CHAMBERLAIN NR 293 | GALEN NUR 210 | WCU NURS 180 | RASMUSSEN NUR 2474 | GCU NSG 318 | 2026/2027
ACADEMIC CYCLE
NR 293 & NUR 210 PHARMACOLOGY COMPLETE EXAM 1–4 & FINAL
STUDY GUIDE
Curriculum Alignment: BSN / ADN Undergraduate Nursing Pharmacology, ATI CMS RN Pharmacology & Next-Gen NCLEX (NGN) |
Aligned Texts: Lilley's Pharmacology and the Nursing Process, Adams & Urban, Lehne's Pharmacology for Nursing Care
(2026/2027).
Legal & Authorship Disclaimer: Independently authored educational synthesis and original clinical practice bank created for
undergraduate academic revision during the 2026/2027 cycle. Not affiliated with or reproduced from any proprietary university
exam. All 80 drug prototype tables, antidote matrices, and NGN rationales are 100% original clinical formulations.
DOCUMENT ARCHITECTURE (PAGES 1–16): Page 1: High-Alert Antidote & Reversal Matrix + Therapeutic Drug Monitoring (TDM)
Windows | Mod 1 (p. 2–3): Autonomic & CNS Drugs (Prototypes #1–20) | Mod 2 (p. 4–5): Cardiovascular, Renal & Hematologic
Drugs (Prototypes #21–40) | Mod 3 (p. 6–7): Endocrine, Respiratory & GI Drugs (Prototypes #41–60) | Mod 4 (p. 8–9):
Antimicrobials, Antineoplastics & Immunologics (Prototypes #61–80) | Mod 5 (p. 10): Top 10 Nursing Administration & Safety
Algorithms | Mod 6 (p. 11–16): 4 Unfolding NGN Case Studies + 20 Exam 1–4 Board Vignettes with Verified Rationales.
PREVIEW HOOK: MASTER ANTIDOTE, REVERSAL AGENT & THERAPEUTIC DRUG MONITORING (TDM) MATRIX
SPECIFIC ANTIDOTE / THERAPEUTIC LAB CRITICAL NURSING INTERVENTION & HIGH-
DRUG / TOXIN CLASS
REVERSAL WINDOW / TARGET YIELD EXAM TRAP
Opioids ANTIDOTE Naloxone Hold Opioid if RR < 12 bpm; EXAM TRAP Naloxone half-life (30–90 min)
(Morphine, Fentanyl, (Narcan) 0.4–2 mg monitor EtCO2 & sedation is shorter than most opioids; monitor closely
Hydromorphone) IV/IM/IN scale (Pasero). for rebound respiratory depression
(renarcotization) and acute withdrawal pain.
Benzodiazepines ANTIDOTE Flumazenil Used for status epilepticus, BLACK BOX Concurrent opioid + benzo use
(Lorazepam, 0.2 mg IV over 15–30 sec acute alcohol withdrawal causes fatal respiratory depression. Flumazenil
Midazolam, Diazepam) (CIWA), & procedural can precipitate acute refractory seizures in
sedation. chronic benzo users or TCA overdose.
Unfractionated ANTIDOTE Protamine aPTT: 60–80 sec (1.5–2.5× BLACK BOX Epidural/spinal hematoma risk.
Heparin & LMWH Sulfate (1 mg per 100 control). Anti-Xa: 0.3–0.7 Monitor platelets daily for HIT (stop if platelets
(Enoxaparin) units Heparin) IU/mL. drop >50% or <100,000/mm3). Max Protamine
dose = 50 mg slow IV over 10 min.
Warfarin (Coumadin) ANTIDOTE Standard INR: 2.0–3.0 EXAM TRAP Vitamin K takes 6–24h to
(Vitamin K Antagonist) Phytonadione (Vit K) + 4- Mechanical Valve INR: 2.5– synthesize new clotting factors; give 4-Factor
Factor PCC (Kcentra) 3.5 PCC or FFP immediately for life-threatening
active hemorrhage. Maintain consistent leafy
green intake.
Digoxin (Lanoxin) ANTIDOTE Digoxin 0.5–2.0 ng/mL (Heart PRIORITY Auscultate apical pulse for 1 full
(Cardiac Glycoside) Immune Fab (DigiFab) IV Failure optimal: 0.5–0.9 minute (hold if <60 bpm). Hypokalemia (<3.5
ng/mL). Check K+ (3.5–5.0). mEq/L) from loop diuretics dramatically
precipitates fatal digoxin arrhythmias &
yellow/green halos.
Acetaminophen ANTIDOTE Max Adult Dose: 4,000 Restores hepatic glutathione stores to detoxify
(Tylenol) Acetylcysteine (NAC / mg/day (2,000–3,000 NAPQI metabolite; most effective within 8–10h
(Analgesic / Mucomyst) PO or IV mg/day in liver of ingestion. Oral solution smells like rotten
Antipyretic) disease/alcohol). eggs (mix with juice/soda). Monitor
AST/ALT/INR.
Lithium Carbonate Hemodialysis + IV 0.9% 0.6–1.2 mEq/L (Acute EXAM TRAP Hyponatremia, dehydration,
(Bipolar Mood Normal Saline Hydration Mania: up to 1.5; Toxic: >1.5 NSAIDs, and thiazide diuretics force proximal
Stabilizer) mEq/L). renal tubules to reabsorb Lithium, causing
coarse tremors, ataxia, confusion, and
seizures.
Magnesium Sulfate & MgSO4: Calcium Therapeutic OB MgSO4: 4–7 Hold MgSO4 and infuse Calcium Gluconate if
Cholinergics / Gluconate 10% mEq/L. loss of patellar DTRs, RR < 12 bpm, or urine
Organophosphates Cholinergic: Atropine + Phenytoin TDM: 10–20 output < 30 mL/hr. For organophosphate
Pralidoxime mcg/mL. poisoning (SLUDGE), give Atropine to dry
Vancomycin Trough: 10–20 airway secretions.
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 1 of 16
, MODULE 1A: FOUNDATIONAL PRINCIPLES & AUTONOMIC NERVOUS SYSTEM EXAM 1 CORE
(PROTOTYPES 1–10) BLUEPRINT
FIGURE 1.1: AUTONOMIC RECEPTOR ARCHITECTURE & NEUROMUSCULAR JUNCTION TARGET MAP
1. ALPHA-1 & ALPHA-2 RECEPTORS 2. BETA-1 (1 HEART) & BETA-2 (2 LUNGS) 3. MUSCARINIC (PARASYMPATHETIC) 4. NICOTINIC M (NEUROMUSCULAR)
• Alpha-1 (Vascular Smooth Muscle): • Beta-1 (Myocardium, SA/AV, JGA): • Cholinergic Agonists ("SLUDGE"): • Depolarizing (Succinylcholine):
↑
Vasoconstriction, BP, Mydriasis ↑HR, ↑Contractility, ↑Renin (Dobutamine) Bethanechol (Bladder), Neostigmine (MG) Fasciculations → Flaccid Paralysis
Agonists: Norepinephrine, Phenylephrine • Beta-2 (Bronchioles, Uterus, Liver): • Anticholinergics (Atropine, Ipratropium): Triggers Malignant Hyperthermia & K+ ↑
• Alpha-2 (Central Brainstem Sympatholytic): ↑
Bronchodilation, Glucose, Shifts K+ in ↑HR, Dry Mouth, Urinary Retention, • Non-Depolarizing (Pancuronium/Roc):
↓
Clonidine ( NE outflow; Rebound HTN) Trap: Propranolol blocks B2 → Bronchospasm Contraindicated in Glaucoma & BPH Zero sedation/analgesia! Reverse w/ Neostig
PRIORITY NURSING
PROTOTYPE DRUG & EXACT MECHANISM OF BLACK BOX WARNINGS (BBW)
# INTERVENTIONS & PATIENT
CLASS ACTION & SERIOUS ADVERSE EFFECTS
TEACHING
1 Epinephrine Stimulates α1 Hypertensive crisis, ventricular 1ST LINE Anaphylaxis & Cardiac
Non-Selective (vasoconstriction), β1 dysrhythmias, angina, Arrest. Inject EpiPen (0.3 mg IM
Adrenergic Agonist
↑
( HR/contractility), and β2
pulmonary edema, extravasation 1:1,000) into outer anterolateral
tissue necrosis. thigh (hold 3–10s). Massage not
(bronchodilation & mast cell
required; go to ED immediately.
stabilization).
2 Norepinephrine Profound α1 peripheral BLACK BOX Severe ischemic 1ST LINE Vasopressor for Septic
(Levophed) arterial/venous tissue necrosis and sloughing Shock. Infuse via central venous
Potent α1 > β1 Agonist vasoconstriction with with peripheral IV extravasation; line whenever possible. If
modest β1 positive inotropic reflex bradycardia. extravasation occurs, infiltrate site
cardiac stimulation. immediately with Phentolamine
(5–10 mg).
3 Dopamine Low (1–5 mcg/kg/min): D1 BLACK BOX Peripheral Correct hypovolemia with IV fluids
Dose-Dependent renal dilation; Med (5–10): ischemia/gangrene upon prior to initiating infusion.
Inotrope / Vasopressor β1 cardiac output; High extravasation. Severe sinus Continuous ECG and arterial BP
(>10): α1 vasoconstriction. tachycardia, ectopic beats, monitoring. Antidote for local
angina. extravasation: Phentolamine.
4 Dobutamine Selectively stimulates Tachyarrhythmias, premature Used for acute decompensated
Selective β1 Adrenergic myocardial β1 receptors to ventricular contractions (PVCs), heart failure and cardiogenic
Agonist increase stroke volume and myocardial ischemia, blood shock. TRAP Physically
cardiac output with minimal pressure fluctuations. incompatible with alkaline
vascular tone change. solutions (do not mix with Sodium
Bicarbonate).
5 Albuterol Selectively activates Paradoxical bronchospasm, RESCUE For acute
Short-Acting β2 bronchial smooth muscle β2 reflex tachycardia, palpitations, asthma/bronchospasm. Wait 1
Agonist (SABA) receptors →↑cAMP → rapid fine skeletal muscle tremors, min between puffs of SABA; wait 5
bronchodilation. hypokalemia & hyperglycemia. min before inhaled steroid. Always
use Albuterol FIRST to open
airways.
6 Atropine Sulfate Competitively blocks Anticholinergic toxidrome: 1ST LINE Symptomatic
Anticholinergic acetylcholine at muscarinic hyperthermia, delirium, severe Bradycardia (0.5–1 mg IV push
(Muscarinic receptors in SA/AV nodes, tachycardia, paralytic ileus, q3–5m) & Organophosphate
Antagonist) exocrine glands, and urinary retention, acute poisoning. Antidote for Atropine
smooth muscle. glaucoma. overdose: Physostigmine.
Contraindicated in angle-closure
glaucoma.
7 Bethanechol Directly stimulates Cholinergic crisis (SLUDGE: Indicated for non-obstructive
Direct Muscarinic muscarinic receptors of the salivation, lacrimation, urination, postoperative/postpartum urinary
Agonist urinary tract →
contracts diaphoresis, GI cramps, emesis), retention. Administer 1h before or
detrusor muscle and relaxes hypotension, bronchospasm. 2h after meals. Strictly
trigone/sphincter. contraindicated in asthma, peptic
ulcer, or GI/urinary obstruction.
8 Neostigmine / Inhibits acetylcholinesterase Cholinergic Crisis (overdose: Used for Myasthenia Gravis &
Pyridostigmine enzyme in synaptic cleft → bradycardia, fasciculations, reversal of nondepolarizing
Reversible prolongs acetylcholine bronchorrhea, respiratory neuromuscular blockers.
Cholinesterase stimulation at paralysis) vs. Myasthenic Crisis Administer 30–60 min before
Inhibitor neuromuscular junction (underdose) meals to improve swallowing Keep
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 2 of 16
, MODULE 1B: CENTRAL NERVOUS SYSTEM, ANALGESICS & PSYCHOTROPICS EXAM 1 CORE
(PROTOTYPES 11–20) BLUEPRINT
PRIORITY NURSING
PROTOTYPE DRUG & EXACT MECHANISM OF BLACK BOX WARNINGS (BBW)
# INTERVENTIONS & PATIENT
CLASS ACTION & SERIOUS ADVERSE EFFECTS
TEACHING
11 Morphine Sulfate Binds central & spinal μ BLACK BOX Life-threatening Assess pain & respiratory rate prior
Pure Opioid Agonist (mu) and κ (kappa) opioid respiratory depression, to giving; hold if RR < 12 bpm.
(Schedule II) receptors; inhibits addiction/misuse, neonatal Tolerance develops to all effects
ascending pain abstinence syndrome. EXCEPT constipation and miosis
transmission & alters pain Orthostatic hypotension, urinary (always co-prescribe a stimulant
perception. retention, miosis, severe laxative + stool softener). Antidote:
constipation. Naloxone.
12 Fentanyl High-affinity lipophilic μ- BLACK BOX Fatal respiratory EXAM TRAP Transdermal
Synthetic Opioid opioid agonist; 50 to 100 depression; transdermal heat patches take 12–24h to reach peak
Agonist (Schedule II) times more potent than exposure causes massive fatal onset (only for opioid-tolerant
Morphine. overdose; chest wall rigidity with chronic pain, never acute post-op
rapid IV push. pain). Never apply heating pads
over patch. Fold used patch in half
and flush.
13 Naloxone (Narcan) Competitively displaces Acute precipitated opioid Titrate slowly IV in post-op patients
Pure Competitive opioid agonists from μ, κ, withdrawal: severe pain crisis, to reverse respiratory depression
Opioid Antagonist and δ receptors in the CNS agitation, emesis, tachycardia, without ablating all analgesia.
without intrinsic agonist hypertensive surge, pulmonary Monitor vital signs every 15 min for
activity. edema, ventricular arrhythmias. 2 hours due to short half-life
(rebound sedation).
14 Lorazepam (Ativan) Binds allosterically to BLACK BOX Profound 1ST LINE IV drug of choice for
Benzodiazepine GABAA receptor complex, sedation, coma, and death when acute Status Epilepticus and acute
(Schedule IV) increasing the frequency of combined with opioids/alcohol; alcohol withdrawal delirium. Never
chloride channel opening physical dependence and fatal discontinue abruptly (taper slowly).
(hyperpolarization). withdrawal seizures. Antidote: Flumazenil.
15 Phenytoin (Dilantin) Stabilizes neuronal BLACK BOX Cardiovascular TDM: 10–20 mcg/mL (>20 =
Hydantoin membranes by delaying collapse, severe hypotension, & nystagmus, ataxia, slurred speech).
Anticonvulsant recovery of voltage-gated VF if IV infusion exceeds 50 TRAP Infuse ONLY in 0.9%
Na+ channels from mg/min. SJS/TEN, teratogenic Normal Saline (precipitates in
inactivated state. (fetal hydantoin syndrome), D5W!). Causes gingival
Purple Glove Syndrome. hyperplasia (soft toothbrush,
dental visits). Continuous tube
↓
feedings absorption (hold feed
1–2h before/after).
16 Carbamazepine Blocks voltage-gated Na+ BLACK BOX Fatal aplastic TDM: 4–12 mcg/mL. Induces its
(Tegretol) channels in hyperactive anemia & agranulocytosis; fatal own metabolism (autoinduction)
Iminostilbene neurons; inhibits repetitive SJS/TEN in patients with HLA- and decreases oral contraceptive &
Anticonvulsant action potentials. B*1502 allele (Asian ancestry). Warfarin efficacy. Report fever,
SIADH (hyponatremia). sore throat, mouth ulcers, or
petechiae immediately.
17 Levetiracetam Binds synaptic vesicle Behavioral/psychiatric Renally cleared with minimal
(Keppra) protein SV2A in the brain, abnormalities ("Keppra rage": hepatic CYP450 drug interactions
Pyrrolidine modulating agitation, hostility, depression, (preferred in oncology and
Anticonvulsant neurotransmitter release suicidal ideation), somnolence, polypharmacy). Adjust dose in
and inhibiting burst firing. asthenia, Stevens-Johnson CKD. Monitor mood and suicidal
syndrome. ideation at every clinic visit.
18 Fluoxetine (Prozac) / Selectively blocks BLACK BOX Increased risk of Takes 4–6 weeks for full
Sertraline presynaptic serotonin (5-HT) suicidal ideation and behavior in therapeutic mood lift; energy
Selective Serotonin reuptake transporters, children, adolescents, and young returns in week 1–2 (highest
Reuptake Inhibitor increasing synaptic adults (<24 yrs) during initial 1– suicide attempt risk!). Avoid St.
(SSRI) serotonin concentration. 4 weeks. Serotonin Syndrome. John's Wort, MAOIs (14-day
washout; 5 weeks for Fluoxetine),
Linezolid, and Tramadol.
19 Haloperidol (Haldol) Potent blockade of BLACK BOX Increased EPS Triad: Acute Dystonia
1st-Gen Typical postsynaptic dopamine D2 mortality in elderly patients with (oculogyric crisis/torticollis → give
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 3 of 16
ACADEMIC CYCLE
NR 293 & NUR 210 PHARMACOLOGY COMPLETE EXAM 1–4 & FINAL
STUDY GUIDE
Curriculum Alignment: BSN / ADN Undergraduate Nursing Pharmacology, ATI CMS RN Pharmacology & Next-Gen NCLEX (NGN) |
Aligned Texts: Lilley's Pharmacology and the Nursing Process, Adams & Urban, Lehne's Pharmacology for Nursing Care
(2026/2027).
Legal & Authorship Disclaimer: Independently authored educational synthesis and original clinical practice bank created for
undergraduate academic revision during the 2026/2027 cycle. Not affiliated with or reproduced from any proprietary university
exam. All 80 drug prototype tables, antidote matrices, and NGN rationales are 100% original clinical formulations.
DOCUMENT ARCHITECTURE (PAGES 1–16): Page 1: High-Alert Antidote & Reversal Matrix + Therapeutic Drug Monitoring (TDM)
Windows | Mod 1 (p. 2–3): Autonomic & CNS Drugs (Prototypes #1–20) | Mod 2 (p. 4–5): Cardiovascular, Renal & Hematologic
Drugs (Prototypes #21–40) | Mod 3 (p. 6–7): Endocrine, Respiratory & GI Drugs (Prototypes #41–60) | Mod 4 (p. 8–9):
Antimicrobials, Antineoplastics & Immunologics (Prototypes #61–80) | Mod 5 (p. 10): Top 10 Nursing Administration & Safety
Algorithms | Mod 6 (p. 11–16): 4 Unfolding NGN Case Studies + 20 Exam 1–4 Board Vignettes with Verified Rationales.
PREVIEW HOOK: MASTER ANTIDOTE, REVERSAL AGENT & THERAPEUTIC DRUG MONITORING (TDM) MATRIX
SPECIFIC ANTIDOTE / THERAPEUTIC LAB CRITICAL NURSING INTERVENTION & HIGH-
DRUG / TOXIN CLASS
REVERSAL WINDOW / TARGET YIELD EXAM TRAP
Opioids ANTIDOTE Naloxone Hold Opioid if RR < 12 bpm; EXAM TRAP Naloxone half-life (30–90 min)
(Morphine, Fentanyl, (Narcan) 0.4–2 mg monitor EtCO2 & sedation is shorter than most opioids; monitor closely
Hydromorphone) IV/IM/IN scale (Pasero). for rebound respiratory depression
(renarcotization) and acute withdrawal pain.
Benzodiazepines ANTIDOTE Flumazenil Used for status epilepticus, BLACK BOX Concurrent opioid + benzo use
(Lorazepam, 0.2 mg IV over 15–30 sec acute alcohol withdrawal causes fatal respiratory depression. Flumazenil
Midazolam, Diazepam) (CIWA), & procedural can precipitate acute refractory seizures in
sedation. chronic benzo users or TCA overdose.
Unfractionated ANTIDOTE Protamine aPTT: 60–80 sec (1.5–2.5× BLACK BOX Epidural/spinal hematoma risk.
Heparin & LMWH Sulfate (1 mg per 100 control). Anti-Xa: 0.3–0.7 Monitor platelets daily for HIT (stop if platelets
(Enoxaparin) units Heparin) IU/mL. drop >50% or <100,000/mm3). Max Protamine
dose = 50 mg slow IV over 10 min.
Warfarin (Coumadin) ANTIDOTE Standard INR: 2.0–3.0 EXAM TRAP Vitamin K takes 6–24h to
(Vitamin K Antagonist) Phytonadione (Vit K) + 4- Mechanical Valve INR: 2.5– synthesize new clotting factors; give 4-Factor
Factor PCC (Kcentra) 3.5 PCC or FFP immediately for life-threatening
active hemorrhage. Maintain consistent leafy
green intake.
Digoxin (Lanoxin) ANTIDOTE Digoxin 0.5–2.0 ng/mL (Heart PRIORITY Auscultate apical pulse for 1 full
(Cardiac Glycoside) Immune Fab (DigiFab) IV Failure optimal: 0.5–0.9 minute (hold if <60 bpm). Hypokalemia (<3.5
ng/mL). Check K+ (3.5–5.0). mEq/L) from loop diuretics dramatically
precipitates fatal digoxin arrhythmias &
yellow/green halos.
Acetaminophen ANTIDOTE Max Adult Dose: 4,000 Restores hepatic glutathione stores to detoxify
(Tylenol) Acetylcysteine (NAC / mg/day (2,000–3,000 NAPQI metabolite; most effective within 8–10h
(Analgesic / Mucomyst) PO or IV mg/day in liver of ingestion. Oral solution smells like rotten
Antipyretic) disease/alcohol). eggs (mix with juice/soda). Monitor
AST/ALT/INR.
Lithium Carbonate Hemodialysis + IV 0.9% 0.6–1.2 mEq/L (Acute EXAM TRAP Hyponatremia, dehydration,
(Bipolar Mood Normal Saline Hydration Mania: up to 1.5; Toxic: >1.5 NSAIDs, and thiazide diuretics force proximal
Stabilizer) mEq/L). renal tubules to reabsorb Lithium, causing
coarse tremors, ataxia, confusion, and
seizures.
Magnesium Sulfate & MgSO4: Calcium Therapeutic OB MgSO4: 4–7 Hold MgSO4 and infuse Calcium Gluconate if
Cholinergics / Gluconate 10% mEq/L. loss of patellar DTRs, RR < 12 bpm, or urine
Organophosphates Cholinergic: Atropine + Phenytoin TDM: 10–20 output < 30 mL/hr. For organophosphate
Pralidoxime mcg/mL. poisoning (SLUDGE), give Atropine to dry
Vancomycin Trough: 10–20 airway secretions.
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 1 of 16
, MODULE 1A: FOUNDATIONAL PRINCIPLES & AUTONOMIC NERVOUS SYSTEM EXAM 1 CORE
(PROTOTYPES 1–10) BLUEPRINT
FIGURE 1.1: AUTONOMIC RECEPTOR ARCHITECTURE & NEUROMUSCULAR JUNCTION TARGET MAP
1. ALPHA-1 & ALPHA-2 RECEPTORS 2. BETA-1 (1 HEART) & BETA-2 (2 LUNGS) 3. MUSCARINIC (PARASYMPATHETIC) 4. NICOTINIC M (NEUROMUSCULAR)
• Alpha-1 (Vascular Smooth Muscle): • Beta-1 (Myocardium, SA/AV, JGA): • Cholinergic Agonists ("SLUDGE"): • Depolarizing (Succinylcholine):
↑
Vasoconstriction, BP, Mydriasis ↑HR, ↑Contractility, ↑Renin (Dobutamine) Bethanechol (Bladder), Neostigmine (MG) Fasciculations → Flaccid Paralysis
Agonists: Norepinephrine, Phenylephrine • Beta-2 (Bronchioles, Uterus, Liver): • Anticholinergics (Atropine, Ipratropium): Triggers Malignant Hyperthermia & K+ ↑
• Alpha-2 (Central Brainstem Sympatholytic): ↑
Bronchodilation, Glucose, Shifts K+ in ↑HR, Dry Mouth, Urinary Retention, • Non-Depolarizing (Pancuronium/Roc):
↓
Clonidine ( NE outflow; Rebound HTN) Trap: Propranolol blocks B2 → Bronchospasm Contraindicated in Glaucoma & BPH Zero sedation/analgesia! Reverse w/ Neostig
PRIORITY NURSING
PROTOTYPE DRUG & EXACT MECHANISM OF BLACK BOX WARNINGS (BBW)
# INTERVENTIONS & PATIENT
CLASS ACTION & SERIOUS ADVERSE EFFECTS
TEACHING
1 Epinephrine Stimulates α1 Hypertensive crisis, ventricular 1ST LINE Anaphylaxis & Cardiac
Non-Selective (vasoconstriction), β1 dysrhythmias, angina, Arrest. Inject EpiPen (0.3 mg IM
Adrenergic Agonist
↑
( HR/contractility), and β2
pulmonary edema, extravasation 1:1,000) into outer anterolateral
tissue necrosis. thigh (hold 3–10s). Massage not
(bronchodilation & mast cell
required; go to ED immediately.
stabilization).
2 Norepinephrine Profound α1 peripheral BLACK BOX Severe ischemic 1ST LINE Vasopressor for Septic
(Levophed) arterial/venous tissue necrosis and sloughing Shock. Infuse via central venous
Potent α1 > β1 Agonist vasoconstriction with with peripheral IV extravasation; line whenever possible. If
modest β1 positive inotropic reflex bradycardia. extravasation occurs, infiltrate site
cardiac stimulation. immediately with Phentolamine
(5–10 mg).
3 Dopamine Low (1–5 mcg/kg/min): D1 BLACK BOX Peripheral Correct hypovolemia with IV fluids
Dose-Dependent renal dilation; Med (5–10): ischemia/gangrene upon prior to initiating infusion.
Inotrope / Vasopressor β1 cardiac output; High extravasation. Severe sinus Continuous ECG and arterial BP
(>10): α1 vasoconstriction. tachycardia, ectopic beats, monitoring. Antidote for local
angina. extravasation: Phentolamine.
4 Dobutamine Selectively stimulates Tachyarrhythmias, premature Used for acute decompensated
Selective β1 Adrenergic myocardial β1 receptors to ventricular contractions (PVCs), heart failure and cardiogenic
Agonist increase stroke volume and myocardial ischemia, blood shock. TRAP Physically
cardiac output with minimal pressure fluctuations. incompatible with alkaline
vascular tone change. solutions (do not mix with Sodium
Bicarbonate).
5 Albuterol Selectively activates Paradoxical bronchospasm, RESCUE For acute
Short-Acting β2 bronchial smooth muscle β2 reflex tachycardia, palpitations, asthma/bronchospasm. Wait 1
Agonist (SABA) receptors →↑cAMP → rapid fine skeletal muscle tremors, min between puffs of SABA; wait 5
bronchodilation. hypokalemia & hyperglycemia. min before inhaled steroid. Always
use Albuterol FIRST to open
airways.
6 Atropine Sulfate Competitively blocks Anticholinergic toxidrome: 1ST LINE Symptomatic
Anticholinergic acetylcholine at muscarinic hyperthermia, delirium, severe Bradycardia (0.5–1 mg IV push
(Muscarinic receptors in SA/AV nodes, tachycardia, paralytic ileus, q3–5m) & Organophosphate
Antagonist) exocrine glands, and urinary retention, acute poisoning. Antidote for Atropine
smooth muscle. glaucoma. overdose: Physostigmine.
Contraindicated in angle-closure
glaucoma.
7 Bethanechol Directly stimulates Cholinergic crisis (SLUDGE: Indicated for non-obstructive
Direct Muscarinic muscarinic receptors of the salivation, lacrimation, urination, postoperative/postpartum urinary
Agonist urinary tract →
contracts diaphoresis, GI cramps, emesis), retention. Administer 1h before or
detrusor muscle and relaxes hypotension, bronchospasm. 2h after meals. Strictly
trigone/sphincter. contraindicated in asthma, peptic
ulcer, or GI/urinary obstruction.
8 Neostigmine / Inhibits acetylcholinesterase Cholinergic Crisis (overdose: Used for Myasthenia Gravis &
Pyridostigmine enzyme in synaptic cleft → bradycardia, fasciculations, reversal of nondepolarizing
Reversible prolongs acetylcholine bronchorrhea, respiratory neuromuscular blockers.
Cholinesterase stimulation at paralysis) vs. Myasthenic Crisis Administer 30–60 min before
Inhibitor neuromuscular junction (underdose) meals to improve swallowing Keep
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 2 of 16
, MODULE 1B: CENTRAL NERVOUS SYSTEM, ANALGESICS & PSYCHOTROPICS EXAM 1 CORE
(PROTOTYPES 11–20) BLUEPRINT
PRIORITY NURSING
PROTOTYPE DRUG & EXACT MECHANISM OF BLACK BOX WARNINGS (BBW)
# INTERVENTIONS & PATIENT
CLASS ACTION & SERIOUS ADVERSE EFFECTS
TEACHING
11 Morphine Sulfate Binds central & spinal μ BLACK BOX Life-threatening Assess pain & respiratory rate prior
Pure Opioid Agonist (mu) and κ (kappa) opioid respiratory depression, to giving; hold if RR < 12 bpm.
(Schedule II) receptors; inhibits addiction/misuse, neonatal Tolerance develops to all effects
ascending pain abstinence syndrome. EXCEPT constipation and miosis
transmission & alters pain Orthostatic hypotension, urinary (always co-prescribe a stimulant
perception. retention, miosis, severe laxative + stool softener). Antidote:
constipation. Naloxone.
12 Fentanyl High-affinity lipophilic μ- BLACK BOX Fatal respiratory EXAM TRAP Transdermal
Synthetic Opioid opioid agonist; 50 to 100 depression; transdermal heat patches take 12–24h to reach peak
Agonist (Schedule II) times more potent than exposure causes massive fatal onset (only for opioid-tolerant
Morphine. overdose; chest wall rigidity with chronic pain, never acute post-op
rapid IV push. pain). Never apply heating pads
over patch. Fold used patch in half
and flush.
13 Naloxone (Narcan) Competitively displaces Acute precipitated opioid Titrate slowly IV in post-op patients
Pure Competitive opioid agonists from μ, κ, withdrawal: severe pain crisis, to reverse respiratory depression
Opioid Antagonist and δ receptors in the CNS agitation, emesis, tachycardia, without ablating all analgesia.
without intrinsic agonist hypertensive surge, pulmonary Monitor vital signs every 15 min for
activity. edema, ventricular arrhythmias. 2 hours due to short half-life
(rebound sedation).
14 Lorazepam (Ativan) Binds allosterically to BLACK BOX Profound 1ST LINE IV drug of choice for
Benzodiazepine GABAA receptor complex, sedation, coma, and death when acute Status Epilepticus and acute
(Schedule IV) increasing the frequency of combined with opioids/alcohol; alcohol withdrawal delirium. Never
chloride channel opening physical dependence and fatal discontinue abruptly (taper slowly).
(hyperpolarization). withdrawal seizures. Antidote: Flumazenil.
15 Phenytoin (Dilantin) Stabilizes neuronal BLACK BOX Cardiovascular TDM: 10–20 mcg/mL (>20 =
Hydantoin membranes by delaying collapse, severe hypotension, & nystagmus, ataxia, slurred speech).
Anticonvulsant recovery of voltage-gated VF if IV infusion exceeds 50 TRAP Infuse ONLY in 0.9%
Na+ channels from mg/min. SJS/TEN, teratogenic Normal Saline (precipitates in
inactivated state. (fetal hydantoin syndrome), D5W!). Causes gingival
Purple Glove Syndrome. hyperplasia (soft toothbrush,
dental visits). Continuous tube
↓
feedings absorption (hold feed
1–2h before/after).
16 Carbamazepine Blocks voltage-gated Na+ BLACK BOX Fatal aplastic TDM: 4–12 mcg/mL. Induces its
(Tegretol) channels in hyperactive anemia & agranulocytosis; fatal own metabolism (autoinduction)
Iminostilbene neurons; inhibits repetitive SJS/TEN in patients with HLA- and decreases oral contraceptive &
Anticonvulsant action potentials. B*1502 allele (Asian ancestry). Warfarin efficacy. Report fever,
SIADH (hyponatremia). sore throat, mouth ulcers, or
petechiae immediately.
17 Levetiracetam Binds synaptic vesicle Behavioral/psychiatric Renally cleared with minimal
(Keppra) protein SV2A in the brain, abnormalities ("Keppra rage": hepatic CYP450 drug interactions
Pyrrolidine modulating agitation, hostility, depression, (preferred in oncology and
Anticonvulsant neurotransmitter release suicidal ideation), somnolence, polypharmacy). Adjust dose in
and inhibiting burst firing. asthenia, Stevens-Johnson CKD. Monitor mood and suicidal
syndrome. ideation at every clinic visit.
18 Fluoxetine (Prozac) / Selectively blocks BLACK BOX Increased risk of Takes 4–6 weeks for full
Sertraline presynaptic serotonin (5-HT) suicidal ideation and behavior in therapeutic mood lift; energy
Selective Serotonin reuptake transporters, children, adolescents, and young returns in week 1–2 (highest
Reuptake Inhibitor increasing synaptic adults (<24 yrs) during initial 1– suicide attempt risk!). Avoid St.
(SSRI) serotonin concentration. 4 weeks. Serotonin Syndrome. John's Wort, MAOIs (14-day
washout; 5 weeks for Fluoxetine),
Linezolid, and Tramadol.
19 Haloperidol (Haldol) Potent blockade of BLACK BOX Increased EPS Triad: Acute Dystonia
1st-Gen Typical postsynaptic dopamine D2 mortality in elderly patients with (oculogyric crisis/torticollis → give
NR 293 & NUR 210 Pharmacology Complete Exam 1–4 & Final Master Study Guide (2026/2027) Page 3 of 16
