Common Medications
High-Alert Medications
ISMP High-Alert Medications list — require extra safeguards.
| Category | Examples | Key Precautions |
|---|---|---|
| Anticoagulants | Heparin, warfarin, enoxaparin, DOACs | Bleeding risk; double-check dosing; monitor labs |
| Insulin | All insulin types | Never use "U" for units; verify type and dose; hypoglycemia risk |
| Opioids | Morphine, fentanyl, hydromorphone | Respiratory depression; have naloxone available; assess sedation |
| Concentrated Electrolytes | KCl, MgSO₄, NaCl (hypertonic) | Dilute per protocol; never push concentrated K⁺; cardiac monitoring |
| Chemotherapy | Various cytotoxic agents | Double verification; PPE; vesicant precautions; extravasation protocol |
Antihypertensives
| Class | Examples | Key Nursing Considerations |
|---|---|---|
| ACE Inhibitors (-pril) | Lisinopril, enalapril, ramipril | Monitor K⁺, creatinine; dry cough; angioedema risk; avoid in pregnancy |
| ARBs (-sartan) | Losartan, valsartan, olmesartan | Similar to ACE-I but no cough; monitor K⁺, renal function |
| Beta-blockers (-olol) | Metoprolol, atenolol, carvedilol | Mask hypoglycemia; bradycardia; avoid abrupt withdrawal; caution in asthma |
| Calcium Channel Blockers (-dipine) | Amlodipine, nifedipine, diltiazem | Peripheral edema; constipation (verapamil, diltiazem); grapefruit interaction |
| Diuretics | Thiazide (HCTZ), loop (furosemide), K⁺-sparing (spironolactone) | Monitor electrolytes; orthostatic hypotension; I/O; ototoxicity (aminoglycosides + loop) |
Anticoagulants
| Drug | Monitoring | Antidote |
|---|---|---|
| Heparin | aPTT (1.5–2.5× control), platelets (HIT) | Protamine sulfate |
| Enoxaparin (Lovenox) | Anti-Xa (if needed); renal function | Protamine (partial reversal) |
| Warfarin (Coumadin) | INR (typically 2–3) | Vitamin K, PCC, FFP |
| Rivaroxaban (Xarelto) | Renal function; no routine coagulation monitoring | Andexanet alfa |
| Apixaban (Eliquis) | Renal function; no routine coagulation monitoring | Andexanet alfa |
Insulin
| Type | Onset | Peak | Duration |
|---|---|---|---|
| Rapid (lispro, aspart) | 15 min | 1–2 hr | 3–5 hr |
| Short (regular) | 30–60 min | 2–4 hr | 5–8 hr |
| Intermediate (NPH) | 1–2 hr | 4–12 hr | 12–18 hr |
| Long (glargine, detemir) | 1–2 hr | No distinct peak | 18–24 hr (glargine up to 24) |
Common Antibiotics
| Class | Examples | Key Considerations |
|---|---|---|
| Penicillins | Amoxicillin, ampicillin, piperacillin/tazobactam | Allergy cross-reactivity; take with food (some) |
| Cephalosporins | Cefazolin, ceftriaxone, ceftaroline | 10% cross-reactivity with penicillin; avoid in anaphylactic penicillin allergy |
| Fluoroquinolones | Levofloxacin, ciprofloxacin, moxifloxacin | Tendon rupture, QT prolongation; avoid in myasthenia gravis |
| Macrolides | Azithromycin, clarithromycin, erythromycin | QT prolongation; CYP interactions |
| Aminoglycosides | Gentamicin, tobramycin, amikacin | Nephrotoxicity, ototoxicity; peak/trough monitoring |
| Vancomycin | Vancomycin | Red man syndrome (infuse slowly); trough monitoring; nephrotoxicity |
Opioid Analgesics
| Drug | Equianalgesic Dose (PO) | Key Points |
|---|---|---|
| Morphine | 30 mg (baseline) | Gold standard; active metabolites accumulate in renal failure |
| Hydromorphone | 7.5 mg | More potent; fewer metabolites; preferred in renal impairment |
| Oxycodone | 20 mg | Often combined with acetaminophen; avoid exceeding APAP limits |
| Fentanyl | N/A (transdermal/IV) | Transdermal: 100 mcg/hr ≈ morphine 200 mg/day PO; lipophilic |
| Codeine | 200 mg | Prodrug; CYP2D6 poor metabolizers get little analgesia |
| Tramadol | ~300 mg | SNRI + weak opioid; seizure risk; serotonin syndrome |