UNIT 2: CENTRAL NERVOUS SYSTEM PHARMACOLOGY
Pharmacology for Advanced Practice Nurses
Lehne’s Pharmacology for Nursing Care (9 th edition):
Chapters 20 – 40
Edited by: Jessica Santos
,SECTION I: INDEX
Question Page(s)
1. Headaches: Appropriate drugs for prophylaxis. (p. 312; key search term: “drugs
preventive”)
2. Headaches: Indications for Ca2+ channel blockers, tricyclics (Amitriptyline),
triptans. (pp. 307, 313; key search term: “2013 mechanism”)
3. Headaches: Review the indications for Topamax (topiramate). (pp. 231, 312; key
search term: “2004 benefits”)
4. Headaches: Actions/role of opioids in headaches. (p. 306; key search term:
“analgesics are reserved”)
5. Headaches: Medications for cluster headaches and menstrual headaches. (p. 313;
key search terms: “cluster headaches occur,” and “menstrually associated
migraine”)
6. Headaches: Side effects and contraindications of drugs, such as beta blockers,
triptans, and clozapine. (pp. 312-313, 326-327; key search term: “patients benefits
take”)
7. Headaches: Which drugs have vasoconstrictive effects? (pp. 306-308; key search
term: “prolonged vasospasm”)
8. Local Anesthetics: Esters versus amides. (p. 245; key search term: “amides the
ester”)
9. Local Anesthetics: What are some SEs of these medications? (p. 246; key search
term: “administration local effects”)
10. Local Anesthetics: Think about ages of patients when prescribing these
medications. (please see question #9 for additional information; pp. 250; key search
term: “result warn”)
11. Seizures: Actions, side effects, contraindications, monitoring and assessment (e.g.,
phenytoin, valproic acid, carnamazapine, phenobarbital with dosing, when can it
cause CNS depression, target levels). (p. 218; key search term: “long known that
AED”)
12. Seizures: Understand which drug is appropriate for the type of seizure. (p. 216;
key search term: “seizures in partial”)
13. Seizures: Review phenytoin – understand action of drugs, SEs of toxicity, etc.
(please see Table 24-2 on p. 219 for dosing of all AEDs; p. 221; key search term:
“most widely used AED”)
14. Seizures: Make sure you understand how these drugs are impacted by the
cytochrome P450 system. (p. 221; key search term: “owing to effects on drug”)
15. Seizures: Which comorbidities need to be considered when prescribing these
medications? Which medications should you not prescribe? (p.224; key search
term: “thereafter patients with preexisting”)
16. Seizures: Newer seizure meds—what are advantages? How are they used? (p.
228; key search term: “members although most”)
17. General Anesthetics: Review different types, review minimum/median alveolar
concentration. (p. 252; key search term: “concentration is an index”)
18. Benzodiazepines: Side effects, contraindications, antidotes. (p. 389; key search
term: “anxiety as discussed”)
19. Benzodiazepines: Good agent to use for conscious sedation. (p. 256; key search
term: “anxiety the patient”)
20. Benzodiazepines: Good agent for insomnia and panic attacks (short term use, not
a good drug for chronic anxiety). (pp. 383, 391; key search term: “insomnia these
agents” and “benzodiazepines although”)
21. Skeletal Relaxants: Review pharmacokinetics and use. (pp. 240-244; key search
term: “group muscle spasm”)
22. Skeletal Relaxants: What labs are important to evaluate when utilizing these
medications? (p. 243; key search term: “damage obtain LFTs”)
23. Antipsychotics: Indications, actions, SEs, contraindications for first and second-
generation drugs, such as Haldol (haloperidol), Zyprexa (olanzapine), Dantrolene,
Thioridazine, Clozapine, Seroquel (quetiapine), Risperdal (risperidone),
paliperidone (Invega), ziprasidone (Geodon) and others. What are key differences
between first and second-generation antipsychotics? (pp. 317-333; key search
term: “psychotic disorders specific”)
24. Antipsychotics: Consider the patient’s comorbidities – which medications would
you prescribe if the patient has HTN, DM, etc.? (p. 331; key search term:
“reasonable for a patient”)
2
,25. Antipsychotics: Treatment for malignant hyperthermia or neuroleptic malignant
syndrome. (pp. 242, 322; key search terms: “SR Dantrolene” and “intervention
primary symptoms”)
26. Antipsychotics: Review the treatment of psychosis – what medications are used;
what SEs are often seen? (p. 318, 319, 321, 325, 326; key search term: “interest it
is”)
27. Antipsychotics: Review tardive dyskinesia. Who is more likely to experience this?
(p. 322; key search term: “the most troubling EPS”)
28. Antipsychotics: Extrapyramidal symptoms. (p. 321; key search term: “motor
system the”)
29. What medications are good for bipolar patients? (pp. 365-372; key search term:
“stabilizers mood”)
30. Lithium: Side effects and treatment. What medications would you give to alleviate
some of the SEs of this medication? (pp. 368, 371; key search term: “subside
gastrointestinal”)
31. Lithium: When should serum blood levels be drawn? Make sure you understand
the difference between starting the medications versus maintenance. (p. 367; key
search term: “evening dose during”)
32. Lithium: What labs and clinical markers should be monitored on these patients?
(pp. 367-368; key search term: “sodium specifically”)
33. Lithium: What should patients avoid when on lithium therapy? (p. 368; key
search term: “lithium also pregnancy”)
34. Other drugs used in the treatment of BPD and other serious mental illnesses (e.g.
aripiprazole, carbamazepine, chlorpromazine, lamotrigine, etc.). What other
medications are used in combination with lithium for treatment? (pp. 370 – see
additional pages listed below; key search term: “valproate currently”)
35. Dopamine Agonists: Review dopamine agonists, muscarinic agents as related to
the disorders studied in this unit. (p. 183 – see pages listed below; key search
term: “for PD beneficial”)
36. Dopamine Agonists: Understand Parkinson-type disorders induced by psychiatric
medications. Review peripheral nervous system stimulation as related to side
effects of these drugs (e.g., anticholinergic effects). You may need to review
autonomic information again. (p. 321; key search term: “reactions especially
tardive”)
37. Dopamine Agonists: What are some common SEs seen by patients taking these
medications? (p. 183; key search term: “however dopamine”)
38. Dopamine Agonists: How do you treat dyskinesias from psychotropic
medications? (pp. 178, 183, 322; key search terms: “first-line drugs” and “TD is
characterized”)
39. Dopamine Agonists: General information regarding MOAIs (monoamine oxidase
inhibitors) – very old, rarely used now, but still a testable favorite! (pp. 352-353;
key search term: “inhibitors the MAOIs”)
40. Dopamine Agonists: Tyramine-containing foods to avoid. (p. 353; key search
term: “tyramine although”)
41. Dopamine Agonists: Interactions with tyramine. (p. 353; key search term: “first
inhibition of”)
42. Opioid Analgesics: Pharmacokinetics and appropriateness. (pp. 260-261; key
search term: “narcotic is any”)
43. Opioid Analgesics: Review medications that are appropriate for pain control with
acute cardiac issues. (p. 277; key search term: “infarction morphine”)
44. Opioid Analgesics: Appropriate medications for those with history of opioid
abuse. (pp. 261, 275; key search term: “balancing the need”)
45. Opioid Analgesics: Make sure you understand the differences between the types of
dependence. (pp. 264, 275; key search term: “stopped opioid dependence”)
46. Opioid Analgesics: Review methadone prescribing and management. (p. 434; key
search term: “methadone in addition”)
47. Opioid Analgesics: What are some of the long-term SEs of opioids? (pp. 262-264;
key search term: “adverse effects from prolonged use” and “equianalgesic”)
48. Opioid Analgesics: What are some symptoms of withdrawal from long-term use?
(pp. 264-265; key search term: “depends on two factors”)
49. Opioid Analgesics: Antidote for narcotics, benzodiazepines, and other CNS
agents. (p. 433; key search term: “choice this agent”)
50. Opioid Analgesics: Review the effects of agents such
as Hydrocodone/Lortab/Oxycontin, long-acting vs. immediate release opiates. (p.
432; key search term: “oxycodone in some”)
3
, 51. Opioid Analgesics: Appropriate drugs for PCAs (patient-controlled anesthesia).
(p. 295; key search term: “analgesia patient controlled”)
52. Opioid Analgesics: Review Risk Evaluation and Mitigation Strategies (REMS).
(pp. 277; key search term: “abuse in 2011”)
53. Antidepressants: Actions/SEs for Prozac, MOAs for all, Paxil, Elavil, SSRIs as a
class, Deseryl and other agents or classes. (p. 339; key search term: “depression is
the most common”)
54. Antidepressants: Directions for medications – when to take, what medications not
to take while on these. (p. 343; key search term: “the first SSRI”)
55. Antidepressants: Dosing for medications – what dose to start, how do you titrate,
etc. (pp. 341-342; key search term: “response with all”)
56. Antidepressants: make sure you are familiar with combining medications – which
medications should be combined, and which should not? (p. 345; key search term:
“MAOIs increase”)
57. Antidepressants: How do you monitor these medications? What are the interval
lengths? What medications would you check? (p. 360; key search term: “arrange
for the patient”)
58. Antidepressants: When do you use an EKG? What are you looking for? (p. 351;
key search term: “undergo ECG evaluation”)
59. Antidepressants: Understand how to discontinue medications after long-term use.
(p. 342; key search term: “unnecessary when antidepressant”)
60. Antidepressants: Dosing with TCAs (safe monitoring). (p. 352; key search term:
“administration all TCAs”)
61. Antidepressants: Use of antidepressants in pregnancy and breast-feeding – which
medications are best? (please see Table 9-4 on p. 86; p. 340; key search term:
“however if a woman”)
62. Illicit Drugs: Review illicit drugs such as PCP, LSD, DMT, marijuana, cocaine,
alcohol. (pp. 436-444; key search term: “cocaine cocaine is”)
63. Illicit Drugs: Understand the length of time symptoms subside from use of these
drugs. (pp. 437-444; key search term: “because cocaine has”)
64. Illicit Drugs: Review disulfiram – when is it used, why is it used? What would
happen if the patient drinks while taking this medication? (p. 419; key search
term: “disulfiram aversion”)
65. Illicit Drugs: What drugs are prescribed to reduce the symptoms of alcohol
withdrawal? (pp. 418-419; key search term: “withdrawal management of”)
66. Illicit Drugs: Review indications for use of Varenicline – what are some SEs from
use of this medication? (p. 429; key search term: “patch estimated”)
67. Illicit Drugs: When is clonidine indicated? (p. 434; key search term: “withdrawal
clonidine”)
68. Transmitters and Receptors: Actions of the following transmitters
or receptors: alpha, B2, GABA, DA, muscarinic and others highlighted in
reading. (p. 173; key search term: “neurotransmitters the CNS”)
69. Parkinson’s Disease: How do Ropinarole, Amantadine, Bromocriptine, Pergolide,
and L-Dopa work? Why are they often used in combination? (p. 178; key search
term: “levodopa levodopa was”)
70. Parkinson’s Disease: What is the goal of treatment in Parkinson’s disease (that
will fit in nicely with answers to the above)? (p. 177; key search term: “reverse
neuronal degeneration”)
71. Parkinson’s Disease: Further, what are the SEs of the above drugs? (please see
question #69 for the answer to this item)
72. Parkinson’s Disease: Because we are playing with brain chemistry in this patient,
what are some CNS side effects we may see? How do we manage these? We are
also affecting the peripheral NS—what sorts of SE can be expected? (pp. 181; key
search term: “effects levodopa may cause”)
73. Parkinson’s Disease: Why are anticholinergics sometimes used in the
management of Parkinson’s? (p. 187; key search term: “used in PD since”)
74. Parkinson’s Disease: What is a good drug for initial selection? What are drugs
for “off” times? Make note of the table in the text. (p. 178; key search term:
“selegiline an MAO”)
75. Alzheimer’s Disease: What is the therapeutic goal in this patient? (p. 192; key
search term: “ideally the goal of AD”)
76. Alzhemier’s Disease: How is Donepezil dosed? How should it be monitored?
Know the other cholinesterase inhibitors that are available, but recognize that
Donepezil will be your exemplar drug. (pp. 193-194; key search term: “donepezil
donepezil”)
4
Pharmacology for Advanced Practice Nurses
Lehne’s Pharmacology for Nursing Care (9 th edition):
Chapters 20 – 40
Edited by: Jessica Santos
,SECTION I: INDEX
Question Page(s)
1. Headaches: Appropriate drugs for prophylaxis. (p. 312; key search term: “drugs
preventive”)
2. Headaches: Indications for Ca2+ channel blockers, tricyclics (Amitriptyline),
triptans. (pp. 307, 313; key search term: “2013 mechanism”)
3. Headaches: Review the indications for Topamax (topiramate). (pp. 231, 312; key
search term: “2004 benefits”)
4. Headaches: Actions/role of opioids in headaches. (p. 306; key search term:
“analgesics are reserved”)
5. Headaches: Medications for cluster headaches and menstrual headaches. (p. 313;
key search terms: “cluster headaches occur,” and “menstrually associated
migraine”)
6. Headaches: Side effects and contraindications of drugs, such as beta blockers,
triptans, and clozapine. (pp. 312-313, 326-327; key search term: “patients benefits
take”)
7. Headaches: Which drugs have vasoconstrictive effects? (pp. 306-308; key search
term: “prolonged vasospasm”)
8. Local Anesthetics: Esters versus amides. (p. 245; key search term: “amides the
ester”)
9. Local Anesthetics: What are some SEs of these medications? (p. 246; key search
term: “administration local effects”)
10. Local Anesthetics: Think about ages of patients when prescribing these
medications. (please see question #9 for additional information; pp. 250; key search
term: “result warn”)
11. Seizures: Actions, side effects, contraindications, monitoring and assessment (e.g.,
phenytoin, valproic acid, carnamazapine, phenobarbital with dosing, when can it
cause CNS depression, target levels). (p. 218; key search term: “long known that
AED”)
12. Seizures: Understand which drug is appropriate for the type of seizure. (p. 216;
key search term: “seizures in partial”)
13. Seizures: Review phenytoin – understand action of drugs, SEs of toxicity, etc.
(please see Table 24-2 on p. 219 for dosing of all AEDs; p. 221; key search term:
“most widely used AED”)
14. Seizures: Make sure you understand how these drugs are impacted by the
cytochrome P450 system. (p. 221; key search term: “owing to effects on drug”)
15. Seizures: Which comorbidities need to be considered when prescribing these
medications? Which medications should you not prescribe? (p.224; key search
term: “thereafter patients with preexisting”)
16. Seizures: Newer seizure meds—what are advantages? How are they used? (p.
228; key search term: “members although most”)
17. General Anesthetics: Review different types, review minimum/median alveolar
concentration. (p. 252; key search term: “concentration is an index”)
18. Benzodiazepines: Side effects, contraindications, antidotes. (p. 389; key search
term: “anxiety as discussed”)
19. Benzodiazepines: Good agent to use for conscious sedation. (p. 256; key search
term: “anxiety the patient”)
20. Benzodiazepines: Good agent for insomnia and panic attacks (short term use, not
a good drug for chronic anxiety). (pp. 383, 391; key search term: “insomnia these
agents” and “benzodiazepines although”)
21. Skeletal Relaxants: Review pharmacokinetics and use. (pp. 240-244; key search
term: “group muscle spasm”)
22. Skeletal Relaxants: What labs are important to evaluate when utilizing these
medications? (p. 243; key search term: “damage obtain LFTs”)
23. Antipsychotics: Indications, actions, SEs, contraindications for first and second-
generation drugs, such as Haldol (haloperidol), Zyprexa (olanzapine), Dantrolene,
Thioridazine, Clozapine, Seroquel (quetiapine), Risperdal (risperidone),
paliperidone (Invega), ziprasidone (Geodon) and others. What are key differences
between first and second-generation antipsychotics? (pp. 317-333; key search
term: “psychotic disorders specific”)
24. Antipsychotics: Consider the patient’s comorbidities – which medications would
you prescribe if the patient has HTN, DM, etc.? (p. 331; key search term:
“reasonable for a patient”)
2
,25. Antipsychotics: Treatment for malignant hyperthermia or neuroleptic malignant
syndrome. (pp. 242, 322; key search terms: “SR Dantrolene” and “intervention
primary symptoms”)
26. Antipsychotics: Review the treatment of psychosis – what medications are used;
what SEs are often seen? (p. 318, 319, 321, 325, 326; key search term: “interest it
is”)
27. Antipsychotics: Review tardive dyskinesia. Who is more likely to experience this?
(p. 322; key search term: “the most troubling EPS”)
28. Antipsychotics: Extrapyramidal symptoms. (p. 321; key search term: “motor
system the”)
29. What medications are good for bipolar patients? (pp. 365-372; key search term:
“stabilizers mood”)
30. Lithium: Side effects and treatment. What medications would you give to alleviate
some of the SEs of this medication? (pp. 368, 371; key search term: “subside
gastrointestinal”)
31. Lithium: When should serum blood levels be drawn? Make sure you understand
the difference between starting the medications versus maintenance. (p. 367; key
search term: “evening dose during”)
32. Lithium: What labs and clinical markers should be monitored on these patients?
(pp. 367-368; key search term: “sodium specifically”)
33. Lithium: What should patients avoid when on lithium therapy? (p. 368; key
search term: “lithium also pregnancy”)
34. Other drugs used in the treatment of BPD and other serious mental illnesses (e.g.
aripiprazole, carbamazepine, chlorpromazine, lamotrigine, etc.). What other
medications are used in combination with lithium for treatment? (pp. 370 – see
additional pages listed below; key search term: “valproate currently”)
35. Dopamine Agonists: Review dopamine agonists, muscarinic agents as related to
the disorders studied in this unit. (p. 183 – see pages listed below; key search
term: “for PD beneficial”)
36. Dopamine Agonists: Understand Parkinson-type disorders induced by psychiatric
medications. Review peripheral nervous system stimulation as related to side
effects of these drugs (e.g., anticholinergic effects). You may need to review
autonomic information again. (p. 321; key search term: “reactions especially
tardive”)
37. Dopamine Agonists: What are some common SEs seen by patients taking these
medications? (p. 183; key search term: “however dopamine”)
38. Dopamine Agonists: How do you treat dyskinesias from psychotropic
medications? (pp. 178, 183, 322; key search terms: “first-line drugs” and “TD is
characterized”)
39. Dopamine Agonists: General information regarding MOAIs (monoamine oxidase
inhibitors) – very old, rarely used now, but still a testable favorite! (pp. 352-353;
key search term: “inhibitors the MAOIs”)
40. Dopamine Agonists: Tyramine-containing foods to avoid. (p. 353; key search
term: “tyramine although”)
41. Dopamine Agonists: Interactions with tyramine. (p. 353; key search term: “first
inhibition of”)
42. Opioid Analgesics: Pharmacokinetics and appropriateness. (pp. 260-261; key
search term: “narcotic is any”)
43. Opioid Analgesics: Review medications that are appropriate for pain control with
acute cardiac issues. (p. 277; key search term: “infarction morphine”)
44. Opioid Analgesics: Appropriate medications for those with history of opioid
abuse. (pp. 261, 275; key search term: “balancing the need”)
45. Opioid Analgesics: Make sure you understand the differences between the types of
dependence. (pp. 264, 275; key search term: “stopped opioid dependence”)
46. Opioid Analgesics: Review methadone prescribing and management. (p. 434; key
search term: “methadone in addition”)
47. Opioid Analgesics: What are some of the long-term SEs of opioids? (pp. 262-264;
key search term: “adverse effects from prolonged use” and “equianalgesic”)
48. Opioid Analgesics: What are some symptoms of withdrawal from long-term use?
(pp. 264-265; key search term: “depends on two factors”)
49. Opioid Analgesics: Antidote for narcotics, benzodiazepines, and other CNS
agents. (p. 433; key search term: “choice this agent”)
50. Opioid Analgesics: Review the effects of agents such
as Hydrocodone/Lortab/Oxycontin, long-acting vs. immediate release opiates. (p.
432; key search term: “oxycodone in some”)
3
, 51. Opioid Analgesics: Appropriate drugs for PCAs (patient-controlled anesthesia).
(p. 295; key search term: “analgesia patient controlled”)
52. Opioid Analgesics: Review Risk Evaluation and Mitigation Strategies (REMS).
(pp. 277; key search term: “abuse in 2011”)
53. Antidepressants: Actions/SEs for Prozac, MOAs for all, Paxil, Elavil, SSRIs as a
class, Deseryl and other agents or classes. (p. 339; key search term: “depression is
the most common”)
54. Antidepressants: Directions for medications – when to take, what medications not
to take while on these. (p. 343; key search term: “the first SSRI”)
55. Antidepressants: Dosing for medications – what dose to start, how do you titrate,
etc. (pp. 341-342; key search term: “response with all”)
56. Antidepressants: make sure you are familiar with combining medications – which
medications should be combined, and which should not? (p. 345; key search term:
“MAOIs increase”)
57. Antidepressants: How do you monitor these medications? What are the interval
lengths? What medications would you check? (p. 360; key search term: “arrange
for the patient”)
58. Antidepressants: When do you use an EKG? What are you looking for? (p. 351;
key search term: “undergo ECG evaluation”)
59. Antidepressants: Understand how to discontinue medications after long-term use.
(p. 342; key search term: “unnecessary when antidepressant”)
60. Antidepressants: Dosing with TCAs (safe monitoring). (p. 352; key search term:
“administration all TCAs”)
61. Antidepressants: Use of antidepressants in pregnancy and breast-feeding – which
medications are best? (please see Table 9-4 on p. 86; p. 340; key search term:
“however if a woman”)
62. Illicit Drugs: Review illicit drugs such as PCP, LSD, DMT, marijuana, cocaine,
alcohol. (pp. 436-444; key search term: “cocaine cocaine is”)
63. Illicit Drugs: Understand the length of time symptoms subside from use of these
drugs. (pp. 437-444; key search term: “because cocaine has”)
64. Illicit Drugs: Review disulfiram – when is it used, why is it used? What would
happen if the patient drinks while taking this medication? (p. 419; key search
term: “disulfiram aversion”)
65. Illicit Drugs: What drugs are prescribed to reduce the symptoms of alcohol
withdrawal? (pp. 418-419; key search term: “withdrawal management of”)
66. Illicit Drugs: Review indications for use of Varenicline – what are some SEs from
use of this medication? (p. 429; key search term: “patch estimated”)
67. Illicit Drugs: When is clonidine indicated? (p. 434; key search term: “withdrawal
clonidine”)
68. Transmitters and Receptors: Actions of the following transmitters
or receptors: alpha, B2, GABA, DA, muscarinic and others highlighted in
reading. (p. 173; key search term: “neurotransmitters the CNS”)
69. Parkinson’s Disease: How do Ropinarole, Amantadine, Bromocriptine, Pergolide,
and L-Dopa work? Why are they often used in combination? (p. 178; key search
term: “levodopa levodopa was”)
70. Parkinson’s Disease: What is the goal of treatment in Parkinson’s disease (that
will fit in nicely with answers to the above)? (p. 177; key search term: “reverse
neuronal degeneration”)
71. Parkinson’s Disease: Further, what are the SEs of the above drugs? (please see
question #69 for the answer to this item)
72. Parkinson’s Disease: Because we are playing with brain chemistry in this patient,
what are some CNS side effects we may see? How do we manage these? We are
also affecting the peripheral NS—what sorts of SE can be expected? (pp. 181; key
search term: “effects levodopa may cause”)
73. Parkinson’s Disease: Why are anticholinergics sometimes used in the
management of Parkinson’s? (p. 187; key search term: “used in PD since”)
74. Parkinson’s Disease: What is a good drug for initial selection? What are drugs
for “off” times? Make note of the table in the text. (p. 178; key search term:
“selegiline an MAO”)
75. Alzheimer’s Disease: What is the therapeutic goal in this patient? (p. 192; key
search term: “ideally the goal of AD”)
76. Alzhemier’s Disease: How is Donepezil dosed? How should it be monitored?
Know the other cholinesterase inhibitors that are available, but recognize that
Donepezil will be your exemplar drug. (pp. 193-194; key search term: “donepezil
donepezil”)
4
