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NORCET pharmacology high yield questions 2025 nursing exam
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I now have rich material from the Lippincott Pharmacology textbook and other references. Let me compile the comprehensive NORCET Pharmacology high-yield key points.
NORCET Pharmacology - High-Yield Key Points
Sourced from Lippincott Illustrated Reviews: Pharmacology, Katzung's Basic and Clinical Pharmacology, and Goodman & Gilman's
1. ANTIDOTES (Most Tested in NORCET)
| Poison / Drug Overdose | Antidote / Treatment |
|---|---|
| Paracetamol (Acetaminophen) | N-Acetylcysteine (NAC) - sulfhydryl donor |
| Organophosphates (pesticides) | Atropine (muscarinic symptoms) + Pralidoxime (nicotinic symptoms/fasciculations) |
| Carbon monoxide | 100% Oxygen (hyperbaric O2 in severe cases) |
| Cyanide | Hydroxocobalamin (Vitamin B12a) |
| Methanol / Ethylene glycol | Fomepizole (blocks alcohol dehydrogenase); ethanol is alternative |
| Methemoglobinemia | Methylene blue |
| Iron toxicity | Deferoxamine |
| Heparin overdose | Protamine sulfate (immediate reversal) |
| Warfarin overdose | Vitamin K (12-24 hrs to reverse); FFP/PCC for urgent reversal |
| Opioid overdose | Naloxone (competitive antagonist) |
| Benzodiazepine overdose | Flumazenil |
| Beta-blocker overdose | Glucagon |
| Digoxin toxicity | Digoxin-specific antibody fragments (Digibind) |
| Heavy metals (arsenic, mercury, lead) | BAL (British Anti-Lewisite / Dimercaprol) |
| Lead poisoning | EDTA or DMSA (Succimer) |
Key NORCET trick: Isopropyl alcohol (rubbing alcohol) - NO antidote needed, only supportive care (it metabolizes to acetone, not a toxic acid).
2. ORGANOPHOSPHATE POISONING - DUMBBELS Mnemonic
DUMBBELS = signs of cholinergic excess (organophosphate/carbamate toxicity):
- D - Diarrhea
- U - Urination
- M - Miosis (pinpoint pupils)
- B - Bronchorrhea / Bronchospasm
- B - Bradycardia
- E - Emesis
- L - Lacrimation
- S - Salivation / Sweating
Treatment: Atropine (first and large doses) + Pralidoxime (2-PAM) early, before acetylcholinesterase "ages"
3. ACETAMINOPHEN TOXICITY - 4 Phases
| Phase | Time | Features |
|---|---|---|
| I | 0-24 hrs | Nausea, vomiting, malaise |
| II | 24-72 hrs | RUQ pain, rising LFTs, apparent improvement |
| III | 72-96 hrs | Peak hepatotoxicity, jaundice, coagulopathy |
| IV | 4-14 days | Recovery or fulminant hepatic failure |
- Antidote: NAC - most effective within 8 hours of ingestion
- Use Rumack-Matthew nomogram to guide antidote therapy
- (Lippincott Pharmacology, p.1524-1527)
4. ALCOHOL TOXICOLOGY
| Alcohol | Toxic Metabolite | Antidote | Target Organ |
|---|---|---|---|
| Methanol | Formic acid | Fomepizole + Folate | Eyes (blindness) |
| Ethylene glycol | Oxalic acid + Calcium oxalate | Fomepizole + Thiamine + Pyridoxine | Kidneys (renal failure, hypocalcemia) |
| Isopropanol | Acetone (non-toxic acid) | None - supportive | CNS depression |
- Ethylene glycol key labs: high anion gap metabolic acidosis + hypocalcemia + renal failure + calcium oxalate crystals in urine
5. ANTICOAGULANTS
| Drug | Mechanism | Reversal |
|---|---|---|
| Heparin (UFH) | Antithrombin III activation | Protamine sulfate (1 mg reverses 100 units heparin) |
| LMWH (enoxaparin) | Anti-Xa | Protamine (partial reversal) |
| Warfarin | Blocks Vitamin K-dependent factors II, VII, IX, X (+ Protein C & S) | Vitamin K (12-24 hrs); FFP/PCC urgent |
| Dabigatran (DOAC) | Direct thrombin inhibitor | Idarucizumab (Praxbind) |
| Rivaroxaban/Apixaban | Anti-Xa | Andexanet alfa |
- Warfarin monitoring: PT/INR
- Heparin monitoring: aPTT
6. HYPOGLYCEMIA MANAGEMENT
- Conscious patient: 15-20 g oral glucose (dextrose tablets/juice)
- Unconscious/IV access: 25 g IV Dextrose 50% (D50W - 50 mL)
- No IV access: Glucagon 1 mg IM/SC
- Note: Glucagon is NOT recommended for sulfonylurea-induced hypoglycemia (can worsen by stimulating insulin release)
7. ANTIHYPERTENSIVE DRUG CLASSES - High-Yield Points
| Class | Example | Key Nursing Point |
|---|---|---|
| ACE Inhibitors | Enalapril, Lisinopril | Side effect: dry cough (bradykinin); avoid in pregnancy |
| ARBs | Losartan, Valsartan | No cough; also avoid in pregnancy |
| Beta-blockers | Metoprolol, Atenolol | Avoid in asthma; mask hypoglycemia symptoms |
| Calcium Channel Blockers | Amlodipine, Nifedipine | Cause reflex tachycardia (DHP); constipation (verapamil) |
| Thiazide Diuretics | HCTZ | Causes hypokalemia, hyperuricemia, hyperglycemia |
| Loop Diuretics | Furosemide | Most potent; causes ototoxicity (large IV doses), hypokalemia |
8. OPIOID ANALGESICS
- Class effect: Analgesia, respiratory depression, miosis (pinpoint pupils), constipation, euphoria
- Morphine - gold standard opioid
- Naloxone: competitive opioid antagonist; reverses respiratory depression; short half-life - "renarcotization" possible with long-acting opioids like morphine
- Tramadol: atypical opioid + serotonin-norepinephrine reuptake inhibitor; risk of serotonin syndrome
9. ANTIBIOTICS - KEY NURSING POINTS
| Drug | Key Side Effect / Nursing Alert |
|---|---|
| Aminoglycosides (Gentamicin) | Nephrotoxicity + Ototoxicity; monitor trough levels |
| Tetracyclines | Avoid in children <8 yrs (tooth discoloration); photosensitivity; avoid with milk |
| Fluoroquinolones (Ciprofloxacin) | Tendon rupture (especially Achilles); avoid in children |
| Chloramphenicol | Gray baby syndrome in neonates |
| Metronidazole (Flagyl) | Disulfiram-like reaction with alcohol |
| Sulfonamides | Stevens-Johnson syndrome; avoid in newborns (kernicterus) |
10. CARDIAC DRUGS
- Digoxin (cardiac glycoside): Increases myocardial contractility, slows heart rate. Toxicity signs: nausea, vomiting, yellow-green visual disturbances, bradycardia, arrhythmias. Hypokalemia increases toxicity. Antidote: Digibind (digoxin-specific Fab antibodies)
- Atropine: Increases heart rate (blocks vagus); used in bradycardia; first-line for symptomatic sinus bradycardia
- Adenosine: Drug of choice for paroxysmal SVT (PSVT); very short half-life (~10 sec); causes transient complete heart block
11. CNS DRUGS
| Drug | Use | Key Point |
|---|---|---|
| Phenytoin | Epilepsy | Zero-order kinetics; gingival hyperplasia, ataxia, diplopia; teratogenic |
| Lithium | Bipolar disorder | Narrow therapeutic index; toxicity: tremor, polyuria, hypothyroidism; monitor renal function |
| Haloperidol | Antipsychotic | Risk of extrapyramidal symptoms (EPS), tardive dyskinesia |
| SSRIs (Fluoxetine) | Depression | Risk of serotonin syndrome if combined with MAOIs |
| Benzodiazepines | Anxiety/seizures | Dependence potential; antidote: flumazenil |
12. DRUG INTERACTIONS - MOST TESTED
- MAOIs + Tyramine-rich foods (cheese, wine) → hypertensive crisis
- Metronidazole + Alcohol → flushing, vomiting (disulfiram reaction)
- Aspirin + Warfarin → increased bleeding risk
- Tetracycline + Antacids (Ca2+, Mg2+, Al3+) → chelation, reduced absorption
- SSRIs + MAOIs → Serotonin syndrome (potentially fatal; never combine)
13. PREGNANCY DRUG SAFETY (NORCET Favorites)
- Safe in pregnancy: Heparin (doesn't cross placenta), Insulin, Methyldopa (antihypertensive of choice)
- Contraindicated in pregnancy: Warfarin (crosses placenta, teratogenic), ACE inhibitors / ARBs (fetal renal damage), Tetracyclines, Fluoroquinolones, Methotrexate, Thalidomide
- Folic acid: Must be taken periconceptionally to prevent neural tube defects
14. QUICK DRUG-SUFFIX MNEMONICS
| Suffix | Drug Class |
|---|---|
| -olol | Beta-blockers (atenolol, metoprolol) |
| -pril | ACE inhibitors (enalapril, lisinopril) |
| -sartan | ARBs (losartan, valsartan) |
| -dipine | Calcium channel blockers (amlodipine, nifedipine) |
| -statin | HMG-CoA reductase inhibitors (atorvastatin) |
| -mycin/-micin | Aminoglycosides / macrolides |
| -caine | Local anesthetics (lidocaine, bupivacaine) |
| -azepam/-azolam | Benzodiazepines (diazepam, midazolam) |
Sources: Lippincott Illustrated Reviews: Pharmacology (p.1524-1540), Katzung's Basic and Clinical Pharmacology 16e, Goodman & Gilman's Pharmacological Basis of Therapeutics
These cover the most heavily tested pharmacology areas in NORCET - antidotes, toxicology, anticoagulants, antibiotics, cardiac drugs, and drug safety in special populations. Want me to go deeper into any one category or create MCQs for practice?
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