NCLEX Pharmacology Guide 2026: Master Medications for the NCLEX
Pharmacology accounts for 13-19% of the NCLEX-RN and is often considered the most challenging content area. This guide covers essential drug knowledge, calculations, and test strategies.
Pharmacology on the NCLEX
| Aspect | Details |
|---|---|
| Percentage | 13-19% of NCLEX-RN |
| Question Types | Multiple choice, SATA, calculations |
| Focus Areas | Drug classes, side effects, nursing implications |
| Key Skills | Safe administration, patient teaching, calculations |
Start Your Free NCLEX Pharmacology Practice
Our free practice includes questions on all major drug classes with detailed rationales.
Essential Drug Classes for NCLEX
Cardiovascular Medications
Beta Blockers (-olol)
Examples: metoprolol, atenolol, propranolol
- Action: Decrease heart rate and blood pressure
- Uses: Hypertension, heart failure, angina
- Side Effects: Bradycardia, hypotension, fatigue
- Nursing: Check HR before giving (hold if <60), don't stop abruptly
ACE Inhibitors (-pril)
Examples: lisinopril, enalapril, captopril
- Action: Block angiotensin-converting enzyme
- Uses: Hypertension, heart failure, diabetic nephropathy
- Side Effects: Dry cough, hyperkalemia, angioedema
- Nursing: Monitor potassium, watch for cough, first-dose hypotension
Calcium Channel Blockers (-dipine)
Examples: amlodipine, nifedipine, diltiazem
- Action: Block calcium channels, vasodilation
- Uses: Hypertension, angina, arrhythmias
- Side Effects: Peripheral edema, constipation, headache
- Nursing: Monitor BP, check for edema, avoid grapefruit juice
Diuretics
| Type | Examples | Key Point |
|---|---|---|
| Loop | furosemide, bumetanide | Potassium wasting |
| Thiazide | HCTZ, chlorthalidone | Potassium wasting |
| Potassium-sparing | spironolactone | Retain potassium |
Anticoagulants and Antiplatelets
Heparin
- Route: IV or SubQ
- Monitoring: aPTT (1.5-2.5x normal)
- Antidote: Protamine sulfate
- Nursing: No IM injections, watch for bleeding
Warfarin (Coumadin)
- Route: Oral
- Monitoring: PT/INR (goal usually 2-3)
- Antidote: Vitamin K
- Nursing: Consistent vitamin K intake, many drug interactions
DOACs (Direct Oral Anticoagulants)
Examples: rivaroxaban, apixaban, dabigatran
- Advantage: No routine monitoring
- Nursing: Assess for bleeding, limited reversal options
Diabetes Medications
Insulin Types
| 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 | 18-24 hr |
| Long (glargine, detemir) | 1-2 hr | No peak | 24 hr |
Key Nursing Points:
- Check blood glucose before giving
- Know signs of hypoglycemia
- Rotate injection sites
- Never shake insulin (roll NPH)
Oral Antidiabetics
- Metformin - First-line, hold before contrast
- Sulfonylureas (-ide) - Cause hypoglycemia
- SGLT2 inhibitors (-flozin) - UTI risk
Pain Medications
Opioids
Examples: morphine, hydrocodone, oxycodone, fentanyl
- Side Effects: Respiratory depression, constipation, sedation
- Antidote: Naloxone (Narcan)
- Nursing: Assess pain and respiratory status, prevent constipation
NSAIDs
Examples: ibuprofen, naproxen, ketorolac
- Risks: GI bleeding, renal impairment
- Nursing: Take with food, avoid in renal disease
Antibiotics
| Class | Examples | Key Points |
|---|---|---|
| Penicillins | amoxicillin, ampicillin | Allergy risk, take on empty stomach |
| Cephalosporins | cephalexin, ceftriaxone | Cross-reactivity with PCN allergy |
| Fluoroquinolones | ciprofloxacin, levofloxacin | Tendon rupture risk, avoid antacids |
| Aminoglycosides | gentamicin, tobramycin | Nephrotoxic, ototoxic, monitor levels |
| Macrolides | azithromycin, erythromycin | GI upset, QT prolongation |
Psychiatric Medications
Antidepressants
- SSRIs (fluoxetine, sertraline) - 4-6 weeks for effect, serotonin syndrome risk
- SNRIs (venlafaxine, duloxetine) - Monitor BP
- TCAs (amitriptyline) - Anticholinergic effects, cardiac toxicity
Antipsychotics
- Typical (haloperidol) - EPS, tardive dyskinesia
- Atypical (risperidone, quetiapine) - Weight gain, metabolic syndrome
Mood Stabilizers
- Lithium - Narrow therapeutic range, monitor levels, hydration critical
Medication Calculations
Dosage Calculations
Formula: Desired/Have × Quantity = Amount to give
Example: Order: 500mg. Available: 250mg tablets
- 500mg/250mg × 1 tablet = 2 tablets
IV Flow Rates
Formula: (Volume × Drop factor) / Time in minutes = gtts/min
Example: 1000mL over 8 hours, drop factor 15
- (1000 × 15) / 480 min = 31 gtts/min
Weight-Based Dosing
Formula: Weight (kg) × Dose per kg = Total dose
Example: Patient 70kg, order 2mg/kg
- 70 × 2 = 140mg
Six Rights of Medication Administration
| Right | Verification |
|---|---|
| Right Patient | Two identifiers (name, DOB) |
| Right Medication | Check label 3 times |
| Right Dose | Calculate and verify |
| Right Route | Appropriate for medication |
| Right Time | Per order and schedule |
| Right Documentation | After administration |
High-Yield NCLEX Pharmacology Topics
| Topic | Frequency | Priority |
|---|---|---|
| Anticoagulants | Very High | Essential |
| Insulin | Very High | Essential |
| Cardiac medications | High | Important |
| Antibiotics | High | Important |
| Pain management | Medium | Review |
| Calculations | Medium | Must practice |
Common Medication Errors to Know
Types Tested on NCLEX
- Wrong dose - Always calculate and verify
- Wrong patient - Use two identifiers
- Wrong route - Check order carefully
- Missed allergies - Always assess first
- Drug interactions - Know major interactions
Prevention Strategies
- Follow the 6 rights
- Use barcode scanning
- Independent double-check for high-alert meds
- Question unclear orders
Study Strategies for Pharmacology
1. Learn Drug Classes, Not Individual Drugs
Focus on:
- Common suffixes (-olol, -pril, -statin)
- Class actions and side effects
- Nursing implications
2. Create Comparison Charts
Compare similar drugs:
- Heparin vs warfarin
- ACE inhibitors vs ARBs
- Different insulin types
3. Focus on Safety
Know for each drug:
- When to hold
- What to monitor
- Patient teaching points
- Signs of toxicity
4. Practice Calculations Daily
- Work through problems by hand
- Check your work
- Time yourself
Frequently Asked Questions
How much pharmacology is on the NCLEX?
Pharmacology accounts for 13-19% of NCLEX-RN questions. It's integrated throughout the exam, appearing in various clinical scenarios.
Should I memorize all drug names?
Focus on drug classes and their common characteristics. Knowing suffixes (-olol, -pril) helps identify drug classes quickly.
What calculations are on the NCLEX?
Basic dosage calculations, IV flow rates, and weight-based dosing. The NCLEX provides a calculator, but you must know how to set up problems.
What are high-alert medications?
Medications with high risk for harm if given incorrectly: insulin, anticoagulants, opioids, chemotherapy, potassium chloride.
Start Your NCLEX Pharmacology Practice Today
Our free resources include:
- 500+ NCLEX-style questions
- Drug class coverage
- Calculation practice
- Detailed rationales
- AI study assistant
Master pharmacology and boost your NCLEX score with our free practice questions.