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.
12 high-alert classes
Antiarrhythmics
Cardiovascular
Prototype amiodarone
Restore & maintain normal rhythm across the four Vaughan-Williams classes. All can be proarrhythmic.
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.
Cardiac Glycosides (Digoxin)
Cardiovascular
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, phosphate & fluids, and correcting acidosis with IV bicarbonate. 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
Magnesium Sulfate (Obstetric)
Reproductive & OB
Prevents/controls eclamptic seizures in preeclampsia. High-alert: monitor reflexes; antidote is calcium gluconate.
Antidote Calcium gluconate
Neuromuscular Blockers
Nervous
Prototype succinylcholine
Paralyze skeletal muscle for intubation/surgery. Handle with high-alert safeguards (ISMP lists rocuronium): they paralyze but do NOT sedate or relieve pain. Sugammadex reverses rocuronium and vecuronium.
Antidote Neostigmine (or sugammadex)
Opioid Analgesics
Nervous
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.
Thrombolytics
Cardiovascular
Prototype alteplase
Clot-dissolving drugs for acute ischemic stroke, STEMI and massive PE — they break down a clot that has already formed, at the price of serious bleeding.
Vasopressors & Inotropes
Cardiovascular
Prototype norepinephrine
Adrenergic drugs (and vasopressin) that raise blood pressure — and, for most, cardiac output — in shock, plus the PDE3-inhibitor inotrope milrinone. ICU titration (epinephrine and norepinephrine are ISMP high-alert). Oral midodrine treats orthostatic hypotension, and IV ephedrine treats hypotension during anesthesia.
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.