Pharmacology questions make up 12-18% of the NCLEX exam—and for many Filipino nurses, this section feels like the biggest hurdle. With thousands of medications to study, where do you even begin?
Here’s the secret successful NCLEX passers know: you don’t need to memorize every drug. Instead, focus on the 50 high-alert medications that appear most frequently on the exam.
At Ray A. Gapuz Review System (RAGRS), we’ve helped thousands of Filipino nurses pass NCLEX since 2001. Our systematic approach to pharmacology focuses on understanding drug classes rather than memorizing individual drugs—and it works.
In this comprehensive guide, you’ll discover:
- The 50 most-tested high-alert medications organized by category
- Key nursing interventions for each drug
- Memory tips that actually stick
- The RAGRS syndromic approach to medication mastery
Let’s transform pharmacology from your weakness into your strength.
Why High-Alert Medications Matter on NCLEX
What Are High-Alert Medications?
The Institute for Safe Medication Practices (ISMP) defines high-alert medications as drugs that carry a heightened risk of causing significant patient harm when used incorrectly. These aren’t necessarily the most dangerous drugs—they’re the ones where errors are most likely to cause serious consequences.
Why does NCLEX focus on these medications? Because they test what matters most: patient safety. The National Council of State Boards of Nursing (NCSBN) wants to ensure every new nurse can safely administer these critical drugs.
How Pharmacology Questions Appear on NGN
On the Next Generation NCLEX (NGN), pharmacology questions don’t just ask you to identify a drug. You’ll encounter:
- Standalone questions: “Which assessment finding indicates digoxin toxicity?”
- Case study integration: Managing a patient with multiple medications across 6 connected questions
- SATA (Select All That Apply): “Which nursing interventions are appropriate before administering this medication?”
- Drug calculations: Dosage calculations embedded in clinical scenarios
- Priority questions: “Which medication should the nurse administer first?”
The key is understanding why you’re giving a medication, what to assess before and after, and when to hold or question an order.
The 50 High-Alert Medications by Category
How to use this guide: Each table includes the drug name, classification, key nursing considerations, and a memory tip. Focus on understanding the class first—drugs with similar suffixes often share similar effects and side effects.
Category 1: Cardiovascular Drugs (10 Medications)
Cardiovascular medications appear frequently on NCLEX because cardiac patients are high-risk. Master these 10 drugs and you’ll be prepared for most cardiac pharmacology questions.
| # | Drug | Classification | Key Nursing Considerations | Memory Tip |
|---|---|---|---|---|
| 1 | Digoxin | Cardiac glycoside | Check apical pulse (hold if <60 bpm), monitor potassium levels, assess for toxicity (nausea, visual changes, bradycardia) | “Dig into the heart rate first” |
| 2 | Warfarin (Coumadin) | Anticoagulant | Monitor INR (therapeutic: 2-3), Vitamin K is antidote, teach bleeding precautions, many food/drug interactions | “War on clots—but causes bleeding” |
| 3 | Heparin | Anticoagulant | Monitor PTT (therapeutic: 1.5-2.5x control), Protamine sulfate is antidote, check for HIT | “Heparin = Hours to work, monitor PTT” |
| 4 | Enoxaparin (Lovenox) | Low-molecular-weight heparin | SubQ injection only (abdomen), no routine monitoring needed, don’t expel air bubble | “Low-maintenance heparin” |
| 5 | Metoprolol | Beta-blocker | Monitor HR and BP before giving, don’t stop abruptly (rebound hypertension), masks hypoglycemia | “-olol = slow heart rate” |
| 6 | Lisinopril | ACE inhibitor | Dry cough (common side effect), risk of hyperkalemia, angioedema risk (stop immediately) | “-pril = Pressure Reduction” |
| 7 | Furosemide (Lasix) | Loop diuretic | Monitor potassium (hypokalemia risk), ototoxicity with IV push, assess for dehydration | “Lasix lasts 6 hours” |
| 8 | Amiodarone | Antiarrhythmic | Pulmonary toxicity, thyroid dysfunction, extremely long half-life (weeks), photosensitivity | “Amio for dangerous arrhythmias” |
| 9 | Nitroglycerin | Vasodilator | Headache is expected (indicates working), hypotension risk, max 3 doses for chest pain (then call 911) | “Nitro = No more than 3“ |
| 10 | Dopamine | Vasopressor | Dose-dependent effects, extravasation causes tissue necrosis (Phentolamine is antidote) | “Dope for low blood pressure” |
Memory Strategy: For cardiovascular drugs, always assess vital signs before administration. If the drug lowers BP or HR, and the patient already has low BP/HR, hold and notify the provider.
Category 2: Diabetes & Metabolic Drugs (8 Medications)
Diabetes medications are NCLEX favorites because they require careful patient teaching and timing. Understanding the difference between insulin types is essential.
| # | Drug | Classification | Key Nursing Considerations | Memory Tip |
|---|---|---|---|---|
| 11 | Regular Insulin (Humulin R) | Short-acting insulin | Only insulin given IV, onset 30-60 min, peak 2-4 hrs, clear solution | “Regular goes in Regular Veins” |
| 12 | NPH Insulin | Intermediate-acting insulin | Cloudy (roll, don’t shake), onset 1-2 hrs, peak 4-12 hrs, do not give IV | “NPH = Noon peak” |
| 13 | Insulin Glargine (Lantus) | Long-acting insulin | No peak (steady release), once daily, NEVER mix with other insulins, clear solution | “Glargine goes all day (24 hrs)” |
| 14 | Metformin | Biguanide | Hold 48 hrs before/after contrast dye, lactic acidosis risk, don’t use if renal impairment | “Met your glucose goals without weight gain” |
| 15 | Glipizide | Sulfonylurea | Hypoglycemia risk (stimulates insulin release), take 30 min before meals | “Gli- = Glucose goes Lower” |
| 16 | Levothyroxine (Synthroid) | Thyroid hormone replacement | Take on empty stomach (AM), wait 30-60 min before eating, many drug interactions | “Levo = the Left side of your neck (thyroid)” |
| 17 | Prednisone | Corticosteroid | Never stop abruptly (taper), immunosuppression, hyperglycemia, weight gain, mood changes | “Prednisone = Predictable side effects” |
| 18 | Potassium Chloride (KCl) | Electrolyte replacement | NEVER IV push (cardiac arrest), max 10 mEq/hr via peripheral line, monitor ECG | “K+ Kills if pushed Kwickly” |
Memory Strategy: For insulins, remember RANLi (Rapid → Regular → NPH → Long-acting) for onset order. Regular is the only one that can go IV.
Category 3: CNS & Pain Management Drugs (10 Medications)
Neurological and pain medications require careful monitoring for sedation and respiratory depression. Know your antidotes!
| # | Drug | Classification | Key Nursing Considerations | Memory Tip |
|---|---|---|---|---|
| 19 | Morphine | Opioid analgesic | Respiratory depression (#1 concern), constipation, Naloxone (Narcan) is antidote | “Morphine = Major pain, Monitor breathing” |
| 20 | Fentanyl | Opioid analgesic | 100x stronger than morphine, patches last 72 hrs, fatal if misused | “Fentanyl = Fast-acting, Fatally strong” |
| 21 | Hydrocodone | Opioid analgesic | Often combined with acetaminophen, monitor liver function, teach not to exceed daily limits | “Hydro for Home use” |
| 22 | Naloxone (Narcan) | Opioid antagonist | Reverses opioid overdose, short half-life (may need repeat doses), precipitates withdrawal | “Naloxone Nullifies Narcotics” |
| 23 | Phenytoin (Dilantin) | Anticonvulsant | Gingival hyperplasia, requires IV filter, never mix with D5W (precipitates), therapeutic level 10-20 | “Phenytoin Fights seizures” |
| 24 | Levetiracetam (Keppra) | Anticonvulsant | Fewer drug interactions than phenytoin, watch for behavioral/mood changes | “Keppra keeps seizures away (fewer side effects)” |
| 25 | Haloperidol (Haldol) | Antipsychotic | EPS (extrapyramidal symptoms), NMS risk, QT prolongation—monitor ECG | “Haldol halts psychosis but watch for EPS” |
| 26 | Lorazepam (Ativan) | Benzodiazepine | Respiratory depression, Flumazenil is antidote, avoid in elderly (fall risk) | “Lorazepam for anxiety (but watch breathing)” |
| 27 | Lithium | Mood stabilizer | Narrow therapeutic range (0.6-1.2 mEq/L), toxicity signs (tremors, confusion, seizures), maintain sodium/fluid intake | “Lithium = Listen for toxicity” |
| 28 | Sertraline (Zoloft) | SSRI antidepressant | Serotonin syndrome risk (with other serotonergic drugs), 2-4 weeks to work, don’t stop abruptly | “Sertraline = Serotonin” |
Memory Strategy: For opioid safety, remember the 3 Rs: Respiratory rate, Rise slowly (orthostatic hypotension), Relieve constipation.
Category 4: Antibiotics & Anti-Infectives (8 Medications)
Antibiotic questions focus on proper administration, monitoring for toxicity, and patient teaching. Pay attention to nephrotoxicity and ototoxicity risks.
| # | Drug | Classification | Key Nursing Considerations | Memory Tip |
|---|---|---|---|---|
| 29 | Vancomycin | Glycopeptide antibiotic | Monitor trough levels (10-20 mcg/mL), Red Man Syndrome (infuse slowly), ototoxicity, nephrotoxicity | “Vanco = Very potent, Verify trough” |
| 30 | Gentamicin | Aminoglycoside | Nephrotoxicity and ototoxicity, monitor peak/trough, assess hearing and kidney function | “Gentamicin is NOT gentle on kidneys or ears” |
| 31 | Ciprofloxacin | Fluoroquinolone | Tendon rupture risk (especially with steroids), avoid in children/pregnant, photosensitivity | “Cipro = Caution with Tendons” |
| 32 | Penicillin | Beta-lactam antibiotic | Always ask about allergies first! Anaphylaxis risk, cross-reactivity with cephalosporins | “Penicillin = Possible Allergy Always ask” |
| 33 | Metronidazole (Flagyl) | Antibiotic/Antiparasitic | NO alcohol (disulfiram-like reaction), metallic taste, darkened urine is normal | “Metro + alcohol = Misery” |
| 34 | Fluconazole | Antifungal | Hepatotoxicity risk, many drug interactions (CYP450), avoid in pregnancy | “Flu-con = Fights Fungus, check liver” |
| 35 | Acyclovir | Antiviral | Hydration essential (crystallizes in kidneys), adjust dose for renal impairment | “Acyclovir Attacks viruses—hydrate!” |
| 36 | Isoniazid (INH) | Anti-tuberculosis | Hepatotoxicity, give Vitamin B6 (pyridoxine) to prevent peripheral neuropathy | “INH = Isolate for TB, Need B6″ |
Memory Strategy: For aminoglycosides (drugs ending in -mycin), remember: “My Two Kin” = Mycin, Toxic to ears (ototoxic), Kidneys (nephrotoxic).
Category 5: Respiratory & Other Critical Drugs (14 Medications)
This category includes emergency medications, respiratory drugs, and high-risk specialty medications. These are often tested in critical care scenarios.
| # | Drug | Classification | Key Nursing Considerations | Memory Tip |
|---|---|---|---|---|
| 37 | Albuterol | Beta-2 agonist bronchodilator | Tremors and tachycardia (expected), rescue inhaler (use first in asthma attack) | “Albuterol = Always first for asthma” |
| 38 | Fluticasone | Inhaled corticosteroid | Rinse mouth after use (prevents thrush), maintenance—not rescue | “Fluticasone = Fights Inflammation (rinse after)” |
| 39 | Theophylline | Bronchodilator | Narrow therapeutic index (10-20 mcg/mL), caffeine toxicity symptoms, many drug/food interactions | “Theo = Therapeutic levels critical” |
| 40 | Epinephrine | Catecholamine/Vasopressor | First-line for anaphylaxis, causes tachycardia and hypertension, IM (thigh) for allergic reactions | “Epi for Emergencies” |
| 41 | Magnesium Sulfate | Electrolyte/Anticonvulsant | Pre-eclampsia seizure prevention, monitor respirations (hold if <12), check reflexes, Calcium gluconate is antidote | “Mag for Moms (pre-eclampsia)” |
| 42 | Oxytocin (Pitocin) | Uterotonic | Water intoxication risk, monitor contractions and fetal heart rate continuously | “Oxy = Oh, baby’s coming!” |
| 43 | Amphotericin B | Antifungal | “Ampho-terrible”—severe nephrotoxicity, fever/chills during infusion, premedicate | “Ampho = Awful side effects” |
| 44 | Methotrexate | Immunosuppressant/Antineoplastic | Give with folic acid (leucovorin rescue), bone marrow suppression, teratogenic | “Methotrexate = give vitaMins (folic acid)” |
| 45 | Cyclosporine | Immunosuppressant | Nephrotoxicity, monitor drug levels, many drug interactions, gingival hyperplasia | “Cyclo = check Creatinine” |
| 46 | Propofol | Anesthetic/Sedative | “Milk of amnesia” (white), respiratory depression, lipid-based (change tubing q12h) | “Propofol = Procedure sedation” |
| 47 | Succinylcholine | Neuromuscular blocker | Malignant hyperthermia risk, causes complete paralysis (patient is awake but can’t move) | “Succ = Surgery paralysis” |
| 48 | Alteplase (tPA) | Thrombolytic | Bleeding risk, stroke within 3-4.5 hrs, MI within 12 hrs, no IM injections after | “Alteplase Alters clots (time-sensitive!)” |
| 49 | Chemotherapy agents | Antineoplastics | Wear PPE, vesicant precautions, monitor nadir (lowest WBC count), reproductive counseling | “Chemo = Careful Handling” |
| 50 | IV Potassium | Electrolyte | Max 10 mEq/hr peripheral (20 mEq/hr central), cardiac monitoring required, NEVER IV push | “K+ = Kills if infused too fast” |
Memory Strategy: For emergency drugs, remember “Every Patient Always Takes Medication”: Epinephrine, Propofol, Alteplase, Thrombolytics, Magnesium sulfate.
Memory Strategies for NCLEX Pharmacology
The RAGRS Syndromic Approach to Medications
At RAGRS, we don’t teach you to memorize 1,000 individual drugs. Instead, we focus on the syndromic approach:
- Master drug CLASSES, not individual drugs
- All drugs ending in -olol are beta-blockers (slow heart rate)
- All drugs ending in -pril are ACE inhibitors (cause dry cough)
- All drugs ending in -statin are for cholesterol (check liver function)
- Learn the PROTOTYPE for each class
- Metoprolol represents all beta-blockers
- Lisinopril represents all ACE inhibitors
- If you know the prototype, you know the class
- Focus on nursing INTERVENTIONS, not just drug facts
- NCLEX doesn’t just ask “What is digoxin?” It asks “What should the nurse assess before giving digoxin?”
Creating Effective Mnemonics
Build memory aids that work for YOU:
- Personal connections: Link to patients you’ve cared for
- Visual associations: Picture a “heart digging” for digoxin
- Suffix rules: “-mycin” drugs are toxic to ears and kidneys
Practice Questions Over Flashcards
Flashcards teach recognition. NCLEX tests application.
- Practice with NCLEX-style questions that integrate pharmacology into patient scenarios
- Focus on “What would the nurse do?” not “What is this drug?”
Common NCLEX Pharmacology Traps to Avoid
❌ Memorizing every drug without understanding classes → ✅ Learn suffixes and prototypes—if you know one, you know them all
❌ Ignoring antidotes and reversal agents → ✅ Know: Narcan for opioids, Vitamin K for warfarin, Protamine for heparin, Flumazenil for benzos
❌ Forgetting patient teaching points → ✅ NCLEX loves questions about what to teach patients (signs of toxicity, when to take meds, what to avoid)
❌ Missing drug-drug and drug-food interactions → ✅ Warfarin interacts with EVERYTHING. Grapefruit affects many drugs. Tetracycline and dairy don’t mix.
Frequently Asked Questions
How many pharmacology questions are on NCLEX?
Approximately 12-18% of NCLEX questions involve pharmacology. However, medications are integrated throughout all question types—you might see pharmacy concepts in a maternity, pediatric, or psychiatric scenario.
Should I memorize all 50 medications on this list?
Focus on understanding drug classes first. These 50 represent the most frequently tested high-alert medications, but knowing the class (beta-blockers, ACE inhibitors, opioids) is more valuable than memorizing individual drugs.
What are the most commonly tested NCLEX medications?
Digoxin, warfarin, heparin, insulin, potassium, and opioids appear most frequently. These high-alert medications require careful monitoring and have life-threatening risks if administered incorrectly.
How do I remember drug side effects?
Use the RAGRS syndromic approach: group drugs by class and learn common class effects. All “-olol” drugs slow heart rate. All aminoglycosides are nephrotoxic and ototoxic. All opioids cause respiratory depression.
What’s the best way to study NCLEX pharmacology?
Practice application questions, not just flashcards. Focus on:
- What to assess before giving the drug
- What to monitor after administration
- When to hold the medication
- What to teach the patient
Does RAGRS cover pharmacology in their review program?
Yes! The RAGRS syndromic approach specifically addresses medication mastery through systematic classification. Our review includes dedicated pharmacology modules with practice questions and the memory strategies used by our 100% pass rate students.
Start Your NCLEX Pharmacology Journey
Pharmacology doesn’t have to be overwhelming. With the right approach—focusing on drug classes, mastering the 50 most-tested medications, and practicing application questions—you can transform this challenging topic into a strength.
Ready to master NCLEX pharmacology? The Ray A. Gapuz Review System has helped thousands of Filipino nurses pass NCLEX since 2001 using our proven syndromic approach.
📞 Contact RAGRS today to learn more about our comprehensive NCLEX review program, including our dedicated pharmacology module.