Kata Series (Deep-Dive Courses)
Pharmacology Bootcamp
Decode drugs by suffix, know the 25 that keep showing up, and recall every antidote, interaction, and calculation in seconds.
By the end you can
- Name a drug's class, hold rule, and main danger from its suffix
- Recall the antidote, interaction, or hold parameter that keeps the client safe
- Set up and solve dose, drip, and weight-based calculations
Your case
Med-surg · 0800 med pass · heart failure, AF
Mrs. K, 74. Home meds: digoxin, metoprolol, furosemide, and warfarin. She started ibuprofen for knee pain 3 days ago.
This morning she is nauseated, food tastes off, and the lights have yellow rings around them.
Apical HR 52BP 108/64K+ 3.1 mEq/LINR 2.6
Hold that thought
- Which of her 0800 meds do you hold?
- Why did her digoxin turn toxic?
- What is wrong with her new knee pain pill?
You will answer all three at the end of the lesson.
Concept 1 · Suffixes
Read the ending, know the class
Heart and blood pressure
- -olol, beta-blocker: metoprolol. Hold for HR under 60 or SBP under 90. Never stop abruptly
- -pril, ACE inhibitor: lisinopril. Dry cough, high K+, never in pregnancy
- -sartan, ARB: losartan, valsartan. Same K+ and pregnancy rules, but no cough
- -dipine, calcium channel blocker: amlodipine. Ankle edema, headache, flushing. No grapefruit
- -statin: atorvastatin. Report muscle pain (rhabdo), monitor liver tests. Simvastatin in the evening
Pearl: never heard of carvedilol? The -lol ending tells you beta-blocker, so you already know to check the HR and BP first.
Quick check 1 of 4
New order: valsartan 80 mg PO daily. From the suffix alone, which assessment matters most before the first dose?
-sartan is an ARB: it raises potassium and harms the fetus, so check K+ and pregnancy status first. Holding for HR under 60 is the beta-blocker rule (-olol), and liver tests go with statins.
Concept 2 · More suffixes
One ending unlocks the whole class
- -prazole, PPI: omeprazole, pantoprazole. 30 minutes before breakfast. Swallow whole
- -tidine, H2 blocker: famotidine. Milder acid control, fewer long-term risks
- Long-term PPI: low magnesium, calcium loss (fractures), low B12, C. diff
- -lam, -pam, benzodiazepine: lorazepam, midazolam. Respiratory depression, worse with opioids
- Benzo safety: fall risk in older adults. Reversal: flumazenil
- -triptan: sumatriptan. Acute migraine only. Not with CAD or uncontrolled HTN
- Triptan plus an SSRI: serotonin syndrome risk
- -parin: heparin, enoxaparin. aPTT for heparin. Reversal: protamine. Watch platelets (HIT)
- -teplase, thrombolytic: alteplase. Dissolves clots in MI and stroke, within the time window
- Thrombolytic contraindications: active bleeding, recent surgery, hemorrhagic stroke
- -floxacin: ciprofloxacin. Tendon rupture, neuropathy. Avoid under 18 and in pregnancy. Raises INR
- -micin, -mycin, aminoglycoside: gentamicin. Kidneys and hearing. Peak and trough levels
- -cillin: amoxicillin. Ask about allergy every time. Some cross-reactivity with cephalosporins
- -azole, antifungal: fluconazole. Liver toxicity, many drug interactions
- -vir, antiviral: acyclovir (push fluids). Oseltamivir within 48 hours of flu symptoms
Name that class
Say the class, then tap to check.
- Pantoprazole:
- Lorazepam:
- Enalapril:
- Levofloxacin:
- Tobramycin:
- Alteplase:
Watch out: azithromycin, clindamycin, and vancomycin are not aminoglycosides. Opioids have no reliable suffix: learn them by name.
Concept 3 · Cardiac and BP
Check the numbers before you give
Metoprolol: beta-blocker
- Does: lowers HR, BP, and the heart's oxygen demand
- Hold: HR under 60 or SBP under 90
- Diabetes: hides the fast heart rate of hypoglycemia
- Never stop abruptly: rebound tachycardia, hypertension, angina
- Teach: rise slowly. Daily weights in heart failure
Lisinopril: ACE inhibitor
- Does: blocks angiotensin-converting enzyme to lower BP
- Dry cough: from bradykinin. Switch to an ARB if it can't be tolerated
- High K+: no K+ supplements or K+-sparing diuretics. Monitor K+, creatinine, BUN
- Pregnancy: contraindicated in every trimester
- Swollen lips, tongue, or face: stop it. Airway emergency
Furosemide: loop diuretic
- Does: strong diuresis for heart failure, pulmonary edema, fluid overload
- Drops: K+, sodium, magnesium, calcium
- Low K+: weakness, U waves, arrhythmias
- Monitor: daily weight, I&O, K+, hearing at high doses or with aminoglycosides
- Give in the morning to prevent nocturia
Nitroglycerin: vasodilator
- Does: venodilation lowers preload and oxygen demand
- Check BP first: hold for SBP under 90
- Chest pain: 1 SL tab every 5 minutes, max 3. Call 911 if not better 5 minutes after the first
- Headache is expected. It is not a reason to stop
- Never with sildenafil or tadalafil in the past 24 to 48 hours: fatal hypotension
- Store in the original dark glass bottle
Pearl: the low K+ that furosemide causes is the classic setup for digoxin toxicity. That is the next screen.
Concept 4 · Digoxin
Low potassium makes digoxin toxic
- Does
- Stronger squeeze, slower rate
- Level
- 0.5 to 2.0 ng/mL. Narrow range
- Hold
- Apical HR under 60 adult, under 70 child. Count a full minute
- Toxicity
- Nausea, anorexia, yellow-green halos, bradycardia, arrhythmias
- Low K+
- Raises the risk of toxicity. Always check K+
- Antidote
- Digoxin immune fab (DigiFab). Recheck K+ after: it can fall fast
In practice now: heart failure guidelines aim for 0.5 to 0.9 ng/mL.
Quick check 2 of 4
A client on digoxin has nausea, yellow halos, and an apical pulse of 52. Digoxin level 2.8 ng/mL. What is the priority?
GI upset, halos, bradycardia, and a level over 2.0 are digoxin toxicity. Hold it, check K+ (low K+ worsens toxicity), and call the provider, who may order digoxin immune fab (DigiFab). Atropine treats the rate but not the toxic drug, so stopping the drug comes first.
Concept 5 · Endocrine and pain
Know the peak, the max, and the antidote
| Insulin | Type | Key fact |
|---|---|---|
| Regular | Clear, short-acting | The insulin for IV drips. SQ onset 30 minutes |
| NPH | Cloudy, intermediate | Peaks 4 to 12 hours: highest low-glucose risk |
| Glargine | Clear, long-acting | No peak. Never mix with other insulins |
Pearl: clear before cloudy: draw regular, then NPH. Tremor, sweating, confusion, fast HR? Give 15 g of fast-acting glucose. Rotate sites.
First-line for type 2 diabetes. No hypoglycemia when used alone. Rare but fatal lactic acidosis: hold at the time of IV contrast and for 48 hours after, and restart once kidney function is stable. Avoid in severe kidney impairment. Take with food for GI upset.
In practice now: radiology guidelines hold metformin only for eGFR under 30, acute kidney injury, or arterial contrast.
Empty stomach, 30 to 60 minutes before breakfast. Separate from calcium, iron, and antacids by 4 hours. Too much looks like hyperthyroidism: tachycardia, weight loss, tremor, heat intolerance. Full effect takes 4 to 6 weeks, so recheck TSH then.
Hold for RR under 12. Give a bowel regimen with every opioid. Also hypotension, urinary retention, sedation. Naloxone reverses it but wears off sooner, so watch for re-sedation. Itching is histamine release, not an allergy.
Pain and fever, no anti-inflammatory effect. Max 4 g a day, often 3 g for older adults or chronic use, and about 2 g with liver disease or heavy alcohol use. Overdose is the top cause of acute liver failure. Antidote: acetylcysteine, best within 8 hours. Hidden in many combination products.
Prednisone, methylprednisolone, dexamethasone. High glucose, infection risk, bone loss, GI ulcers, adrenal suppression. Taper. Never stop abruptly.
Concept 6 · Neuro and psych
Narrow ranges and slow pushes
- Phenytoin: 10 to 20 mcg/mL. IV in NS only, max 50 mg/min, on a monitor. Gum overgrowth: oral care
- Lithium: 0.6 to 1.2 mEq/L, toxic over 1.5. Dehydration, diuretics, low salt raise it
- Lithium teaching: steady salt intake and 2 to 3 L of fluid a day
- Sertraline (SSRI): 2 to 6 weeks to work. Watch young clients for suicidal thoughts early on
- Haloperidol: watch for EPS. Acute dystonia: benztropine or diphenhydramine. Prolongs QT
- Levodopa/carbidopa: rise slowly, no high-protein meals with it. No nonselective MAOIs
Lithium toxicity: vomiting, diarrhea, coarse tremor, confusion, seizures. Also check thyroid and kidney function. Phenytoin: nystagmus, ataxia, sedation, teratogenic, many drug interactions. Haloperidol EPS in order: dystonia, akathisia, parkinsonism, then tardive dyskinesia. Levodopa: on-off swings and dyskinesias with long-term use. SSRIs: wait 14 days after an MAOI.
Work it out
Order: phenytoin 1,000 mg IV in NS. What is the shortest safe infusion time for an adult?
minutes
Worked answer: 1,000 mg ÷ 50 mg per minute = 20 minutes at the fastest. Older adults run slower (25 mg/min, so 40 minutes). Faster than the max risks hypotension and cardiac arrest.
Concept 7 · Anticoagulants
Know the lab and the reversal
| Drug | Monitor | Reverse |
|---|---|---|
| Heparin | aPTT 1.5 to 2.5 times control. Platelets | Protamine sulfate |
| Warfarin | INR 2 to 3. Mechanical valve 2.5 to 3.5 | Vitamin K. PCC or FFP if bleeding |
| Enoxaparin | No routine aPTT. Anti-Xa if needed. Kidney function | Protamine (only partial) |
- HIT: platelets fall over 50 percent. Stop all heparin, switch to argatroban
- Heparin is never IM. SQ in the abdomen: rotate, don't aspirate, don't rub
- Enoxaparin: SQ, never IM. Leave the air bubble in the prefilled syringe
- Warfarin: 3 to 5 days to work, so it overlaps heparin. Not in pregnancy
- Any new drug on warfarin: recheck the INR
Pearl: warfarin diet means consistent vitamin K, not zero. A sudden jump in greens lowers the INR. A sudden drop raises it.
Concept 8 · Antibiotics, airway, GI
Order and speed matter here
- Vancomycin: MRSA, and by mouth for C. diff. Infuse over at least 60 minutes
- Too fast: flushing, rash, low BP. Not an allergy: slow it down, diphenhydramine if ordered
- Vanc toxicity: kidneys and hearing. Creatinine, BUN, trough levels
- Amoxicillin: ask about penicillin allergy every time. Finish the full course
- Rash with mono: amoxicillin or ampicillin plus EBV. Not a true allergy
In practice now: for vancomycin, most hospitals now dose by AUC instead of trough levels.
- Albuterol: rescue inhaler, works in minutes. Tachycardia, tremor, low K+
- Rescue use over 2 days a week: asthma is not controlled. Step up the controller
- Fluticasone: daily controller, not rescue. Takes days to weeks to work
- After fluticasone: rinse and spit to prevent thrush. A spacer helps delivery
- Omeprazole: short-term is best. Taper off to avoid rebound acid
- Ondansetron: prolongs QT. Headache, constipation. ODT for clients who are vomiting
- IV KCl: never IV push. Diluted, on a pump, max 10 mEq an hour peripherally (up to 20 through a central line, on a monitor)
- Site burning: slow the rate. Oral KCl with a full glass of water and food
Put the two-inhaler routine in order
Concept 9 · Antidotes
Antidotes are pure recall
Match the problem to its antidote
Five more
Say the antidote, then tap to check.
- Digoxin toxicity:
- Magnesium sulfate toxicity:
- Methotrexate toxicity:
- Beta-blocker overdose:
- Anaphylaxis:
Concept 10 · Emergency drugs
The crash cart six
- Epinephrine
- Anaphylaxis 0.3 to 0.5 mg IM, repeat every 5 to 15 min. Arrest: 1 mg IV every 3 to 5 min
- Atropine
- Symptomatic bradycardia: 1 mg IV every 3 to 5 min, max 3 mg
- Amiodarone
- VF or pulseless VT: 300 mg IV, then 150 mg. Prolongs QT
- Adenosine
- SVT: rapid push in a proximal IV, instant flush. Warn of brief asystole
- D50
- Severe low glucose with altered LOC: 25 to 50 mL IV. Glucagon IM if no IV
- Naloxone
- 0.4 to 2 mg IV or IM, 4 mg nasal. Lasts 30 to 90 min: watch for re-sedation
Quick check 3 of 4
A client on magnesium sulfate for severe preeclampsia has absent deep tendon reflexes and RR 10. What does the nurse give?
Absent DTRs and respiratory depression are magnesium toxicity. Stop the infusion and give calcium gluconate, which belongs at the bedside for every MgSO4 infusion. Naloxone and flumazenil reverse opioids and benzodiazepines, which this client did not get.
Concept 11 · Interactions
Question the order that would harm
Question it or give it?
Tap an order, then tap the box it belongs in.
Three more never-combines
- Aminoglycoside + loop diuretic: double ototoxicity. Avoid, or check hearing closely
- Warfarin + NSAIDs or aspirin: platelet effects, GI erosion, more free warfarin. Bleeding
- Grapefruit + statins, CCBs, cyclosporine: blocks CYP3A4. Levels climb for 24 to 72 hours
Concept 12 · Serotonin syndrome vs NMS
Jerky and fast, or rigid and slow
- Cause: serotonin excess. MAOI plus SSRI is the most dangerous
- Other combos: SSRI with tramadol, a triptan, linezolid, or St. John's wort. Meperidine with any
- Signs: myoclonus, hyperreflexia, fever, sweating, diarrhea, agitation
- Onset: hours
- Treat: stop every serotonergic drug, cool, benzodiazepines, cyproheptadine
- Cause: dopamine blockade. Antipsychotics, especially haloperidol
- Signs: very high fever, confusion, unstable vitals, high CPK
- Rigidity: lead pipe, a smooth and constant resistance
- Onset: days
- Treat: stop the antipsychotic, dantrolene, bromocriptine, aggressive cooling, ICU
Quick check 4 of 4
A client on sertraline gets a new order for tramadol after a minor procedure. Which complication concerns the nurse?
Tramadol has serotonergic activity, so adding it to an SSRI can cause serotonin syndrome. Question the order and ask for another analgesic. NMS comes from dopamine blockers such as antipsychotics, not from serotonergic drugs.
Concept 13 · Safety rules
Hold it or give it?
Decide each dose
Metoprolol, HR 56:
Adult on digoxin, apical HR 64:
Child on digoxin, apical HR 68:
Lisinopril, K+ 5.6:
Morphine, RR 16, awake and alert:
Losartan, SBP 86:
Line rules
- IV KCl: never push. Diluted, on a pump
- Phenytoin: NS only, max 50 mg/min
- Vancomycin: over at least 60 minutes
- Blood: NS only. Never LR: its calcium triggers clotting
- Regular insulin: the IV drip insulin. Heparin: never IM
Concept 14 · Dosage calculations
Set it up right and the math is free
- Basic
- Desired ÷ have × quantity. 500 mg ordered, 250 mg tabs = 2 tabs
- Drip rate
- mL × drop factor ÷ minutes. 1,000 mL in 8 hr at 15 gtt/mL = 31 gtt/min
- Weight
- mg/kg × kg. Pounds ÷ 2.2 = kg
Work it out
Heparin 1,200 units/hr. The bag holds 25,000 units in 500 mL. Pump rate?
mL/hr
Worked answer: 25,000 ÷ 500 = 50 units/mL. 1,200 ÷ 50 = 24 mL/hr. At 48 mL/hr she would get 2,400 units an hour.
Work it out
Child, 33 lb. Ceftriaxone 50 mg/kg IV daily. You have 1 g in 10 mL. How many mL?
mL
Worked answer: 33 ÷ 2.2 = 15 kg. 50 × 15 = 750 mg. 1 g in 10 mL = 100 mg/mL. 750 ÷ 100 = 7.5 mL.
Work it out
Dopamine 5 mcg/kg/min for an 80 kg client. The bag holds 400 mg in 250 mL. Pump rate?
mL/hr
Worked answer: 5 × 80 = 400 mcg/min. 400 mg ÷ 250 mL = 1.6 mg/mL = 1,600 mcg/mL. 400 ÷ 1,600 = 0.25 mL/min. × 60 = 15 mL/hr.
Decide it
The 0800 med pass
Back to Mrs. K · apical HR 52 · K+ 3.1
Due now: digoxin, metoprolol, furosemide, and warfarin. She is still nauseated and seeing yellow rings around the lights.
What do you do first?
Digoxin plus a beta-blocker at HR 52 slows her further. Toxicity signs mean hold.
Right. HR 52 is under 60 for both drugs, and nausea plus halos says digoxin toxicity. Ask for a digoxin level and report the K+ of 3.1.
Atropine does not treat the toxic drug, and more digoxin feeds the problem.
Digoxin level 2.8 ng/mL. The provider orders KCl 10 mEq IV over 1 hour. How do you give it?
Never. IV push potassium causes fatal arrhythmias at any speed.
Not safe. Potassium runs on a pump so the rate is controlled.
Right. IV potassium is always diluted and always on a pump. If the site burns, slow the rate.
Her knee aches, and she asks for her ibuprofen. What do you do?
Right. NSAIDs with warfarin raise bleeding risk: platelet effects, GI erosion, and more free warfarin. Acetaminophen, 3 g a day or less, is the safer choice.
Over the counter does not mean safe. An NSAID adds bleeding risk to warfarin even when the INR is in range.
Stopping warfarin exposes her to a stroke from AF. The ibuprofen is the problem, not the warfarin.
How it ends
- Digoxin and metoprolol held, KCl run on a pump, K+ and digoxin level rechecked
- The halos and nausea fade as her digoxin level falls
- Ibuprofen stopped, acetaminophen for the knee, furosemide plan reviewed
Lock it in
Three hooks to carry into the exam
Two more
- Clear before cloudy: draw regular insulin first, then NPH
- 60, 90, 12: hold for HR under 60, SBP under 90, or RR under 12
Rapid fire
Clients on warfarin should avoid all green leafy vegetables.
Consistency, not avoidance. Sudden changes in vitamin K swing the INR.
Protamine sulfate reverses heparin.
About 1 mg per 100 units. It only partly reverses enoxaparin.
Pantoprazole works best taken with a meal.
PPIs go 30 minutes before the first meal, swallowed whole.
Itching after morphine is a true allergy.
It is histamine release. A true allergy looks like anaphylaxis.
Clients should rinse the mouth after using fluticasone.
Steroid left in the mouth causes thrush.
NCLEX traps
What the exam will try to trick you with
Read the suffix. Carvedilol ends in -lol: beta-blocker. Check HR and BP, and never stop it abruptly.
Wrong antidote. Protamine is for heparin. Warfarin gets vitamin K, plus PCC or FFP for active bleeding.
It is a rate problem. Slow the infusion to at least 60 minutes. Diphenhydramine first if ordered.
Divide. 154 lb ÷ 2.2 = 70 kg. Convert every unit (mg to mcg, hours to minutes) before you calculate.
Check the safe range. Above the safe dose: hold and notify the provider. An answer like 2.7 tablets or 500 tablets means recalculate.
Cheat card
The whole lesson on one card
Suffixes
- -olol: HR 60, SBP 90, no abrupt stop
- -pril: cough, high K+, no pregnancy
- -sartan: same, minus the cough
- -micin: kidneys, ears, peak and trough
Antidotes
- Opioid: naloxone, may repeat
- Heparin: protamine
- Warfarin: vitamin K, PCC or FFP
- Magnesium: calcium gluconate
Safety
- No nitro after sildenafil
- SSRI + tramadol = serotonin syndrome
- IV K+: never push, always a pump
- Phenytoin: NS only, 50 mg/min
Math
- Desired ÷ have × quantity
- mL × gtt factor ÷ minutes
- Pounds ÷ 2.2 = kg
- mcg/kg/min: convert, then × 60
The printable version is in the Cheat Sheets library.
Lesson quiz · 1 of 5
A client is starting IV gentamicin for a severe UTI. Which monitoring matters most?
Gentamicin is an aminoglycoside, toxic to the kidneys and the ears. Peak and trough levels keep it in range, with the trough drawn just before the next dose. It is not a liver, clotting, or glucose drug.
Lesson quiz · 2 of 5
An unresponsive client has pinpoint pupils and RR 6 after taking "pills from the medicine cabinet." What does the nurse prepare first?
Pinpoint pupils, respiratory depression, and unresponsiveness are the opioid overdose triad. Naloxone treats it and confirms it while you support breathing. Charcoal is unsafe when the client can't protect the airway, and benzodiazepines do not cause pinpoint pupils.
Lesson quiz · 3 of 5
A client on warfarin has an INR of 9.2, bleeding gums, a nosebleed, and dark stools. Which treatment fits best?
Active bleeding with a very high INR needs clotting factors now (PCC or FFP) and IV vitamin K for lasting reversal. Oral vitamin K alone is too slow. Protamine reverses heparin, not warfarin.
Lesson quiz · 4 of 5
A client takes levothyroxine every morning and started calcium and iron supplements this week. What is the most important teaching?
Calcium and iron both bind levothyroxine in the gut and cut its absorption. Take it on an empty stomach 30 to 60 minutes before breakfast, with the supplements at least 4 hours away. They don't need to stop, just be timed.
Lesson quiz · 5 of 5
Which action shows correct IV phenytoin administration?
Phenytoin precipitates in dextrose, so NS is the only solution. Faster than 50 mg/min can cause hypotension, arrhythmias, and cardiac arrest, so the client stays on a monitor. Flush with NS before and after.
Wrap-up
0 / 5
Quiz score
Back to Mrs. K · 0800 med pass
Which meds do you hold? Digoxin and metoprolol. Her apical HR is 52, under the 60 cutoff for both, and her symptoms say digoxin toxicity. Report the K+ of 3.1 before the furosemide goes in.
Why did her digoxin turn toxic? Furosemide dropped her K+ to 3.1, and low potassium makes digoxin toxic. Nausea, yellow halos, and bradycardia are the classic signs.
What is wrong with the knee pill? Ibuprofen with warfarin raises bleeding risk: platelet effects, GI erosion, and more free warfarin. Stop it, tell the provider, and use acetaminophen at 3 g a day or less.
Keep going