NCLEX Quick Sheet – Neuropharmacology, Pain, and
Toxicology Review
•Autonomic Drugs – Sympathomimetics (epinephrine, norepinephrine): ↑ HR/BP, used for shock.
Parasympathomimetics (bethanechol): stimulate bladder, contraindicated in asthma.
•Anticholinergics (atropine, scopolamine) – Block ACh → dry mouth, blurred vision, tachycardia, urinary
retention. NCLEX: Avoid in glaucoma, BPH, and elderly delirium.
•Cholinesterase Inhibitors (donepezil, rivastigmine) – ↑ ACh for Alzheimer’s. SE: bradycardia, GI upset.
NCLEX: Give at bedtime to reduce GI effects.
•Levodopa/Carbidopa – Dopamine precursor + peripheral decarboxylase inhibitor. SE: dyskinesia, orthostatic
hypotension, hallucinations. NCLEX: Avoid high-protein meals, change positions slowly.
•MAO-B Inhibitors (selegiline, rasagiline) – Prolong dopamine. Avoid tyramine foods (hypertensive crisis).
•COMT Inhibitors (entacapone) – Extend levodopa effect. SE: orange urine, dyskinesia.
•Antiepileptics – Phenytoin: gingival hyperplasia, teratogenic, narrow range (10–20). Valproic acid:
hepatotoxic, teratogenic. Carbamazepine: agranulocytosis, rash. NCLEX: Use barrier contraception.
•Levetiracetam – Common antiseizure drug. Fewer interactions, causes somnolence and mood changes.
•Benzodiazepines (lorazepam, diazepam, midazolam) – Enhance GABA; sedation, dependence. Antidote:
flumazenil. NCLEX: Fall risk; taper slowly.
•Barbiturates (phenobarbital) – CNS depressant for seizures or sedation. NCLEX: Avoid alcohol, monitor
respiratory depression.
•General Anesthetics – Propofol: rapid onset/offset; watch for hypotension, propofol infusion syndrome.
NCLEX: Change IV tubing q12h.
•Local Anesthetics (lidocaine) – Na■ channel blocker. Toxicity: tinnitus, perioral numbness, seizures. NCLEX:
Monitor cardiac rhythm for arrhythmias.
•Opioids (morphine, fentanyl, oxycodone) – µ-receptor agonists. SE: respiratory depression, constipation,
miosis. Antidote: naloxone. NCLEX: Hold if RR <12; reassess pain after 30 min.
•Non-opioid Analgesics – NSAIDs for mild pain/inflammation. Acetaminophen for fever/pain. NCLEX: Avoid >4
g/day; antidote = N-acetylcysteine.
•Tramadol – Weak opioid + serotonin/norepinephrine reuptake inhibition. SE: seizure risk, serotonin
syndrome.
•Migraine Therapy – Abortive: triptans (5-HT■ agonists) cause vasoconstriction; avoid with CAD. Preventive:
beta-blockers, topiramate, valproate.
•Muscle Relaxants – Baclofen (CNS depressant for spasticity); abrupt stop = seizures. Cyclobenzaprine
(anticholinergic); drowsiness, dry mouth.
•Stimulants (methylphenidate, amphetamine) – ↑ dopamine/norepinephrine. SE: insomnia, weight loss,
tachycardia. NCLEX: Take early AM; monitor growth in children.
•Antipsychotics – Typical (haloperidol) → EPS, tardive dyskinesia, NMS. Atypical (risperidone, olanzapine) →
metabolic syndrome. NCLEX: Monitor temp, rigidity, WBC.
•Antidepressants – SSRIs: first-line; risk of serotonin syndrome. TCAs: anticholinergic, cardiotoxic. MAOIs:
avoid tyramine. NCLEX: 2-week washout between MAOI and SSRI.
•Mood Stabilizers – Lithium: therapeutic 0.6–1.2. Toxicity = tremor, polyuria, confusion. NCLEX: Maintain
salt/fluid; avoid NSAIDs and dehydration.
•Sedative-Hypnotics – Z-drugs (zolpidem) cause sleepwalking, next-day drowsiness. NCLEX: Take only
before bed, avoid driving.
•Toxidrome Reversals – Opioids → naloxone; Benzos → flumazenil; Anticholinergic → physostigmine;
Cholinergic crisis → atropine + pralidoxime; β-blocker OD → glucagon; CCB OD → calcium gluconate.
•NCLEX Neuro Tip – Always assess neuro status, airway, and vitals before giving CNS-active meds. Avoid
abrupt withdrawal of anticonvulsants, benzodiazepines, or baclofen.