Pharmacological & Parenteral Therapies is the second-heaviest category (13–19% of your exam). You will never memorize every drug — and you don’t need to. The exam rewards understanding drug classes, safe administration, the labs that monitor key drugs, and the adverse effects worth reporting.
The rights of medication administration
Every med-administration item rests on these. Beyond the classic five, the exam increasingly tests the expanded set:
- Right client — two identifiers, never the room number.
- Right medication — check the label three times against the order.
- Right dose — recalculate; question an unusual amount.
- Right route and right time.
- Right documentation — chart after giving, never before.
- Right reason, right response, right to refuse — the client may decline; document and notify.
Drugs and their monitoring labs
These pairings show up again and again — know which lab tracks which drug, and the therapeutic target.
| Drug | Monitor | Therapeutic / note |
|---|---|---|
| Warfarin | PT / INR | INR 2–3; antidote vitamin K |
| Heparin | aPTT | 1.5–2.5× control; antidote protamine |
| Digoxin | Dig level + K⁺ | 0.5–2.0 ng/mL; hypokalemia raises toxicity risk |
| Lithium | Lithium level + Na⁺ | 0.6–1.2 mEq/L; low sodium/dehydration → toxicity |
| Vancomycin / aminoglycosides | Trough + creatinine | Watch nephro- and ototoxicity |
| Phenytoin | Phenytoin level | 10–20 mcg/mL |
The full reference list lives on the lab values page.
High-yield antidotes
- Opioids → naloxone
- Benzodiazepines → flumazenil
- Warfarin → vitamin K (and FFP for acute bleed)
- Heparin → protamine sulfate
- Acetaminophen → acetylcysteine
- Magnesium sulfate → calcium gluconate
- Digoxin (severe toxicity) → digoxin immune Fab
Class patterns worth knowing
Suffixes and patterns let you reason about unfamiliar drugs:
- -pril (ACE inhibitors) — watch dry cough, hyperkalemia, angioedema; hold for it.
- -olol (beta blockers) — hold for bradycardia; don’t stop abruptly; caution in asthma.
- -statin — monitor liver enzymes; report unexplained muscle pain (rhabdomyolysis).
- -floxacin — tendon rupture risk; photosensitivity.
- Corticosteroids — never stop abruptly; raise glucose, lower immunity, thin bone.
Insulin timing: know onset/peak because peak is when hypoglycemia is most likely. Rapid (lispro/aspart) peaks in about an hour; regular in 2–3 hours; NPH is the intermediate, cloudy insulin.
Safety & what to report
- High-alert drugs — insulin, heparin, opioids, and concentrated electrolytes get independent double-checks.
- Never give IV potassium by push — always diluted and infused slowly.
- Report, don’t just chart: new adverse effects, values outside therapeutic range, and signs of toxicity go to the provider.
Practice it: reinforce this category with explained questions in the question bank, and see how much of your exam it fills on the test plan page.
