autoimmune disease, organ transplant patients. Valerian + kava: sedation — additive with CNS depressants. Saw palmetto: may affect hormone-sensitive conditions. Black cohosh: estrogen-like — avoid in breast cancer. Pre-op assessment: STOP all herbals 2 weeks before surgery — bleeding risk, anesthesia interactions, BP effects. NCLEX: patient on warfarin starts St. John's Wort → INR decreases (under-anticoagulated), DVT/PE risk.

Warfarin (Coumadin) requires constant patient teaching. Vitamin K-rich foods (leafy greens) lower INR — tell patients to keep intake CONSISTENT, not eliminate them. Antidote: Vitamin K (phytonadione). Therapeutic INR for most conditions is 2–3; for mechanical heart valves: 2.5–3.5.

The classic opioid overdose triad: pinpoint pupils (miosis) + unconscious/unresponsive + respiratory rate below 12. Treat immediately with Naloxone (Narcan) IV/IM/IN. Narcan wears off in 30–90 min — patient may re-sedate if opioid has a long half-life. Always monitor post-Narcan.