High-Alert Medications & Antidotes
High-alert medications carry a heightened risk of significant patient harm when used in error (ISMP). This table pairs common ones with their antidotes or reversal agents. Print it for NCLEX review.
| Medication | Main risk | Antidote / reversal | Key monitoring |
|---|---|---|---|
| Heparin (IV) | Bleeding | Protamine sulfate | aPTT, platelets (HIT) |
| Warfarin | Bleeding | Vitamin K (phytonadione) | PT/INR |
| Opioids | Respiratory depression | Naloxone | RR, sedation, SpO₂ |
| Benzodiazepines (IV sedation) | Sedation / resp. depression | Flumazenil | LOC, RR |
| Insulin | Hypoglycemia | Dextrose 50% / glucagon | Blood glucose |
| Magnesium sulfate | Resp. depression, loss of DTRs | Calcium gluconate | DTRs, RR, Mg level |
| Digoxin (IV) | Toxicity / arrhythmia | Digoxin immune Fab | HR, K⁺, dig level |
| Acetaminophen (overdose)† | Hepatotoxicity | N-acetylcysteine (NAC) | LFTs, level |
| Beta-blockers (IV) / CCBs† | Bradycardia, hypotension | Glucagon (BB); calcium (CCB) | HR, BP |
| Potassium (IV) | Fatal arrhythmia if pushed | Never IV push — always dilute/infuse | ECG, K⁺ |
† Not on the ISMP high-alert list; included as a common overdose antidote pair.
Educational reference for nursing students — always follow your institution's formulary and protocols for actual administration and reversal.
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