PNS modifying drugs & Anti-Parkinson's Drug Flashcards
Cholinergic agonist (Parasympathomimetic)
Describe Actions
- Eyes
- Lungs
- Heart
- GI
- GU
- Glands
(Eyes): Pupil Constricts (Miosis)
(Lungs): Bronchoconstriction
(Heart): Vasodilation (decreased BP & HR)
(GI): Increased (gastric acid & Mobility)
(GU): Bladder contraction (Increased bladder emptying)
(Glands): Increased secretion
Bethanechol
Describe
- Drug Class
- Indication
- Contraindication
- Side Effects
Direct-Acting Cholinergic Drugs
(Indication): Post-op or Post-part urinary retention
(Contraindication): Bradycardia, COPD/Asthma, Peptic ulcers, Hypotension, Parkinsonism
(Side effects): Blurred vision, hypotension, bradycardia, sweating, bronchoconstriction, increased (Gastric acid & saliva), N,V,D, abdominal cramps
Methoclopramide
Describe
- Drug Class
- Mechanism of Action
Direct-acting cholinergic drugs
(MOA): Increases gastric emptying
Pilocarpine
Describe
- Drug class
- Mechanism of Action
Direct-acting cholinergic drug
(MOA): Constricts pupils
Donepezil & Rivastigmine
Describe
- Drug Class
- Mechanism of Action
- Indication
Direct-Acting Cholinergic drug
(MOA): Allows more acetylcholine in CNS (Increases memory recall)
(Indication): Treats Alzheimer’s
Pyridostigmine
Describe
- Drug class
- Indication
- Treatment
Direct-Acting Cholinergic Drug
(MOA): Stimulates skeletal muscles & increase tone
(Indication): Weakness in myasthenia gravis patients (Dropping eyes)
(Tx): Edrophonium (Eyes better = positive MG)
Indirect-Acting Cholinergic Drugs
Describe
- Mechanism of Action
- Contraindication
- Side Effects
(MOA): Inhibits Cholinesterase = more available acetylcholine
(Contraindication): Intestinal & Urinary obstruction, Patients w/ (Bradycardia, COPD/Asthma, Peptic ulcers)
(Side effects): Increased GI motility, Bradycardia, Bronchoconstriction, Hypotension, Miosis, Increased urination
Nursing process for Cholinergic drugs
Describe
- Assessment
- Implementation
- Teaching
- Evaluation
(Assessment): Baseline VS, Urine output, & Medical History
(Implementation): Monitor Vs & Cholinergic crisis (OD), muscle weakness , record I&O, Observe for (Orthostatic hypotension, Gastric pain, Cramping, D, Bradycardia, Increased salivation), Assess lung sounds, Have (Atropine IV) Available for OD
(Teaching): Rise slowly in stages, Report (Difficulty breathing, GI bleeding, Epigastric pain, Coffee grounds emesis, Dark tarry stools)
(Evaluation): Ability to empty bladder, Deep breath, walk, chew, swallow
Cholinergic Crisis (OD)
Describe
- Early S/s
- Late S/s
- DUMBELLS
- Treatment for OD
(Early S/s): Abdominal cramps, salivation, flushing of skin, N, V
(Late S/s): Slow HR (Complete Heart Block), Compromised airway, Low BP
(Tx): Atropine, Antihistamine, Epinephrine
Cholinergic Antagonist (Anticholinergic)
Describe Actions
- Eyes
- Lungs
- Heart
- GI
- GU
- Glands
- CNS`
(Eyes): Pupil dilation (Mydriasis)
(Lungs): Bronchodilation (Tx: COPD/Asthma), Decreased secretions
(Heart): Increase pulse
(GI): Reduces smooth muscle, Decreases (Motility, Peristalsis, secretion) = Constipation, (Tx: Gastric Ulcer)
(GU): Increases sphincter constriction (Urinary retention)
(Glands): Decreases (Perspiration & Salivation) = Heat intolerance & Dry mouth
(CNS): Decreases (Tremors & Rigidity) = Tx: Parkinson’s Dz
Atropine
Describe
- Drug Class
- Indication
- Overdose S/s
- Tx for OD
(Indication): Systematic bradycardia, Pre-op, Decrease risk of aspiration during surgery, cholinergic crisis
(OD S/s): Confusion, Flushing of skin, Mildly elevated temperatures, dry mouth, pupil dilation, full as a flask
(Tx for OD): Hydration, (Physostigmine) Cholinergic drug (only for severe side effects)
Ipratropium
Describe
- Drug Class
- Indiction
Anticholinergic Drug
(Indication): Treats COPD/Asthma (Bronchodilator); slow onset of action & prolonged duration
Diphenhydramine
Describe
- Drug Class
- Indiction
Anticholinergic Drug
(Indication): Treats EPS
Benztropine
Describe
- Drug Class
- Indiction
Anticholinergic Drug
(Indication): Treats Parkinson’s Disease & EPS
Tolterodine
Describe
- Drug Class
- Indiction
Anticholinergic Drug
(Indication): Treats Overactive Bladder
Scopolamine
Describe
- Drug Class
- Indiction
Anticholinergic Drug
(Indication): Motion Sickness (Patch) & Pre-op, Decreases death rattle
Anticholinergic Drugs
Describe
- Mechanism of Action
- Indication
- Contraindications
- Side effects
- Interactions
(MOA): Blocks Acetylcholine at muscarinic receptors
(Indications): Drug-induced EPS, Overactive bladder, motion sickness, systematic bradycardia, Asthma/COPD, Parkinson’s Disease, Peptic ulcers
(Contraindications): Glaucoma, Narrow-angle Glaucoma, Myasthenia Graves
(Side Effects): Tachycardia, Palpations, Constipations, Blurred vision, dry mouth, abdominal distention, Anticholinergic effects, photophobia, flushing, nasal congestion, impotence
(Interaction): Anticholinergic drugs, Digoxin
Nursing Process for Anticholinergic drugs
Describe
- Assessment
- Implementation
- Teaching
(Assessment) Vital signs, Urine output, Medical history, bowel function
(Implementation): Monitor (VS, I&O) Encourage to void prior to taking meds, provide frequent oral care (Dry mouth), Observe or (Anticholinergic effects)
Nursing Process for Anticholinergic drugs
Describe
- Assessment
- Implementation
- Teaching
(Assessment) Vital signs, Urine output, Medical history, bowel function
(Implementation): Monitor (VS, I&O) Encourage to void prior to taking meds, provide frequent oral care (Dry mouth), Observe or (Anticholinergic effects)
(Teaching): Avoid heat & physical exertion, Pt w/ (MG & glaucoma) avoid atropine, Wear sunglasses, Tx for (Dry Mouth), Increase (Fluid, Fiber, Ambulation)
Selegiline
Describe b
- Drug Class
- Mechanism of Action
- Indication
- Side Effects
- Interactions
- Implementation
Antiparkinson drug: Monoamine Oxidase Type B Inhibitor (MAOI-B)
(MOA): Inhibits breakdown of dopamine = More dopamine into CNS
(Indication): Parkinson Dz, Depression, Conjunction w/ (Levodopa)
(Side Effects): Headache, Insomnia, Orthostatic Hypotension, Weight Loss, N,D, Serotonin Syndrome, Hypertensive crisis
(Interaction): (Meperidine, Tramadol, Dextramethorphan), Saint John Wart, other MAOIs (Carbamazepine, oral contraceptives, Buspirone), Food w/ Tyramine
(Implementation):
- Clean area & dry
- Apply patch & hold pressure (30 secs)
- Keep on for 24 hrs
- One patch at a time
- Rotate sites
Ropinirole
Describe
- Drug Class
- Mechanism of Action
- Indication
- Side Effects
Antiparkinsons: Dopamine receptor Agonist
(MOA): Direct stimulation of pre/post synaptic receptors in brain = More dopamine
(Indications): Various Stages of Parkinsons & Restless leg syndrome
(Side Effects): Ataxia, Dizziness, Orthostatic hypotension, Upset GI
Carbidopa/Levodopa
Describe
- Drug Class
- Mechanism of Action
- Indication
- Side Effects
- Interactions
- Contraindications
- Teaching
Antiparkinson Drug: Dopamine Replacement Drug
(MOA): Prevents breakdown of Levodopa & Convert to Dopamine
(Indication): Cornerstone therapy for Parkinson’s, becomes ineffective & debilitatied (5-10yrs after Levodopa Tx)
(Side Effect): Cardiac dysrhythmias, Orthostatic hypotension, Involuntary movements, Constipation, Dyskinesia, Depression, N,V
(Contraindications): Angle (Closed or Opened) Glaucoma, High protein meals
(Teaching): Split protein across meals
Nursing Process for Anti-Parkinson’s Drug
Describe
- Assessment
- Implementation
- Teaching
- Evaluation
(Assessment): VS, Depression & Suicidal ideation, Past medical history
(Implementation): Monitor BP throughout therapy & Administer (Seleilgine: Oral or Transdermal)
(Teaching): Rise slowly in stages, Don’t take (Carbidopa/levodopa) with high protein meals, spilt proteins across meals, drink 3L of fluid, increase fiber, Limit Tyramine food
(Evaluation): Ability to participate in ADLs
