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Dirty Sixty Breakdown: NCLEX Pharmacology Red-Flags & Priority Actions

Dirty Sixty Breakdown: NCLEX Pharmacology Red-Flags & Priority Actions

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 Visit thinklikeanurse.orgEPISODE NOTES1. Why Pharmacology Is the GatekeeperLargest and most feared NCLEX subsection.Students may face 20–50+ pharm questions in a row.Scoring under 58% on pharm practice drops first-time pass chance to ~30%.NCLEX repeatedly tests the same 15–20 high-danger scenarios, not broad memorization.2. The Strategy Shift: From Memorizing Everything → Knowing the Life-Threatening Red FlagsStop memorizing hundreds of drugs.Master the 60–70 prototypes (“Dirty 60”) and the red-flag dangers they carry.NCLEX focuses on:Immediate safety threatsPriority nursing actionsReversal agentsToxicity signsSafe administration rules3. The High-Yield Antidotes (Guaranteed Questions)You will see 1–3 antidote questions on the NCLEX.High-Alert DrugAntidoteHeparinProtamine sulfateWarfarinVitamin K; FFP if actively bleedingOpioidsNaloxoneBenzodiazepinesFlumazenilAcetaminophenAcetylcysteineDigoxinDigiBindMagnesium sulfate toxicityCalcium gluconateBeta-blocker overdoseGlucagon4. The “Dirty 60” Prototype DrugsPain / AnticoagulantsOpioids: morphine, hydromorphone, fentanylAnticoagulants: heparin, enoxaparin, warfarin, one DOAC (apixaban)Endocrine / DiabetesInsulins: regular, NPH, lispro, glargineMetforminCardiac / Rhythm / BP ControlDigoxinAmiodaroneAdenosineDopamineNitroglycerinMetoprololACE inhibitors (lisinopril, enalapril)ARBs (losartan)HydralazineNeurologicalPhenytoinValproic acidLevetiracetamMagnesium sulfate (OB + seizure)AntibioticsVancomycinGentamicinTobramycinCeftriaxonePsychLithiumMajor antipsychoticsMiscellaneousAcetaminophenPotassium chlorideAlbuterolLevothyroxine5. The Most Common NCLEX Red-Flag Scenarios & Priority ActionsOpioids → Respiratory Rate Below 8–10Action:Stop infusion immediatelyGive naloxoneStay with patientHeparin → HIT (Heparin-Induced Thrombocytopenia)Red flag: platelets <100,000Action:Stop heparinLabel as allergicNotify providerNever give aspirinACE Inhibitors → AngioedemaAirway emergencyAction:Stop ACE inhibitor for lifeNever restart any drug in the classVancomycin → Red Man SyndromeFlushing during infusionAction:Slow rate to 90–120 minutesPre-treat with antihistamineNot a true allergyAminoglycosides → OtotoxicityRinging, hearing lossAction:Stop drugNotify providerCheck peak/trough levelsDigoxin ToxicityRed flags:Yellow/green halosHR <60Severe N/VAction: Holds dose, check dig level, notify providerMetformin Danger SituationsRed flags:Any imaging with IV contrastMuscle pain + drowsiness → lactic acidosisAction:Hold 48 hours before & after contrastMonitor kidneysMagnesium Toxicity (OB)Red flags:Respiratory depressionLoss of reflexesAction:Give calcium gluconate6. Calculations & IV Rules (Deadly NCLEX Traps)Two formulas you must know:Dose calculations:Desired ÷ Have × VehicleIV drip rate:Total Volume ÷ Time in minutes × Drop factor50 calculation problems daily builds automaticity.7. IV Push Safety Rules the NCLEX LovesNever IV push undiluted potassium chloride (instant cardiac arrest)Fentanyl/morphine: push over 4–5 minutesAdenosine: must be pushed in 6 seconds, followed by rapid flushBlood transfusion:Two nurses verifyStay with patient for first 15 minutes8. The 8-Week Pharmacology Mastery PlanWeeks 1–2: Content OnlyMemorize Dirty 60Memorize antidote listUse Anki/QuizletNo practice questions yetWeeks 3–4: Math Weeks50 dosage calcs per dayBuild accuracy + speedWeeks 5–6: Question Immersion100 pharm questions per dayRead every rationaleWeek 7: ConsolidationWatch Simple Nursing, Mark KlimekOnly focus on high-yield drug classesWeek 8: Final PrepMixed blocksTrack pharm separatelyGoal: 65%+ (UWorld 70–80%)Three cheat sheets to print:Dirty 60Antidote chartIV push rates + insulin peaks9. Final Thought: Lithium ToxicityWhy push fluids?Because lithium is excreted entirely through the kidneys.Hydration increases clearance and prevents worsening toxicity. Need to reach out? Send an email to Brooke at ThinkLikeaNursePodcast@gmail.com
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