ICU Medications Every New Nurse Must Know (with NCLEX Practice)

Walking into your first ICU shift, you will hear three things: alarms, codes, and drug names you have never heard before. Knowing the critical care medications cold is the single biggest separator between a new nurse who survives and one who thrives. The good news: the list is shorter than it feels.

These are the 24 ICU medications you must know for the NCLEX and day one in the unit. Updated for 2026 NCLEX and clinical practice.

Vasopressors and inotropes

Norepinephrine (Levophed)

First-line for septic shock. Titrate to MAP greater than 65. Causes vasoconstriction — watch for extravasation, central line preferred. Antidote for extravasation: phentolamine.

Epinephrine

Code-blue drug. Anaphylaxis. 1 mg IV push every 3 to 5 minutes during arrest. Watch HR and BP.

Dopamine

Dose-dependent: low (renal), medium (cardiac), high (vasopressor). Tachycardia at higher doses.

Dobutamine

Inotrope for cardiogenic shock. Increases contractility without major vasoconstriction.

Vasopressin

Septic shock adjunct. Often added when norepi is maxed.

Sedation and analgesia

Propofol

Sedation for intubated patients. Watch BP (causes hypotension). White milky solution. Propofol infusion syndrome at high doses.

Fentanyl

Most-used ICU opioid. Rapid onset. Watch RR. Antidote: naloxone.

Midazolam (Versed)

Short-acting benzo. Watch RR. Antidote: flumazenil.

Dexmedetomidine (Precedex)

Sedation without respiratory depression. Patient remains arousable. Bradycardia is the main risk.

Ketamine

Sedation and analgesia. Maintains BP and respiratory drive. Emergence reactions a risk.

Paralytics

Rocuronium

Used for intubation. Reversal: sugammadex.

Cisatracurium

Continuous infusion for ARDS. Eliminated by Hofmann degradation — safe in renal/hepatic failure.

Succinylcholine

Rapid sequence intubation. Watch for hyperkalemia and malignant hyperthermia.

Antiarrhythmics

Amiodarone

First-line for v-tach, v-fib, AF. 150 mg IV bolus, then drip. Long half-life. Watch thyroid, lungs, liver with long-term use.

Lidocaine

Backup for v-tach if amio not available. Watch CNS toxicity (tinnitus, confusion).

Adenosine

SVT — 6 mg rapid IV push followed by 20 mL flush. Patient will have a 5-second pause.

Anticoagulation

Heparin drip

Titrate to aPTT. Antidote: protamine sulfate. HIT a serious complication.

Argatroban

Direct thrombin inhibitor for HIT patients.

Electrolyte replacements

Potassium chloride

NEVER IV push. Always diluted, on a pump, max 10 mEq/hour peripheral.

Calcium gluconate

For hyperkalemia (cardiac membrane stabilization). For magnesium toxicity (antidote).

Magnesium sulfate

Torsades. Eclampsia. Watch for respiratory depression.

Diuretics and renal

Furosemide (Lasix)

IV bolus or drip. Wastes K+. Watch hearing (ototoxic at high doses).

Bumetanide

Stronger than furosemide. Used when Lasix is not pulling fluid.

Insulin drip

For DKA and hyperglycemic emergencies. Hourly blood glucose checks. Switch to subq when glucose 200 with overlap.

The 5 antidotes that matter in the ICU

Drug	Antidote
Heparin	Protamine
Warfarin	Vitamin K
Magnesium sulfate	Calcium gluconate
Opioids	Naloxone
Rocuronium	Sugammadex

NCLEX-style practice question

A client in septic shock is on norepinephrine titrated to MAP 65. The peripheral IV site is red and swollen. Which is the priority nursing action?

Answer: Stop the infusion and notify provider. Norepi extravasation causes tissue necrosis. Phentolamine is the antidote.

Frequently Asked Questions

What are the most common medications used in the ICU?

Norepinephrine, propofol, fentanyl, heparin, and amiodarone make up the majority of ICU drips. Vasopressors, sedatives, anticoagulants, and antiarrhythmics are the four major drug families to master.

What is the safest IV potassium rate?

Maximum 10 mEq per hour through a peripheral IV. Central lines can run higher under cardiac monitoring. Never IV push.

What is the antidote for norepinephrine extravasation?

Phentolamine, injected subcutaneously around the affected area, reverses the vasoconstriction that causes tissue damage.