Antiparkinsonian Agents, Anticholinergic Agents Flashcards
Increases the risk of psychosis
Effective in the urgent treatment of Neuroleptic malignant syndrome (NMS)
bromocriptine (Parlodel)
Used for: Dystonia, Parkinsonism, Akinesia, Akathisia
benztropine (Cogentin)
Cogentin
1-2 mg BID
PO/IM/IV
benztropine
__________ is responsible for:
S - salivation
L – lacrimation (tearing of the eyes)
U - urination
D - diarrhea
G – gastrointestinal motility
E - emesis
Acetylcholine
is a chronic progressive, degenerative disorder of the CNS
Symptoms:
resting tremor
bradykinesia
rigidity
postural instability
Risk Factors:
Age
Genetics
Sex
Exposure to Toxins
Parkinsons disease
Part of the Extrapyramidal Nervous System
Controls motor movement
Nigrostriatal pathway
Dopamine in Nigrostriatal pathway:
Decrease in Dopamine
Results in: __________
Parkinson Disease and EPS
Dopamine in Nigrostriatal pathway:
Chronic Blockage of D2 Receptors
Results in: __________
Hyperkinetic Movement Disorder (Tardive Dyskinesia)
______ of d2 receptors or ____ dopamine levels – difficulty controlling voluntary and involuntary muscle movement
Loss; low
___________ nervous system nerve fibres that are responsible brainstem to motor fibres of spinal cord (unconscious, reflexive or responsive control of musculature – muscle tone, balance, posture, locomotion)
Extrapyramidal
There is a reciprocal relationship between __________ and _________
Dopamine; Acetylcholine
Normal Functioning = Dopamine controls ____________ release
acetylcholine
widening the blood vessels in the cardiovascular system allowing blood to flow more easily.
Vasodilator
Blocking Dopamine (=decrease d2) causes an increase in ______
Increasing d2=decrease in Ach
ACh
_____ – receptor sites found in NIGROSTRIATAL pathways, dicephalon, medulla
Also found in peripheral nervous system – (rest and digest – parasympathetic)
CNS
________ receptor sites – found in parasympathetic nervous system
Cholinergic
Increase in acetylcholine activity = increase in ___________ side effects (nigrostriatal pathway)
extrapyramidal
_________ acetylcholine activity by reducing Dopamine increases the risk of EPS
Increasing
_____ potency antipsychotics have a high risk of EPS because of potency of dopamine blocking – hence increase in acetylcholine release – lower risk of anticholinergic effects
High
______ potency antipsychotics have a lower risk of EPS because potency of dopamine blocking is not as high and therefore not as much acetylcholine is released - but a much higher risk of _________ effects
Low; anticholinergic
Increase dopamine activity in the brain
E.g. bromocriptine (Parlodel)
Dopamine Receptor Agonists
Prevent the breakdown of brain dopamine by inhibiting the brain enzyme monoamine oxidase B
MAO-B Inhibitors
Inhibit the action of acetylcholine in the brain and affect the parasympathetic nervous system.
E.g. benztropine (Cogentin)
Anticholinergic Drugs
Both compete or inhibit histamine from binding at receptors
Anticholinergic antagonist (works on those receptors as well)
Antihistaminergic
Competes to bind at adrenergic receptors and has an antagonist effect on certain serotonin receptors
Also used to reduce symptoms of Tardive Dyskinesia
E.g. Propranolol (Inderal)
ß Blocker
Antiparkinsonian drugs: Absorption
well absorbed in the _____
GI Tract
Antiparkinsonian drugs: Distribution
_______ distributed throughout the body
widely
Antiparkinsonian drugs: Metabolism
______
liver
Antiparkinsonian drugs: Excretion
______ & _______
cross the placenta and enter the breast milk
urine and bile
Antiparkinsonian drugs _____ EPS but they can cause their own side effects
reduce
Prophylactic prescription of antiparkinsonian drugs often occurs (________ PRN orders when antipsychotics are first prescribed)
Benztropine
Rating scales (____) should be used to monitor clients side effects while on antipsychotic medication
AIMS
Antipsychotics may cause emergency medical situations. These emergency medical situations will require immediate response and treatment.
Acute Emergency
__________ (Oculogyric crisis, torticollis, opisthotonos)
Tx: Benztropine or Diphenhydramine (PO/IM/IV)
Dystonic Reactions
____________
Tx: Immediate discontinuation of antipsychotic
Bromocriptine (PO)
Neuroleptic Malignant Syndrome
Diphenhydramine (______) is often confused with dimenhydrinate (_______).
Benadryl; Gravol
____________ Parkinson’s Drugs side effects:
Dry Mouth
Blurred Vision
Constipation
Stomach Irritation (nausea, vomiting)
Tachycardia
Urinary Retention, Hesitancy
Paralytic Ileus
Autonomic
____________ Parkinson’s Drugs side effects:
Confusion
Giddiness
Listlessness
Depression
Visual Hallucinations
(EMERGENCY)
Behavioral
Congestive Heart Failure, Decreased libido & Raynaud’s Syndrome
arrythmias
Propranolol
________ also causes sedation
Diphenhydramine
Orthostatic Hypotension, Livido Reticularis (vascular condition that causes purple mottling to the skin) & Abnormal Dreams
Amantadine
_______ causes fewer anticholinergic effects but may cause euphoria and increased tremor
Biperiden
______ Withdrawal Symptoms:
Nausea, vomiting
Dyskinesia
Restlessness
Sweating
Anxiety
Depression
Diarrhea
Dysphoria
Anticholinergic
Anticholinergics need to be titrate down over ______ or _______. Clients who are being titrated down need to be constantly assessed for EPS
weeks; months
impairment of voluntary movements
Dyskinesia
state of unease or general dissatisfaction with life
Dysphoria
There is a risk for anticholinergic agents to be misused.
Some clients find the effects on mood, memory and perceptions pleasurable.
Clients can feel greater sociability or euphoria on higher than normal doses.
This can also cause toxicity (either by purposeful misuse or by the client being prescribed to many drugs with an anticholinergic effect).
Anticholinergic Crisis
“Hot as a hare, blind as a bat, mad as a hatter, dry as a bone”
Anticholinergic Crisis
Dilated pupils
Increased thirst
Urinary retention
Paralytic ileus
Unsteady gait
Dry flushed skin
Tachycardia
Constipation
Decreased appetite and intake
Anticholinergic Crisis
___________ Inhibitors – Donepezil (Aricept), Galantamine, and Rivastigime
- used to slow the symptom progression of Alzheimer’s – combination will produce an antagonistic action
Cholinesterase
Other ___________ –
may cause additive anticholinergic effects and enhance adverse/toxic reactions
Anticholinergics
_____________ ex Chlorpromazine
When used with anticholinergic agents there is a risk of potentially fatal paralytic ileus and an increased risk of toxic psychoses.
Phenothiazines
Drug of choice for children over the age of 6 and more that 9 kg
diphenhydramine