Clinical Drug Formulary & Nursing Considerations
Ward-ready drug monographs built for registered nurses, nursing officers, and clinical students. Features vital signs parameters (apical pulse, blood pressure, respiratory rate), safe IV push rates, high-alert drug warnings, and an instant emergency antidotes quick sheet.
Medications (21)
Showing verified clinical monographs with nursing assessmentsAlbuterol (Salbutamol)
Pregnancy: CCommon Brands: Ventolin, Proventil, Asthalin
Respiratory · Short-Acting Beta-2 Adrenergic Agonist (SABA) / Bronchodilator
Rescue bronchodilator of choice for acute wheezing. Teach proper MDI technique: shake well, exhale completely, inhale slowly while depressing canister, hold breath for 10 seconds, wait 1–2 minutes before second puff. If using concurrent corticosteroid inhaler, ALWAYS INHALE BRONCHODILATOR FIRST to open airways, wait 5 minutes, then inhale steroid, and rinse mouth with water to prevent oral candidiasis (thrush).
Atropine Sulfate
Pregnancy: CCommon Brands: Atropair
Emergency & Cardiovascular · Anticholinergic / Muscarinic Receptor Antagonist
In symptomatic bradycardia, administer 1 mg IV push rapidly every 3–5 minutes (maximum total dose 3 mg). Doses less than 0.5 mg can cause paradoxical reflex bradycardia. Continuous ECG and vital signs monitoring required. Antidote for organophosphates: large repeated doses until bronchial secretions dry.
Calcium Gluconate
Pregnancy: CCommon Brands: Calglucon
Antidotes & Minerals · Calcium Salt / Myocardial Membrane Stabilizer
Administer IV slowly over 5–10 minutes under continuous cardiac monitoring (ECG). Infusing too rapidly can cause sudden severe bradycardia, arrhythmias, or cardiac arrest. Ensure patent IV line; Calcium Gluconate is preferred over Calcium Chloride in peripheral lines due to lower vesicant risk.
Digoxin
High AlertPregnancy: CCommon Brands: Lanoxin, Digitek
Cardiovascular · Cardiac Glycoside / Positive Inotrope
CRITICAL: Measure apical pulse for 1 full minute prior to administration. Hold dose and notify provider if HR < 60 bpm in adults (< 90 bpm in infants). Therapeutic serum range: 0.5–2.0 ng/mL. Hypokalemia (< 3.5 mEq/L) drastically potentiates digoxin toxicity. Antidote: Digoxin Immune Fab (DigiFab).
Digoxin
High AlertPregnancy: CCommon Brands: Lanoxin, Digitek
Cardiovascular · Cardiac Glycoside / Inotrope
Always measure apical pulse for 1 full minute prior to administration; hold dose and notify provider if HR < 60 bpm in adults (< 90 bpm in infants). Therapeutic serum range: 0.5–2.0 ng/mL. Hypokalemia (< 3.5 mEq/L) dramatically increases digoxin toxicity risk. Antidote: Digoxin Immune Fab (DigiFab).
Enoxaparin
Pregnancy: BCommon Brands: Lovenox, Clexane
Hematologic / Anticoagulant · Low Molecular Weight Heparin (LMWH)
Administer deep subcutaneous in the anterolateral or posterolateral abdominal wall ("love handles"). DO NOT expel the air bubble from the manufacturer-filled syringe prior to injection (it seals the needle track). DO NOT rub the injection site post-injection. Does not require routine aPTT monitoring. Monitor platelet counts and renal function (eGFR). Antidote: Protamine Sulfate.
Epinephrine (Adrenaline)
High AlertPregnancy: CCommon Brands: Adrenalin, EpiPen, Auvi-Q
Emergency & Critical Care · Non-selective Alpha- and Beta-Adrenergic Agonist
CRITICAL CONCENTRATION DIFFERENCE: 1) Anaphylaxis dose: 1:1,000 (1 mg/mL) given INTRAMUSCULARLY into the anterolateral mid-thigh. 2) Cardiac Arrest (ACLS) dose: 1:10,000 (0.1 mg/mL, 1 mg) given INTRAVENOUSLY every 3–5 minutes. Administering 1:1,000 intravenously can cause lethal hypertensive crisis or cerebral hemorrhage.
Flumazenil
Pregnancy: CCommon Brands: Romazicon
Antidotes & Reversal Agents · Selective Benzodiazepine Receptor Antagonist
SEIZURE WARNING: Can precipitate intractable status epilepticus in clients physically dependent on benzodiazepines. Administer initial dose of 0.2 mg IV over 15 seconds. Half-life is shorter than most benzodiazepines (re-sedation may occur within 1–2 hours). Maintain airway precautions.
Furosemide
Pregnancy: CCommon Brands: Lasix, Frusene
Cardiovascular / Renal · Loop Diuretic
Administer IV push slowly over 1–2 minutes (max rate 20 mg/min or 4 mg/min for high doses) to prevent transient or permanent ototoxicity. Monitor blood pressure, daily body weight, and strict intake/output. Check serum potassium and creatinine before administration. Encourage potassium-rich diet (bananas, potatoes, citrus).
Heparin (Unfractionated)
High AlertPregnancy: C (Preferred anticoagulant in pregnancy as it does not cross placenta)Common Brands: Hep-Lock, Hepalean
Hematologic / Anticoagulant · Antithrombotic / Indirect Thrombin Inhibitor
HIGH ALERT MEDICATION. Continuous IV infusions must run on an electronic infusion pump. Monitor activated Partial Thromboplastin Time (aPTT) every 6 hours until therapeutic (target 1.5–2.5× baseline, typically 60–80 seconds). Check platelet counts daily; notify immediately if platelets drop > 50% from baseline (HIT suspicion). Antidote: Protamine Sulfate (1 mg neutralizes ~100 units of heparin).
Insulin Glargine (Long-Acting)
High AlertPregnancy: CCommon Brands: Lantus, Toujeo, Basaglar
Endocrine & Metabolic · Basal Long-Acting Insulin Analog
Administer subcutaneously once daily at the same time each day (typically bedtime). It provides steady, peakless 24-hour basal coverage. DO NOT MIX WITH ANY OTHER INSULIN OR SOLUTION in the same syringe because its low pH (pH 4.0) will cause precipitation. NEVER ADMINISTER INTRAVENOUSLY.
Magnesium Sulfate
High AlertPregnancy: D (Safe for acute obstetric emergencies)Common Brands: MgSO4
Obstetrics / Critical Care · Anticonvulsant / Mineral Electrolyte / Tocolytic
HIGH ALERT OBSTETRIC MEDICATION. Continuous infusion must run on an electronic pump with two-nurse verification. Baseline & hourly checks: 1) Deep Tendon Reflexes (patellar DTRs must be present, +2), 2) Respiratory rate (hold if < 12 bpm), 3) Urine output (must be > 30 mL/hr, as magnesium is cleared renally). Therapeutic serum level: 4.0–7.0 mg/dL. Antidote: Calcium Gluconate 10% (10 mL IV over 3 minutes).
Metoprolol (Tartrate & Succinate)
Pregnancy: CCommon Brands: Lopressor, Toprol-XL, Betaloc
Cardiovascular · Cardioselective Beta-1 Adrenergic Receptor Blocker
Check apical pulse and blood pressure before administration. Hold if HR < 60 bpm or systolic BP < 100 mmHg unless specified by provider orders. Do NOT crush or chew extended-release Toprol-XL tablets. Can mask classic adrenergic symptoms of hypoglycemia (tachycardia, tremors) in diabetic patients. Abrupt cessation can cause rebound angina, arrhythmias, or myocardial infarction.
Midazolam
Pregnancy: DCommon Brands: Versed
Sedatives & Anxiolytics · Short-Acting Benzodiazepine (Schedule IV)
Emergency airway equipment (bag-valve-mask, suction, oxygen, endotracheal intubation tray) must be immediately accessible at bedside. Titrate slowly in small increments over 2 minutes. Continuously monitor SpO2, respiratory rate, and blood pressure. Produces anterograde amnesia (patient will not remember procedure). Antidote: Flumazenil (Romazicon).
Morphine Sulfate
High AlertPregnancy: CCommon Brands: MS Contin, Kadian, Roxanol
Analgesics / Central Nervous System · Opioid Agonist (Schedule II)
PRIORITY: Check respiratory rate and depth prior to every administration. HOLD dose and notify physician if respirations are < 12 breaths/minute. Monitor sedation level (POSS scale). Institute bowel regimen (stool softeners + stimulant laxatives) early to prevent severe opioid-induced constipation. Fall precautions are mandatory. Antidote: Naloxone (Narcan).
Naloxone
Pregnancy: BCommon Brands: Narcan, Kloxxado
Antidotes & Reversal Agents · Pure Opioid Antagonist
PRIORITY MONITORING: Naloxone has a significantly shorter elimination half-life (30–90 minutes) than most opioids (e.g., methadone, sustained-release morphine). Re-sedation and recurrent respiratory depression often occur after naloxone wears off. Continuous respiratory monitoring is essential; repeat doses or IV infusion may be needed.
Pantoprazole
Pregnancy: BCommon Brands: Protonix, Pan 40, Pantocid
Gastrointestinal · Proton Pump Inhibitor (PPI) / Antisecretory Agent
Oral tablets must be swallowed whole with water 30 minutes before a meal (do NOT crush, split, or chew delayed-release beads). IV push over at least 2 minutes. For continuous infusion in active upper GI bleeding, titrate according to protocol. Monitor for persistent diarrhea (rule out C. diff).
Potassium Chloride (IV)
High AlertPregnancy: CCommon Brands: K-Lyte, Potchlor, KCl
Electrolytes & Minerals · Potassium Supplement
DEADLY WARNING: NEVER ADMINISTER POTASSIUM CHLORIDE IV PUSH OR BOLUS — FATAL CARDIAC ARREST WILL OCCUR. Maximum peripheral infusion rate is 10 mEq/hr; maximum central line rate is 20 mEq/hr under continuous cardiac monitoring. Ensure adequate urine output (> 30 mL/hr) before administering. Assess IV site hourly for infiltration and phlebitis.
Regular Insulin (Short-Acting)
High AlertPregnancy: B (Safe in gestational diabetes)Common Brands: Humulin R, Novolin R, Actrapid
Endocrine & Metabolic · Pancreatic Hormone / Short-Acting Insulin
HIGH ALERT. Regular Insulin is the ONLY standard insulin that can be administered intravenously. Onset: 30–60 min SubQ, peak: 2–4 hours, duration: 5–8 hours. Ensure the patient eats a meal within 30 minutes of subcutaneous administration to prevent hypoglycemia during peak. When drawing into the same syringe as NPH insulin, always remember: "Clear before Cloudy" (draw Regular first, then NPH).
Vancomycin
Pregnancy: C (IV) / B (Oral)Common Brands: Vancocin, Vancocin HCl
Anti-infective · Glycopeptide Antibiotic
Oral vancomycin is NOT absorbed systemically and is strictly for C. diff. IV vancomycin MUST be infused over at least 60–120 minutes (max 10 mg/min) to prevent "Red Man Syndrome" (histamine flushing of neck/face/chest, pruritus, hypotension). Monitor trough serum concentrations (target 10–20 mcg/mL depending on infection severity) 30 minutes before the 4th dose. Monitor serum creatinine daily.
Warfarin
Pregnancy: X (Teratogenic — contraindicated in pregnancy)Common Brands: Coumadin, Jantoven
Hematologic / Anticoagulant · Vitamin K Antagonist
Monitor International Normalized Ratio (INR) regularly: therapeutic goal is 2.0–3.0 for most indications (2.5–3.5 for mechanical prosthetic mitral valves). Educate client to maintain consistent daily intake of vitamin K-rich green leafy vegetables (spinach, kale, broccoli). Instruct client to use soft toothbrush and electric razor. Antidote: Vitamin K1 (Phytonadione) and Prothrombin Complex Concentrate (PCC) or Fresh Frozen Plasma (FFP).