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🔤 NCLEX guideUpdated October 202610 min read4 practice questions

NCLEX drug suffixes: the pharmacology cheat sheet

A drug's suffix usually names its class, and the class predicts the adverse effect the NCLEX asks about: -olol is a beta blocker, so check the pulse; -pril is an ACE inhibitor, so watch for cough and angioedema. Below are 27 endings with the one effect and one nursing action to know for each, then the antidotes and the places where a suffix lies.

How the exam uses a suffix

Pharmacological and Parenteral Therapies is 13–19% of the 2026 NCLEX-RN, and NCSBN says items use generic names "on most occasions", sometimes only the class. Run four steps: read the ending, name the class, recall its signature adverse effect, then choose the matching action: hold, assess, teach or report. Most items test the action, not the name. Drug Classes by Suffix and the Side Effect That Defines Each drills the pattern.

Heart and blood

SuffixClass (example)Adverse effect to knowNurse's action
-ololBeta blocker (metoprolol)Bradycardia, hypotension; masks hypoglycemia; nonselective ones (propranolol) can trigger bronchospasmPulse and BP first; hold below the ordered parameter (often 60); never stop abruptly
-prilACE inhibitor (lisinopril)Dry cough, angioedema, hyperkalemia, fetal toxicityLip, tongue or face swelling is an emergency; no potassium salt substitutes; report pregnancy
-sartanARB (losartan)Hyperkalemia, hypotension, fetal toxicity; cough is not the typical effectSame potassium and pregnancy teaching; the usual swap when an ACE cough is not tolerated
-dipineCalcium channel blocker (amlodipine)Swollen ankles and feet, dizziness, flushingCheck BP; assess for edema; rise slowly
-statinHMG-CoA reductase inhibitor (atorvastatin)Muscle pain that can progress to rhabdomyolysis (tea-colored urine); liver effectsReport muscle pain, tenderness or weakness; liver tests per order; no grapefruit juice
-parinHeparins (heparin, enoxaparin)Bleeding; heparin-induced thrombocytopeniaaPTT for IV heparin; watch platelets; enoxaparin in the abdomen, no air expelled, no rubbing
-xabanFactor Xa inhibitor (apixaban, rivaroxaban)Bleeding; stopping early raises stroke risk; spinal or epidural hematomaNo routine INR; report bleeding or black stools; never stop without the prescriber

Anti-infectives

SuffixClass (example)Adverse effect to knowNurse's action
-mycin, -micinAminoglycoside (gentamicin, tobramycin)Ototoxicity (tinnitus, hearing loss, dizziness) and nephrotoxicity, worse in older or dehydrated clientsPeak and trough levels as ordered (trough just before the next dose); report ringing in the ears; watch urine output and creatinine
-floxacinFluoroquinolone (ciprofloxacin, levofloxacin)Tendon rupture (highest risk over 60, on steroids, after transplant); neuropathy; CNS effects; worse myasthenia gravisHold and report tendon pain; give ciprofloxacin 2 hours before or 6 hours after antacids, iron or calcium
-cillinPenicillin (amoxicillin, piperacillin)Allergy up to anaphylaxis; cross-sensitivity with cephalosporins; C. difficileCheck allergies first; epinephrine and airway for anaphylaxis; finish the course
-cyclineTetracycline (tetracycline, doxycycline)Permanent tooth discoloration under age 8 (short doxycycline courses for tickborne illness are the CDC exception); fetal harm; photosensitivityAvoid in young children and pregnancy; full glass of water; not with dairy, antacids or iron; sunscreen
-virAntiviral (acyclovir, oseltamivir)Acyclovir: nephrotoxicity. Oseltamivir: neuropsychiatric effects, especially in childrenAcyclovir: fluids, IV over at least 1 hour. Oseltamivir: works best started within 48 hours of symptoms

Stomach, steroids and diabetes

SuffixClass (example)Adverse effect to knowNurse's action
-prazoleProton pump inhibitor (omeprazole, pantoprazole)Long-term: C. difficile diarrhea, hip, wrist or spine fractures, low magnesiumGive before a meal; lowest dose for the shortest time; report watery diarrhea
-tidineH2 blocker (famotidine, cimetidine)Confusion, agitation; cimetidine interacts with warfarin, phenytoin and theophyllineReport new confusion; check the medication list
-sone, -oloneCorticosteroid (prednisone, prednisolone, methylprednisolone)Hyperglycemia, infection, osteoporosis, mood changes, weight gainMonitor glucose; give with food; taper, never stop abruptly (adrenal suppression)
-gliptinDPP-4 inhibitor (sitagliptin)Pancreatitis; severe joint pain; lows with insulin or a sulfonylureaReport severe abdominal pain; the drug is stopped if pancreatitis is suspected
-gliflozinSGLT2 inhibitor (empagliflozin, dapagliflozin)Genital and urinary infections, dehydration and hypotension, ketoacidosis, perineal necrotizing fasciitisAssess volume status first; teach dehydration signs
-glutideGLP-1 agonist (semaglutide, liraglutide)Nausea and vomiting; pancreatitis; thyroid C-cell tumor boxed warning (medullary thyroid carcinoma); lows with insulin or a sulfonylureaAsk about personal or family MTC or MEN 2; report severe abdominal pain, a neck lump or hoarseness

Brain, mood, lungs and more

SuffixClass (example)Adverse effect to knowNurse's action
-azepam, -azolamBenzodiazepine (lorazepam, diazepam, alprazolam)Sedation; respiratory depression and death with opioids; dependence; withdrawal seizuresFall and respiratory precautions; taper, never stop abruptly
-oxetineSSRI (fluoxetine, paroxetine); duloxetine is an SNRISuicidal thoughts in children, teens and young adults; serotonin syndrome with MAOIsWatch mood early; weeks to full effect; taper; 5 weeks after fluoxetine before an MAOI
-ipramineTricyclic antidepressant (imipramine, desipramine)Dry mouth, constipation, urinary retention, blurred vision; sedation; hypotension; cardiotoxicityMonitor BP and heart rate; fall precautions; avoid in glaucoma
-triptanMigraine serotonin agonist (sumatriptan)Chest, throat or jaw tightness; risky with heart diseaseAt the first sign of migraine, not for prevention; report chest pain at once
-lukastLeukotriene modifier (montelukast)Boxed warning: mood and behavior changes, suicidal thoughtsA controller taken in the evening, never for an acute attack; stop and report mood changes
-terolBeta-2 agonist: albuterol (short-acting), salmeterol (long-acting)Tremor, nervousness, tachycardiaAlbuterol is the rescue inhaler; salmeterol is never for immediate relief
-tropiumAnticholinergic bronchodilator (ipratropium, tiotropium)Dry mouth, blurred vision, constipation; avoid in narrow-angle glaucoma and urinary retentionTiotropium is long-term COPD maintenance
-zosinα1 blocker (doxazosin, terazosin, prazosin)Dizziness and fainting on standing, worst after the first dose or a dose increaseRise slowly; no driving for 24 hours after a first dose or increase; tell the eye surgeon
-afilPDE-5 inhibitor (sildenafil, tadalafil)Severe hypotension with nitrates; headache, flushing; sudden vision or hearing lossNever with nitrates in any form; an erection over 4 hours is an emergency

High-alert drugs and their antidotes

ISMP defines high-alert medications as drugs that "bear a heightened risk of causing significant patient harm when they are used in error". Several classes above are on its acute-care list: the anticoagulants (heparin, enoxaparin, warfarin, the factor Xa inhibitors), IV moderate-sedation agents such as lorazepam and midazolam, and IV adrenergic antagonists such as metoprolol and labetalol, alongside insulin and opioids. On the exam these are the drugs where the safe answer checks a lab or vital sign before the dose and knows the reversal.

Drug or classReversalThe catch
Heparin (-parin)Protamine sulfate, by very slow IV injection (max 50 mg in 10 minutes)aPTT guides IV heparin; enoxaparin: no routine aPTT, but check platelets
WarfarinVitamin KFollow the INR; see the lab values guide
Factor Xa inhibitors (-xaban)Four-factor prothrombin complex concentrate (off-label, per institutional protocol) for life-threatening bleedingAndexanet alfa (Andexxa) was withdrawn from the US market on December 22, 2025; older books still list it
Benzodiazepines (-azepam)FlumazenilCan trigger seizures in dependent clients; short-acting, so sedation can return

The Antidote Table You Will See on Exam Day has the full antidote table and Digoxin, Beta Blockers and Nitro: Hold Parameters and Hard Stops the hold parameters for beta blockers and digoxin.

Where the suffix lies

  • Not every -mycin is an aminoglycoside. Azithromycin and erythromycin are macrolides; vancomycin is a glycopeptide.
  • Nystatin is an antifungal, not a statin.
  • -triptyline is not -triptan. Amitriptyline and nortriptyline are tricyclic antidepressants.
  • Some classes skip their suffix. Diltiazem and verapamil are calcium channel blockers with no -dipine; tamsulosin is an α1 blocker with no -zosin.
  • Same suffix, different job. Duloxetine is an SNRI; salmeterol is a -terol you never use for rescue.

Names can look alike too. ISMP's confused-names list pairs hydrALAZINE with hydrOXYzine, predniSONE with prednisoLONE, NIFEdipine with niCARdipine, cloNIDine with KlonoPIN (clonazepam), HumaLOG with HumuLIN, HYDROmorphone with morphine, and metFORMIN with metroNIDAZOLE. The capitals are "tall man" lettering, there to make the difference visible. A stem where the nurse spots a label that does not match the order is testing exactly this.

A worked pharmacology item

A 72-year-old with heart failure is admitted with pneumonia and a COPD flare. Medications: metoprolol, lisinopril, prednisone and levofloxacin. Which finding needs the nurse's immediate follow-up?

  1. Heart rate 64 before the morning metoprolol. -olol: 64 is above the usual hold parameter of 60. Give.
  2. Fasting glucose 168 mg/dL, up from the 130s since prednisone started. -sone: hyperglycemia is an expected effect. Monitor and report per orders, not the emergency.
  3. A dry, tickly cough since lisinopril began last month. -pril: the class cough. Report it; a -sartan is the usual swap. Lip or tongue swelling would be the emergency.
  4. New pain and swelling at the back of the right heel. -floxacin plus -sone in a client over 60: the tendon rupture combination. Correct. Hold the levofloxacin, rest the leg and notify the provider.

Every option was a real class effect; only one was dangerous. Practice the pattern with drug-class practice questions.

✅ Test yourself: 4 questions

Four pharmacology items on adverse effects and antidotes. Name each drug's class first, then pick the action that class calls for. Every client is fictional; exam practice only, not medical advice.

Question 1 of 4

A client with diabetic gastroparesis has taken metoclopramide 10 mg before meals and at bedtime for 5 months. At today's visit, the nurse notes repeated lip smacking, puckering and darting movements of the tongue that the client had not noticed. Which action should the nurse take?

  1. Record the movements as an expected effect of the medication
  2. Teach the client to take the metoclopramide with meals instead of before
  3. Give benztropine as prescribed to relax the muscles of the face
  4. Hold the metoclopramide and report the movements to the provider
Show the answer and rationale

Answer: D

Repetitive, involuntary lip smacking, puckering and tongue movements after months of metoclopramide are tardive dyskinesia, which the drug's boxed warning says can be irreversible; the risk grows with longer use and higher total dose, so treatment is limited to 12 weeks and the drug is stopped when signs appear. Benztropine treats an acute dystonic reaction, a sudden muscle spasm early in therapy, and it does not reverse tardive dyskinesia. These movements are never an expected effect, and changing the timing of doses does nothing for them.

📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each

Question 2 of 4

A client who weighs 154 lb is prescribed IV acetylcysteine by the 3-bag regimen for an acetaminophen overdose, starting with a loading dose of 150 mg/kg over 1 hour. How many grams of acetylcysteine does the loading dose contain?

  1. 3.5 g
  2. 10.5 g
  3. 21 g
  4. 23.1 g
Show the answer and rationale

Answer: B

Convert the weight first: 154 lb ÷ 2.2 = 70 kg. Then 150 mg/kg × 70 kg = 10,500 mg, and 10,500 mg ÷ 1,000 = 10.5 g, infused over 1 hour. Using the weight in pounds gives 23.1 g, an overdose. 3.5 g is the second bag (50 mg/kg × 70 kg, given over 4 hours), and 21 g is the full 300 mg/kg course for all three bags, which runs over 21 hours.

📚 Learn it: The Antidote Table You Will See on Exam Day

Question 3 of 4

Ketorolac 30 mg IV every 6 hours is prescribed for four postoperative clients. For which client should the nurse question the dose?

  1. A 33-year-old weighing 82 kg (180 lb) after ankle surgery
  2. A 74-year-old who weighs 46 kg (101 lb) after a hip repair
  3. A 63-year-old who weighs 52 kg (115 lb) after a knee repair
  4. A 41-year-old on the fourth day of ketorolac after a hernia repair
Show the answer and rationale

Answer: B

Clients who are 65 or older, weigh less than 50 kg or have reduced kidney function have a higher risk of kidney injury and bleeding from ketorolac, so the label lowers the IV dose for them to 15 mg every 6 hours, with a daily maximum of 60 mg. The 63-year-old who weighs 52 kg sounds high-risk but is under 65 and over 50 kg, so the usual dose applies. The client on the fourth day is still within the label's limit of no more than 5 days in total for every client, and the 33-year-old has none of these risks.

📚 Learn it: Drug Classes by Suffix and the Side Effect That Defines Each

Question 4 of 4

Six hours after hip surgery, a client who received IV morphine has a respiratory rate of 7 breaths/min and opens the eyes only to a firm shake. The nurse stops the opioid and prepares naloxone 0.4 mg. How should the nurse give the naloxone?

  1. Dilute the 0.4 mg in 10 mL of saline and give it IV over 10 minutes, then reassess
  2. Push the full 0.4 mg IV at once over 1 minute to reverse the opioid quickly
  3. Inject the full 0.4 mg into the deltoid, recheck in 5 minutes, and repeat once if needed
  4. Give small diluted IV doses every 2 to 3 minutes until breathing improves
Show the answer and rationale

Answer: D

For postoperative opioid-induced respiratory depression, naloxone is given in small IV increments, about 0.1 to 0.2 mg every 2 to 3 minutes, titrated to adequate breathing and alertness so the client is not thrown into severe pain, vomiting and hypertension by abrupt reversal. The runner-up is pushing the full 0.4 mg IV at once: that is a usual starting dose for an unknown overdose, but after surgery it risks exactly that abrupt reversal. Giving the full dose into the deltoid cannot be titrated to response, and stretching the full dose over 10 minutes still delivers all of it while delaying titration. Because naloxone can wear off before the opioid, the client is watched closely afterward.

📚 Learn it: The Antidote Table You Will See on Exam Day

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❓ Frequently asked

What drug suffixes should I know for the NCLEX?

Start with the endings whose class has one famous adverse effect: -olol, -pril, -sartan, -statin, -parin, -xaban, -mycin, -floxacin, -cycline, -sone, -azepam and -prazole.

Does the NCLEX use brand or generic drug names?

Generic names on most occasions, according to NCSBN, and some items refer only to the drug class. Learn the generic name and its suffix.

Is every drug ending in -mycin an aminoglycoside?

No. Gentamicin and tobramycin are aminoglycosides; azithromycin and erythromycin are macrolides, and vancomycin is a glycopeptide.

What is the difference between -pril and -sartan drugs?

Both act on the renin-angiotensin-aldosterone system and share hyperkalemia, hypotension and fetal toxicity. ACE inhibitors (-pril) cause a dry cough; ARBs (-sartan) typically do not, which is why they are the usual swap.

What reverses apixaban or rivaroxaban in 2026?

Andexanet alfa (Andexxa) was withdrawn from the US market on December 22, 2025. Life-threatening bleeding now gets four-factor prothrombin complex concentrate, off-label, per institutional protocol.

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Sources

  1. NCSBN, NCLEX-RN Test Plan effective April 2026 (categories, 85–150 items, case studies, scoring methods, how the exam ends)
  2. NCLEX.com, Frequently Asked Questions: items use "generic medication names only" on most occasions, some refer to drug classes
  3. OpenStax, Pharmacology for Nurses, 19.3 Beta-Adrenergic Blockers
  4. OpenStax, Pharmacology for Nurses, 19.2 Drugs Affecting the Renin-Angiotensin-Aldosterone System (ACE inhibitors, ARBs)
  5. OpenStax, Pharmacology for Nurses, 19.4 Sodium-Glucose Cotransporter-2 Inhibitors
  6. OpenStax, Pharmacology for Nurses, 31.2 Histamine Blockers and Proton Pump Inhibitors
  7. OpenStax, Pharmacology for Nurses, 26.4 Glucocorticoids and Mineralocorticoids
  8. OpenStax, Pharmacology for Nurses, 25.1 Adrenergics and Anticholinergics (albuterol, salmeterol, ipratropium, tiotropium)
  9. OpenStax, Pharmacology for Nurses, 13.1 Antidepressants (TCAs, SSRIs, SNRIs)
  10. Open RN, Nursing Pharmacology, 6.11 Antilipemics (atorvastatin)
  11. Fundamentals of Nursing Pharmacology, Mohawk College edition of the Open RN text (Chippewa Valley Technical College), 6.12 Blood Coagulation Modifiers
  12. Open RN, Nursing Pharmacology 2e, 3.5 Penicillins
  13. Open RN, Nursing Pharmacology 2e, 3.13 Tetracyclines
  14. CDC, Doxycycline and tooth staining (short courses for rickettsial disease in children, AAP and CDC recommendation)
  15. Open RN, Nursing Pharmacology 2e, 3.14 Antivirals (acyclovir, oseltamivir)
  16. MedlinePlus (NIH), Ciprofloxacin: tendon, nerve, CNS and myasthenia gravis warnings; antacid and mineral spacing
  17. MedlinePlus (NIH), Gentamicin Injection: kidney and hearing warnings
  18. MedlinePlus (NIH), Enoxaparin Injection: spinal/epidural hematoma warning, injection technique
  19. MedlinePlus (NIH), Rivaroxaban: stopping and spinal/epidural hematoma warnings
  20. MedlinePlus (NIH), Amlodipine
  21. MedlinePlus (NIH), Prednisone
  22. MedlinePlus (NIH), Semaglutide Injection: thyroid tumor boxed warning
  23. MedlinePlus (NIH), Fluoxetine: suicidality warning, MAOI spacing, time to effect
  24. MedlinePlus (NIH), Sumatriptan
  25. MedlinePlus (NIH), Doxazosin: first-dose dizziness and fainting, driving, eye surgery
  26. FDA, Prilosec (omeprazole) Medication Guide: fractures, C. difficile diarrhea, low magnesium, take before a meal
  27. FDA Drug Safety Communication (May 12, 2016): fluoroquinolone disabling side effects
  28. FDA Drug Safety Communication (Sept. 23, 2020): Boxed Warning updated for the benzodiazepine class
  29. FDA (March 4, 2020): Singulair (montelukast) strengthened Boxed Warning
  30. FDA, Singulair prescribing information (2021): not for an acute asthma attack, evening dosing
  31. FDA, Viagra (sildenafil) prescribing information: nitrate contraindication, priapism, vision and hearing loss
  32. DailyMed (NLM), Januvia (sitagliptin) label: pancreatitis, severe arthralgia, hypoglycemia with insulin or secretagogues
  33. ISMP, List of High-Alert Medications in Acute Care Settings (2024)
  34. ISMP, List of Confused Drug Names (updated through June 2024)
  35. TCTMD (Dec. 22, 2025): andexanet alfa (Andexxa) no longer made or sold in the US after FDA safety review
  36. University of Maryland EM, Educational Pearl: Andexxa withdrawn Dec. 22, 2025; 4F-PCC for factor Xa inhibitor reversal
  37. University of Utah Poison Control Center, Flumazenil (2022): seizure risk, re-sedation

Accessed October 2026. Yearly figures name their year; NCSBN publishes a new statistics brief each June and a new test plan every three years (next: April 2029). Exam preparation only, never medical advice. NCLEX® is a registered trademark of NCSBN, which does not endorse this site.

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