Neurological Medications & NCLEX Pharmacology — NCLEX-PN Neurological Drug Review | Chapter 56: Saunders

Chapter 56 of Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) by Linda Anne Silvestri and Angela E. Silvestri delivers an in-depth breakdown of pharmacological agents used to treat neurological disorders, from myasthenia gravis and multiple sclerosis to seizure disorders, Parkinson’s disease, ADHD, and pain management. This chapter reinforces NCLEX-priority medication safety, side effect recognition, and patient education strategies for safe neurological care.

Watch the lecture above and review the full medication details below to strengthen your NCLEX pharmacology readiness.

Antimyasthenic Medications

• Pyridostigmine: increases muscle strength by improving neuromuscular transmission.
• Edrophonium: used in diagnosis and crisis differentiation — short-acting.
• Crisis identification:
  • Myasthenic crisis — underdosing, improved with edrophonium.
  • Cholinergic crisis — overdosing, worsens with edrophonium, treat with atropine.

Multiple Sclerosis Medications

• Immunomodulators: interferons (flu-like symptoms), glatiramer acetate (injection site reactions).
• Immunosuppressants: mitoxantrone — monitor for hepatotoxicity and myelosuppression.

Parkinson’s Disease Medications

• Dopaminergics: carbidopa-levodopa — avoid high-protein meals, monitor for dyskinesia, orthostatic hypotension.
• Anticholinergics: benztropine — reduce tremor, monitor for dry mouth, blurred vision, constipation.
• COMT inhibitors: entacapone — prolong levodopa effect, monitor liver function.

Seizure Disorder Medications

• Hydantoins: phenytoin — therapeutic range 10–20 mcg/mL, gingival hyperplasia, ataxia.
• Barbiturates: phenobarbital — sedation, tolerance with long-term use.
• Benzodiazepines: diazepam, lorazepam — acute seizure control, risk for respiratory depression, flumazenil as antidote.
• Succinimides: ethosuximide — GI upset, blood dyscrasias.
• Valproates: valproic acid — hepatotoxicity, pancreatitis.
• Iminostilbenes: carbamazepine — blood dyscrasias, visual disturbances.

CNS Stimulants for ADHD

• Methylphenidate, amphetamines — monitor growth in children, risk for insomnia, BP elevation, abuse potential.

Pain Management & Analgesics

• NSAIDs: ibuprofen, naproxen, aspirin — GI bleeding, Reye’s syndrome risk with aspirin in children.
• Acetaminophen: max 4g/day, hepatotoxicity, acetylcysteine as antidote.
• Opioids: morphine, meperidine — respiratory depression, constipation, dependence.
• Opioid antagonists: naloxone, naltrexone — short half-life, monitor for symptom recurrence.

Osmotic Diuretics

• Mannitol: reduces intracranial pressure and intraocular pressure; monitor for pulmonary edema, fluid balance changes.

NCLEX Nursing Priorities

• Administer neuro medications on strict schedules for optimal effectiveness.
• Monitor for toxicities — liver, renal, hematologic, CNS.
• Educate patients on adherence, side effects, and when to seek help.
• Implement seizure and fall precautions as needed.
• Document responses and adverse events promptly.

Conclusion

Chapter 56 ensures mastery of neurological medication classes, mechanisms, and NCLEX-critical safety considerations. Recognizing drug-specific risks and delivering thorough client teaching are key to safe practice and exam success.

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View the complete Saunders Comprehensive Review for the NCLEX-PN® Examination (7th Edition) playlist here: Complete NCLEX-PN Review Playlist