"High-alert" doesn't mean the drug is rare — it means an error with it causes serious harm fast. The exam returns to the same five groups again and again, and it always tests the same thing: the check you perform before the harm, and the first move after.
| Group | Check first | If it goes wrong |
|---|---|---|
| Insulin | Current glucose; independent double-check; insulin type & timing (clear before cloudy when mixing) | Hypoglycemia: conscious → 15 g fast carbs, recheck in 15. Unconscious → IV dextrose 50% or IM glucagon. |
| Anticoagulants (heparin, warfarin, LMWH) | aPTT for heparin, INR for warfarin, platelets for both (HIT) | Bleeding: hold, assess, protamine (heparin) / vitamin K (warfarin) as ordered. |
| Opioids | Respiratory rate & sedation level before every dose | Respiratory depression: stop, stimulate, oxygen, naloxone as ordered — then keep watching (naloxone wears off first). |
| Concentrated electrolytes (esp. potassium chloride) | Never IV push potassium — ever. Verify concentration, pump, and rate. | Cardiac monitoring; treat symptomatic hyperkalemia as an emergency sequence (see the antidotes chart). |
| Chemotherapy | Two-RN verification, vesicant status, counts before infusion | Extravasation: stop the infusion, leave the line in, aspirate, follow the agent's protocol. |
Module 2 of the Core Bundle is built around these groups — every drug class with its monitoring labs, its antidote, and the questions that have ended more exam runs than any rare disease ever will.
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