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High-alert medications

High-alert drugs (ISMP) aren't necessarily the ones errors happen with most — they're the ones where an error causes the most harm. They warrant safeguards like independent double-checks.

11 high-alert classes
Anticoagulants
Cardiovascular
Prototype heparin
Prevent clot formation. High-alert medications — bleeding precautions essential.
Antidote Protamine sulfate (heparin) · Vitamin K / phytonadione (warfarin)
The principles behind cytotoxic chemotherapy: why it harms healthy fast-dividing tissue, hazardous handling, the nadir, extravasation, and tumor lysis.
Prototype digoxin
Strengthen and slow the heart in HF and atrial fibrillation. Narrow therapeutic index — a high-alert drug.
Antidote Digoxin immune Fab (DigiFab)
Replacing potassium, magnesium, calcium & fluids. IV potassium is high-alert — NEVER push it.
Insulins
Endocrine
Replace or supplement the body’s own insulin to lower blood glucose. High-alert — hypoglycemia is the #1 risk.
Antidote Hypoglycemia rescue — 15 g fast-acting carb if conscious; D50 IV or glucagon IM if unconscious
Prevents/controls eclamptic seizures in preeclampsia. High-alert: monitor reflexes; antidote is calcium gluconate.
Antidote Calcium gluconate
Prototype lithium carbonate
Lithium controls bipolar mania but has a tiny therapeutic window — levels are everything.
Antidote No specific antidote
Prototype succinylcholine
Paralyze skeletal muscle for intubation/surgery. High-alert: they paralyze but do NOT sedate or relieve pain.
Antidote Neostigmine (or sugammadex)
Prototype morphine
Potent pain control via µ-opioid receptor agonism. Watch for respiratory depression; reverse with naloxone.
Antidote Naloxone (Narcan)
Oxytocin (Uterotonic)
Reproductive & OB
Prototype oxytocin
Induces/augments labor and controls postpartum bleeding. High-alert: titrate to contractions, watch for tachysystole.
Prototype norepinephrine
Adrenergic drugs that raise blood pressure and cardiac output in shock. High-alert ICU titration.
Antidote Phentolamine

Based on the ISMP List of High-Alert Medications. This shows the classes covered in LearnDrugs.com — it isn't the complete ISMP list. Open each class for its full hold rules, antidote, and monitoring.