Nursing Pharmacology High-Yield Review

Warfarin (Coumadin)

Blocks the liver from making certain clotting factors that need vitamin K, so it takes the blood longer to clot. It works slowly — takes days to reach a therapeutic effect.

heparin

Stopping clots fast — used in the hospital for a new clot, a heart attack, or before/during surgery when quick, short-term anticoagulation is needed. Given IV or under the skin, with frequent blood draws (aPTT) to keep the dose in the safe zone.

Watch for

Bleeding, same as warfarin, but heparin acts fast so trouble can show up quickly too. Also watch platelet counts — a sudden drop can mean heparin-induced thrombocytopenia (HIT), which is serious and means the drug stops right away. Protamine sulfate is the antidote if things go wrong.

Enoxaparin (Lovenox)

Used for

Preventing or treating clots — basically heparin's more convenient cousin. Given as a shot in the belly, usually once or twice a day, and unlike heparin, it usually doesn't need regular blood draws to monitor it.

Watch for

Bleeding and bruising at the injection site is normal, but watch for bigger bleeding elsewhere. Never rub the injection site after giving it — that pushes the medication into surrounding tissue and can cause more bruising.

Clopidogrel (Plavix)

Used for

Keeping platelets from clumping together, given long-term after a heart attack, stroke, or stent placement. One pill a day, and it needs to be stopped about 5 days before any planned surgery because of bleeding risk.

Watch for

Bleeding — bruising, nosebleeds, blood in stool. There's also a sneaky interaction: some heartburn medications (like omeprazole) can block it from working properly, so always flag those to the provider.

Aspirin

Used for

Low daily doses to prevent heart attacks and strokes by keeping platelets from sticking together — this isn't the same as taking aspirin for a headache. It's often paired with clopidogrel after a stent.

Watch for

Stomach bleeding and ulcers — black, tarry stools are the red flag. Take it with food to ease the stomach, and never give it to a child or teenager with a viral illness (flu, chickenpox) — it's linked to Reye syndrome, which can be fatal.

Nitroglycerin

Used for

Relieving chest pain (angina) by relaxing blood vessels so the heart gets more blood flow and doesn't have to work as hard. Sublingual tablets are for an acute attack — one every 5 minutes, up to 3 doses, and if the pain isn't gone, call 911.

Watch for

A pounding headache and low blood pressure are expected and mean it's working, but watch for fainting when standing up too fast. Big one: never combine with erectile dysfunction drugs like sildenafil — the two together can crash blood pressure dangerously.

Propranolol (Inderal)

Used for

A non-selective beta blocker used for high blood pressure, abnormal heart rhythms, migraines, and even performance anxiety. Because it blocks beta receptors everywhere (not just the heart), it can also affect the lungs.

Watch for

Check pulse and blood pressure before every dose — hold it if the heart rate's too slow. Never stop this cold turkey; suddenly quitting can trigger rebound chest pain or a dangerous spike in heart rate. Also risky in people with asthma since it can trigger bronchospasm.

Diltiazem (Cardizem)

Used for

Slowing down a fast heart rhythm (like atrial fibrillation) and controlling blood pressure by relaxing blood vessels and calming the heart's electrical system.

Watch for

Check heart rate and blood pressure before giving it — hold if too low. And skip the grapefruit juice: it can spike diltiazem levels in the blood and cause toxicity.

Digoxin (Lanoxin)

Making a weak heart pump stronger and slowing down fast heart rhythms like atrial fibrillation. It's a long-term daily pill, but the margin between a helpful dose and a toxic one is razor thin.

Watch for

Always check the apical pulse for a full minute before giving it — hold if under 60. Signs of toxicity are sneaky: nausea, confusion, and a very specific one — seeing yellow or green halos around lights. If that shows up, stop the drug and call the provider.

Hydrochlorothiazide (HCTZ)

A mild, everyday water pill for high blood pressure and mild fluid retention. Taken in the morning so you're not up all night peeing.

Watch for

It flushes out potassium along with the extra fluid, so watch for muscle cramps or weakness — a sign potassium's dropping. Also causes sun sensitivity, so sunscreen matters more on this drug.

Furosemide (Lasix)

A much stronger water pill than HCTZ, used when the body's holding onto a lot of extra fluid — like in heart failure or pulmonary edema.

Watch for

Same potassium-wasting risk as HCTZ but bigger, plus ringing in the ears (tinnitus) or hearing changes, which can mean ototoxicity, especially if it's pushed IV too fast.

Mannitol (Osmitrol)

An IV-only diuretic used to pull fluid off the brain in cases of swelling (like a head injury) or to protect the kidneys during acute failure. Not a routine "fluid pill" — it's for pressure emergencies.

Watch for

It needs working kidneys to work at all, so it's never used if someone isn't making urine. Watch for signs the fluid shift backfired — trouble breathing or crackly lung sounds can mean it pulled fluid into the lungs instead.

Spironolactone (Aldactone)

A "potassium-sparing" water pill — it gets rid of extra fluid without dumping potassium, which makes it useful in heart failure and for high blood pressure.

Watch for

The flip side of sparing potassium is that it can build up too much — watch for muscle weakness or an irregular heartbeat. Don't pair it with potassium supplements or salt substitutes, which usually contain potassium.

Nifedipine (Procardia)

Used for

Relaxes blood vessels to lower blood pressure and ease chest pain, without slowing the heart down the way diltiazem does.

Watch for

Swollen, overgrown gums are a known long-term side effect — worth mentioning at the dentist. And like the other calcium channel blockers, don't stop it abruptly — it can cause a rebound spike in blood pressure.

Amlodipine (Norvasc)

Same idea as nifedipine — relaxes blood vessels for high blood pressure and certain types of angina — but it's smoother and longer-acting, so it's just one pill a day.

Watch for

Swelling in the ankles and feet is common and expected, but should be reported if it gets uncomfortable. Same rule as nifedipine: don't stop suddenly.

Lisinopril (Zestril)

An ACE inhibitor that relaxes blood vessels for blood pressure and heart failure, and it's protective for the kidneys, especially in diabetics.

Watch for

A dry, nagging cough is a common (annoying but not dangerous) side effect. The dangerous one is angioedema — sudden swelling of the lips, tongue, or throat — which is a medical emergency and means the drug gets stopped for good.

Captopril (Capoten)

Used for

Same ACE inhibitor family as lisinopril, just shorter-acting, so it's taken multiple times a day instead of once.

Watch for

Same warnings as lisinopril — watch for that dry cough and, more seriously, swelling of the face, lips, or tongue (angioedema).

Metoprolol (Lopressor)

A heart-selective beta blocker, so it's a common choice for blood pressure, chest pain, and heart failure without hitting the lungs as hard as propranolol.

Watch for

Check heart rate before every dose. It can also hide the warning signs of low blood sugar in diabetics (like a racing heart), which is worth knowing if the patient is diabetic.

Carvedilol (Coreg)

A beta blocker that also relaxes blood vessels, often used in heart failure and after a heart attack.

Watch for

Take it with food to prevent a blood pressure drop when standing up. Because it also blocks beta-2 receptors like propranolol, it's riskier for people with asthma.

Losartan

Used for

An ARB — works like an ACE inhibitor (relaxes vessels, lowers blood pressure) but through a different pathway, so it skips the dry cough side effect.

Watch for

Still watch for angioedema (rare but serious) and high potassium — skip potassium-based salt substitutes.

Valsartan (Diovan)

Used for

Same ARB family as losartan, often specifically used after a heart attack to protect a weakened heart.

Watch for

Same as losartan — watch potassium levels and any swelling of the face or throat.

Vasopressin (Vasostrict)

The opposite of everything else on this list — instead of lowering blood pressure, this raises it, used in shock when blood pressure has crashed. It also makes the kidneys hold onto water.

Watch for

It squeezes blood vessels hard, which can starve the heart of blood flow — so it's avoided in anyone with existing heart problems, and chest pain during administration is a red flag.