Nursing Practice in Canada and Drug Therapy PDF

2251 Pharmacology Review and Prep Midterm 1 Nursing Practice in Canada and Drug Therapy Nursing Process 1. Assessment a. Data collection, review and analysis b. Med profile i. Any drugs ii. Home and folk remedies i...

2251 Pharmacology Review and Prep Midterm 1 Nursing Practice in Canada and Drug Therapy Nursing Process 1. Assessment a. Data collection, review and analysis b. Med profile i. Any drugs ii. Home and folk remedies iii. Alcohol and tobacco iv. Caffeine v. Current or past illicit drug use vi. Rx and otc vii. Health hx viii. Fam hx ix. Issues related to age and medication 2. Diagnosis a. 3 steps i. Human response to illness injury or significant change ii. Factors related to the response iii. Lits cues evidence and data 3. Planning a. Goals i. SMART b. Outcome criteria i. Concrete descriptions of pt goals 4. Implementation a. Start plan and nursing action b. Specific instructions for what nurse does 5. Evaluation a. Systemic, ongoing b. Determine if the goal and outcome were reached c. Monitor pt response d. document International classification for Nursing Practice  Project of the international council of nurses  Multidisciplinary health vocabulary in info systems  Uses Nanda  Can endorse Ten Rights of Medication 1. Right med 2. Right dose 3. Right time 4. Right route 5. Right pt  6. Right reason 7. Right documentation 8. Evaluations and assessment 9. Education 10. To refuse Time-critical scheduled medications - At the exact time when necessary ex. Rapid-acting insulin - w/I 30 min pre or post-scheduled times Non-time critical - daily, weekly, monthly meds - w/I 2 hours - more than daily but less than q4h within 1 hour pre or post-schedule Med Errors  Major problem, regardless of health care setting  Defined as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care provider, patient, or consumer” (http://www.nccmerp.org/about-medication-errors)  Patient-related and system-related factors must be considered when examining medication errors. Pharmacological principles Drug - Any chemical that affects physiology and processes Pharmacology - Study or science of drugs Drug Names 1. Chemical name: describes chemical composition 2. Generic Name: official name by Health Canada 3. Trade Name (proprietary name): Trademark/ brand name Drug Classification - Grouped based on: o Properties o Structure o Therapeutic use Pharmacolo GI cal principles - Pharmaceutics o How drug forms affect the body ( optimal compound) - Pharmacokinetics o What the body does with a drug o Absorption  Bioavailability: the extent of drug absorption  First pass effect: reduces bioavailability to less than 100%  Routes  Enteral - oral - Sublingual  - Buccal - Rectal (also can be topical)  Parenteral - ID - SUBCUT - IV - IM - Intrathecally - Intraarticularly - Intra-arterially  Topical - Skin - Eyes - Ears - Nose - Lungs (inhalation) - Rectum - va GI na  Transdermal  inhalation o Distribution  Transport of drug by bloodstream to drug sit of action  First to places of extensive drug supply  Heart  Liver  Kidneys  Brain  Albumin (blood protein) carries protein-bound drug molecules o Metabolism o Excretion - Pharmacodynamics - Pharmacogenomics (pharmacogenetics) - Pharmacotherapeutics - Pharmacognosy - Pharmacoeconomics - Toxicology … need to fill In Antidiarrheal Diarrhea - Abnormal passage of stools with increased frequency, fluidity, and weight or with increased stool water excretion - Consists of three or more loose or liquid stools per day - Acute o Sudden onset in a previously healthy person o Lasts from 3 days to 2 weeks o Self-limiting o Resolves without sequelae o Causes:  Bacteria  Viruses  Drugs  Nutritional  Protozoa - Chronic diarrhea o Lasts for more than 3 to 4 weeks o Associated with recurring passage of diarrheal stools, fever, loss of appetite, nausea, vomiting, weight loss, and chronic weakness o Causes:  Tumours  Diabetes  Addison's disease  Hyperthyroidism  Ibs  Aids - Goals of Tx o Stopping the stool frequency o Alleviating the abdominal cramps o Replenishing fluids and electrolytes o Preventing weight loss and nutritional deficits from malabsorption - Antidiarrheals o Adsorbents  Coat walls of GI Tract  Bind to the causative bacteria or toxin  Bismuth-subsalicylate (Pepto), activated charcoal, antilipemic drugs ( colestipol and cholestyramine.  Adverse effects  Adsorbents decrease the absorption of many drugs, including digoxin, quinidine sulphate, and hypoglycemic drugs.  Adsorbents cause increased bleeding time and bruising when GI ven with anticoagulants (warfarin).  Toxic effects of methotrexate are more likely when GI ven with adsorbents.  Mild:  - Dark stools - Blue or black gums and tongue - Tinnitus - Constipation - Metallic taste  Severe: - Increased bleeding time - Confusion o Antimotility drugs:  Anticholinergics:  Decrease intestinal muscle tone and peristalsis of the GI tract by reducing rhythmic contractions  Results: slows the movement of fecal matter through the GI tract  Ex. Belladonna alkaloids - None are used in Canada as antidiarrheals  Drying  Reduces gastric secretions  Used with absorbents and opiates  Opiates  Decrease bowel motility and reduces pain by relief of rectal spasms  Increase transit time through bowel = more water and electrolytes are absorbed  Ex. Paregoric, opium tincture, codeine phosphate, loperamide hydrochloride, diphenoxylate hydrochloride with atropine sulphate  Anticholiner GI cs adverse effects  Urinary retention, sexual dysfunction  Headache, dizziness, confusion, anxiety, drowsiness  Dry skin, flushing  Blurred vision  Hypotension, bradycardia or tachycardia (yes, sorry!); think of it as precipitating abnormal cardiac rhythms o Probiotics (also known as intestinal flora modifiers and bacterial replacement drugs) Obtain a thorough history of bowel patterns, general state of health, and recent history of illness or dietary changes; assess for aller GI es. Do not GI ve bismuth subsalicylate to children or teenagers with chicken pox or influenza because of the risk of Reye’s syndrome. Use adsorbents carefully in older adult patients and those with decreased bleeding time, clotting disorders, recent bowel surgery, or confusion. Do not administer anticholiner GI cs to patients with a history of narrow-angle glaucoma, gastrointestinal obstruction, myasthenia gravis, paralytic ileus, or toxic megacolon. Teach patients to take medications exactly as prescribed and to be aware of their fluid intake and dietary changes.  Assess fluid volume status, input and output, and mucous membranes before, during, and after initiation of treatment. Antidiarrheals need to know. Generic Name: Bismuth subsalicylate Trade Name: Pepto-Bismol Drug Class: adsorbents Therapeutic Class: MOA: Coats walls of GI tract and binds to the pathogen/ causative agent and eliminates it through the stool Indicators: Adverse effects: - Mild diarrhea - Mild: Pre-admin: o Dark stools Post-admin: o Blue or black gums and tongue o Tinnitus o Constipation o Metallic taste - Severe: o Increased bleeding time o Confusion Interactions: Adsorbents decrease absorption of many drugs including digoxin, quinidine sulphate, and hypoglycemic drugs Implication: Contraindications: - Not for pt on warfarin (increase bruising) - Pt on methotrexate ( increase toxic effects) - Use with caution in children and adolescent with chicken pox and influenza b/c of reyes syndrome Notes: Generic Name: Codeine Phosphate Trade Name: Tylenol with Codeine Drug Class: Antimobility: Opiate Therapeutic Class: MOA: - Decreases bowel motility and reduces pain by relieving rectal spasms - Increase transit time through the bowel means more water and electrolytes can be absorbed Indicators: Severe diarrhea Adverse effects: Respiratory depression Implications: Contraindications: Pre-admin:  Assess fluid volume status, input and output, and mucous membranes before, during, and after initiation of treatment. Notes: Generic Name: Loperamide Hydrochloride Trade Name: Imodium Drug Class: Antimobility: Opiate Therapeutic Class: opioid receptor agonist MOA: - Binds to opiate receptors on intestinal walls which inhibits acetylcholine and prostaglandin release which reduces peristalsis and increasing intestinal transit time - Increased tone of anal sphincter which reduces urgency and incontinence Indicators: Severe diarrhea Adverse effects: - Mild: - Severe: Implication: Contraindications: Pre-admin: - Pt with severe ulcerative colitis, - Asses frequency, volume, and consistency of pseudomembranous colitis, and acute diarrhea stool assoc with Escherichia coli. - Evaluate for dehydration and I&O Post- admin: - Monitor response Notes: Physical dependency has not been a reported side effect. Only opiate that is OTC Generic Name: Diphenoxylate Hydrochloride with Trade Name: Lomotil atropine sulphate Drug Class: Antimobility: opiate Therapeutic Class: antidiarrheal MOA: - Inhibits GI motility of intestine Indicators: Adverse effects: - Severe diarrhea - Mild: o Drowsiness, dizziness, lethargy o nausea, vomiting, constipation o hypotension o urinary retention o flushing - Severe: o Dry mouth o Abdominal pain o Tachycardia o Blurred vision Implication: Contraindications: Pre-admin: - Diarrhea assoc with pseudomembranous  Assess frequency and consistency of stools colitis or toxigenic bacteria  evaluate for signs of dehydration. Post-admin:  Monitor for resolution of diarrhea and observe for constipation or abdominal discomfort Notes: - Little to no analgesic activity - Misuse and chemical dependence can occur - Mixed with atropine sulphate b/c it has subtheraputic qualities to lower the risk of dependency Generic Name: Lactobacillus acidophilus Trade Name: N/A Drug Class: Probiotic Therapeutic Class: Antidiarrheal/ dietary supplement MOA: - Resores and maintains the natural balance of beneficial bacteria, IBS, and as an addition to antibiotic therapy Indicators: Adverse effects: Pre-admin: - Mild: - Asses GI symptoms o Gas - Assess nutrition o Bloating - Assess history of antibiotic use o Mild GI upset Post-admin: - Severe: - Monitor for improvemens o Allergy Implication: Contraindications: - Used in uncomplicated diarrhea - hypersensetivities - Mild, antibiotic-induced diarrhea Notes: Constipation/Laxatives Constipation:  Abnormally infrequent and difficult passage of feces through the lower gastrointestinal tract  A symptom, not a disease  Disorder of movement through the colon or rectum  Can be caused by a variety of diseases or drugs  Tx  Sur GI cal  Nonsur GI cal  Dietary (fibre supplements)  Behavioural ( increase exercise)  pharacolo GI cal Peripherally acting opioid antagonists  Treatment of constipation related to opioid use and bowel resection therapy  Block entrance of opioid into bowel  Yet to be approved by Health Canada; accessible through the Special Access Programme in some jurisdictions  Allow bowel to function normally with continued opioid use  methylnaltrexone (Relistor®)  alvimopan (Entereg®) Nursing Implications:  Obtain a thorough history of presenting symptoms, elimination patterns, and aller GI es.  Assess fluid and electrolytes before initiating therapy.  Inform patients not to take a laxative or cathartic if they are experiencing nausea, vomiting, or abdominal pain.  A healthy, high-fibre diet and increased fluid intake should be encouraged as an alternative to laxative use.  Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.  All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated.  A healthy, high-fibre diet and increased fluid intake should be encouraged as an alternative to laxative use.  Long-term use of laxatives often results in decreased bowel tone and may lead to dependency.   All laxative tablets should be swallowed whole, not crushed or chewed, especially if enteric coated.  GI ve bisacodyl with water on an empty stomach because of interactions with milk, antacids, and juices.  Inform patients to contact their prescribers if they experience severe abdominal pain, muscle weakness, cramps, or dizziness, which may indicate possible fluid or electrolyte loss.  Monitor for therapeutic effect. IBS - Chronic intestinal discomfort - Cramps, diarrhea, constipation - Cope by avoiding irritating foods and otc laxatives and antidiarrheals Drug Class: Bulk Forming Laxatives MOA: - High fiber - Absorb water to increase bulk - Distend bowel to initiate reflex bowel activity Ex. Psyllium (Metamucil), methylcellulose Indications: - Acute and chronic constipation - Ibs - Diverticulosis Adverse Effects: - Impaction - Fluid overload - Electrolyte imbalances - Gas formation - Esophageal blockage - Aller GI c reaction - all cause electrolyte imbalance Drug Class: Emollient MOA: - stool softners and lubricans - promote more water and fat in the stools - lubricate the fecal material and intestinal wall Ex. Stool softners: docusate salts (colace), Lubricants: Mineral oil Indications: - acute and chronic constipation - fecal impaction - helps bowel movements in anorectal conditions Adverse Effects: - skin rashes - decreased absorption of vitamins - electrolyte imbalance - lipid pneumonia Interactions: mineral oil decreases absorption of fat soluble vitamins (A, K, E, D) Drug Class: Hyperosmotic MOA: - Increase fecal water content - Results in bowel distention - Increases peristalsis and evacuation Ex. Polyethylene glycol, sorbitol, glycerin, lactulose (also reduced elevated serum ammonia levels) Indications: - Chronic constipation - Dx and sur GI cal procedures Adverse Effects: - Abdominal bloating - Electrolyte imbalance - Rectal irritation Interactions: cns depression with: - Barbituates, general anasthesia, opioids, antipsychotics - Oral antibiotics decrease lactulose effectiveness Drug Class: Saline MOA: - Increases osmotic pressure within the GI - Bowel distention - Increases peristalsis and evacuation Ex. Magnesium hydroxide ( milk of magnesia), Magnesium citrate Indications: - Constipation - Dx and sur GI cal procedure Adverse Effects: - Magnesium toxicity ( with renal insufficiency) - Cramping - Electrolyte imbalance - Diarrhea - Increased thirst Interactions: Drug Class: Stimulants MOA: - Increase peristalsis via intestinal nerve stimulation Ex. Senna (senokot), bisacodyl ( Dulcolax) Indications: - Acute constipation - Dx and sur GI cal procedure Adverse Effects: - Nutrient malabsorption - Skin rashes - Gastric irritation - Electrolyte imbalance - Discoloured urine - Rectal irritation Interactions: decrease absorption of antibiotics, digoxin, nitrofurantoin, salicylates, tetracyclines, and oral anticoagulants  Constipations Drugs Need to know Generic Name: psyllium hydrophilic mucilloid Trade Name: Metamucil Drug Class: Bulk forming laxative Therapeutic Class: Laxative MOA: - High fibre, absorbs water into the GI Tract to increase bulk - Distends bowel to initiate reflex bowel activity Indicators: Adverse effects: - Acute and chronic constipation, IBS, - Mild: diverticulosis o Electrolyte imbalances o Gas formation o Esophageal blockage - Severe: o Impaction o Fluid overload o Aller GI c reaction Implication: Contraindications: 2g - Intestinal obstruction or fecal impaction Pre-admin: - Pt with abdominal pain and nausea/vomiting - Hx, bowel patterns, aller GI es assessment. - Hypersensetivity Post-admin: Interactions: - Antibiotics, digoxin, salicylates, tetracycline, warfarin sodium Notes: no laxatives in pt is cathartic, nauseous, vomiting, abdominal pain Generic Name: docusate salts Trade Name: Colace Drug Class: Emollient Laxatives Therapeutic Class: Stool softner MOA: Pulls water and fat into fecal mass to soften the stool Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o skin rash Post-admin: o decreased absorption of vitamins - Evaluate o electrolyte imbalances - Severe: o Lipid pneumonia Indicators: Contraindications: - Pt with hemorrhoids or other anorectal - Aller GI es conditions - Caution: - Acute and chronic Constipation o Acute sur GI cal abdomen - Fecal impaction o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid / ED Interactions: Notes: overly not therapeutically infected Generic Name: Mineral Oils Trade Name: Drug Class: Emollient Laxative Therapeutic Class: MOA: - Eases passage of stool by lubricating intestines Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o skin rash Post-admin: o decreased absorption of vitamins Evaluate o electrolyte imbalances - Severe: o Lipid pneumonia Indicators: Contraindications: - Most commonly for fecal impaction and - Aller GI es hard stools - Caution: - Acute and chronic constipation o Acute sur GI cal abdomen - Fecal impactment o Appendicitis symptom ( abdominal - Facilitation of bowel movement in anorectal pain, vomiting, nausea) conditions o Intestinal obstruction o As a weight loss aid - With Eating disorders Interactions: - Decreases absorption of fat-soluble vitamins (A, D, K, E) Notes: can be oral or enema, not recommended b/c aspiration and lipoid pneumonia Generic Name: Polyethylene glycol Trade Name: MiraLax Drug Class: Hyperosmotic Laxatives Therapeutic Class: Laxative MOA: Increases water content of fecal matter Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Abdominal bloating Post-admin: o Electrolyte imbalance - Evaluate o Rectal irritation - Diarrhea will occure within 30 – 60 minutes - Severe: of injestion o Aller GI c reaction - Assess I & O o Dehydration Indicators: Contraindications: - Chronic constipation - Aller GI es - Mainly Before a dx or surgery - Caution: o Acute sur GI cal abdomen o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid or ED Interactions: CNS depression: Barbituates, general anesthesia, opioids, antipsychotics Notes: 3350 indicates osmolality, usually also contains electrolytes Generic Name: Glycerin Trade Name: glycerin suppository Drug Class: Hyperosmotic Laxative Therapeutic Class: laxative MOA: Increase osmotic pressure in intestine, draws fluid into colon Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Abdominal bloating Post-admin: o Electrolyte imbalance - Evaluate bowel movement o Rectal irritation - Severe: o Aller GI c reaction o Dehydration Indicators: Contraindications: - Mild laxative - Aller GI es - Often in children - Caution: - Chronic constipation o Acute sur GI cal abdomen - dx and sur GI cal procedures o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid/ ED Interactions: CNS depression: Barbituates, general anesthesia, opioids, antipsychotics Notes: ensure proper insertion techniques, educate on hydration Generic Name: Lactulose Trade Name: Enulose Drug Class: Hyperosmotic Laxative Therapeutic Class: laxative MOA: Increase osmotic pressure in intestine, draws fluid into colon Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Abdominal bloating Post-admin: o Electrolyte imbalance - o Rectal irritation Evaluate - Severe: o Indicators: Contraindications: - Chronic constipation - Aller GI es - dx and sur GI cal procedures - Low-galactose diet - increased blood ammonia levels in patients - Caution: with hepatic encephalopathy o Acute sur GI cal abdomen o Appendicitis symptom (abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid/ ED Interactions: Oral antibiotics can decrease the effects Notes: synthetic derivation of lactose, can pass into large intestine - Converts ammonia in blood to ammonium Generic Name: Magnesium Hydroxide Trade Name: Milk of Magnesia Drug Class: Saline Laxative Therapeutic Class: MOA: Increase osmotic pressure, bowel distention, increased peristalsis and evacuation Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Hypermagnesemia Post-admin: - Severe: - Evaluate o - Watery stool within 3-6 hrs Indicators: Contraindications: - Used most commonly for endoscopic - Aller GI es examination - Caution: - Help remove unabsorbed poison from GI o Kidney insufficiency = hyper - Chronic constipation magnesemia - Dx and sur GI cal procedures o Kidney disease o Acute sur GI cal abdomen o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction and rectal bleeding o Intestinal obstruction o As a weight loss aid/ ED Interactions: Notes: unpleasant tasting, OTC, Generic Name: Magnesium citrate Trade Name: Drug Class: Saline Laxative Therapeutic Class: Laxative MOA: - Increase osmotic pressure, bowel distention, increase peristalsis and evacuation Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Post-admin: - Severe: - Watery stool w/I 3-6 hours o Evaluate Indicators: Contraindications: - Used most commonly for endoscopic - Aller GI es examination - Caution: - Help remove unabsorbed poison from GI o Acute sur GI cal abdomen - Chronic constipation o Appendicitis symptom ( abdominal - Dx and sur GI cal procedures pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid/ ED Interactions: Notes: Generic Name: Senna Trade Name: Senokot Drug Class: Stimulant Laxative Therapeutic Class: Laxative MOA: - Stimulates peristalsis in the intestine, increase bowel movement frequency and promote evacuation Implications: Adverse effects: Pre-admin: - Mild: - Hx., bowel patterns, aller GI es assessment. o Abdominal pain Post-admin: - Severe: - Complete bowel evac in 6-12 hrs o Indicators: Contraindications: - Acute constipation - Aller GI es - Bowel prep surgery - Caution: o Acute sur GI cal abdomen o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid / ED Interactions: Notes: OTC, Most likely to cause dependence Generic Name: bisacodyl Trade Name: Dulcolax Drug Class: Stimulant Laxative Therapeutic Class: Laxative MOA: - Stimulate peristalsis in intestines Implications: Adverse effects: Pre-admin: - Mild: - Hx, bowel patterns, aller GI es assessment. o Abdominal cramps Post-admin: o diarrhea Evaluate - Severe: o Electrolyte imbalance o Aller GI c rxn Indicators: Contraindications: - Prep for bowel procedures - Aller GI es - Caution: o Acute sur GI cal abdomen o Appendicitis symptom ( abdominal pain, vomiting, nausea) o Fecal impaction/ obstruction o As a weight loss aid/ ed Interactions: - OTC, Notes: Antiparkinsons Drug Class: Direct Acting Dopamine Receptor Agonists Drug Types: Nondopamine dopamine receptor agonists - Ergot Derivatives: Bromocriptine, - Nonergot Drugs: Pramipexole ( Mirapex), ropinirole (ReQuip) MOA: Direct stimulation of presynaptic dopamine receptors or postsynaptic dopamine receptors or both in the brain Indications: Adverse GI Upset effects: Dyskinesias Sleep disturbances Drug Class: Dopamine replacement drugs Drug Types: Presynaptic - Levodopa - Carbidopa MOA: - Levodopa: precursor to dopamine for brain o Can cross BBB, then converted to dopamine o Large doses Needed o Only good in early PD where there are functioning nerve terminals (5-10 years) - Carbidopa o GI ven with levodopa o Cant cross BBB Prevents levodopa breakdown by periphery Indication: Adverse Effects: - Confusion, involuntary movements, GI distress, hypotension, cardiac dysrhythmias Drug Class: Selective Monoamine Oxidase Inhibitor Therapy Drug types: MAO-B Inhibitor: - Sele GI line hydrochloride - Rasa GI line mesylate (Azilect) MOA: - Break down catecholamins in the CNS which increases in levels of dopaminer GI c stimulation in the CNS - Used with Ldopa Adverse Effects: - Cheese effect if >10 mg is used o MAOI’s ( that inhibit MAO-A’s) interact with tyramine in cheese and wine which causes an extreme reaction and can lead to hypertension. MAO-B INHIBITORS ARE UNLIKELY TO CAUSE THE CHEESE EFFECT Drug Class: Dopamine Modulators Drug types: Amantadine hydrochloride MOA: - Indirect acting - Causes release of dopamine and other catecholamines from vessicles in presynaptic fibers of nerve cells within basal ganglia that have not been destroyed yet - Blocks reuptake of dopamine Good to knows - Antiviral drug used to treat influenza - Used in early course of the disease - 6-12 months Indication: - Pt experiencing diskynasia on levodopa-carbidopa therapy Adverse Effects: Dizziness, insomnia, nausea Drug Class: Catechol Ortho-Methyltransferase Inhibitors Drug types: Entacapone (Comtan) MOA: - Blocks COMT from breaking down catecholamines ( dopamine, seretonin, epinephrine, and norepinephrine) - Prolongs the duration of action of levodopa - Reduces wearing off phenominon Adverse Effects: - GI upset - Urin discolouration - Worsen dyskinesia Drug Class: Anticholiner GI c Therapy Drug types: Trihexyphendyl hydrochloride, benztropine, antihistamines (diphenhydramine- Benadryl) MOA: Blocks effects of ach Indication: - Pt with muscle tremors and ri GI sity ( caused by excess choliner GI c activity) o Resolves SLUDGE o Salivation o Lacrimation o Urination o Diarrhea o Emesis Adverse Effects: - Does not relieve bradykinasia Antiparkinsons drugs Generic Name: Levodopa- Carbidopa Trade Name: Sinemet Drug Class: Dopamine replacement Therapeutic Class: Antiparkinsons MOA: Levodopa: - Dopamine replacement drug - precursor to dopamine, it can cross the blood brain barrier, precursor to dopamine Carbidopa: - decreases deoxycarbolase in Peripheral circulation which breaks down levodopa Implications: Adverse effects: Pre-admin: - Mild: - Assessment o Palpations - Hx o Hypotention - Med Hx o Urinary retention - Questions to ask o Depression o CNS o Dyskinesia o GI tracts o involuntary movements o Psycholo GI cal and emotional o GI distress - Pt education (no other meds unless physician consulted) Post-admin: - Masklike - Speech problems/ dyspha GI a - Ri GI dity and shuffle Indicators: Contraindications: - Angle closure glaucoma - Caution with open-angle glaucoma - MAOI-A’s o Hypertensive crisis Interactions: - Vitamin B6: reduces effects - Pyridoxine, nonselective MAOI-A’s, benzodiazepines, antipsychotics, dietary protein - Tricyclic antidepressants Notes: - most common, - carbidopa it cannot be used alone as therapy, - BEST taken on empty stomach, - individualized for each - Sinemet CR o Increases on time, decreases off time - Works in pt with early PD who still have functioning Nerve terminals ( between 5-10 years) - Assist when ambulating b/c dizziness - Encourage 3000ml hydration Generic Name: Bromocriptine Trade Name: Drug Class: Nondopamine dopamine Therapeutic Class: receptor agonists: Ergot derivative MOA: - Activates presynaptic dopamine receptors to stimulate more dopamine - Inhibits prolactin Implications: Adverse effects: Pre-admin: - Mild: - Assessment o GI Upset - Hx o Dyskinesias - Med Hx o Sleep disturbances - Questions to ask o Drowsiness o CNS o Visual changes o GI tracts o Ataxia o Psycholo GI cal and emotional - Pt education (no other meds unless physician consulted) Post-admin: - Masklike - Speech problems/ dyspha GI a - Ri GI dity shuffle Indicators: Contraindications: - Various stages - Allergy - Alone or combo - Adrener GI c drugs - Less risk of motor complications - Younger pt - Lactation excess Interactions: - Erythromycin and adrener GI c drugs o Increased effects of bromocriptine and risks toxicity o Hypo/hypertension and cardiac dysrhythmias Notes: - also, can be used for females with excess milk production and as tx for prolactin producing tumours - can be used for PVD - Assist when ambulating b/c dizziness - Encourage 3000ml hydration Generic Name: Sele GI line hydrochloride Trade Name: Drug Class: MAO-B Inhibitor Therapeutic Class: antiparkinsons MOA: - break down MAO-B enzymes which break down catecholamines (dopamine, epinephrine and norepinephrine) and serotonin, - increases serotonin, epinephrine, norepinephrine, and dopamine in CNS which increases dopaminer GI c stimulation in the CNS Implications: Adverse effects: - used in combo with levodopa- o dizziness carbidopa therapy when pt response is o insomnia fluctuating o hallucination Pre-admin: o ataxia - Assessment o a GI tation - Hx/ Med Hx o depression - Questions to ask o parasthesia o CNS o somnolence o GI tracts o headache o Psycholo GI cal and emotional o dyskinesia - Pt education (no other meds unless o nausea physician consulted) o diarrhea Post-admin: o hypotention/ hypertension - Masklike o chest pain - Speech problems/ dyspha GI a o weight loss - Ri GI dity o dermatolo GI cal rxn shuffle o rhinitis/ pharyn GI tis Indicators: Contraindications: - used in combo with levodopa- - Allergy carbidopa therapy when pt response is - Meperidine hydrochlorides fluctuating Interactions: - Additive CNS stimulation ( serotonin syndrome): o Meperidine hydrochloride  Also: delirium, muscle ri GI sity, hyperprexia, hyperirritability o opioids, tramadol, cyclobenzaprine hydrochloride, dextromethorphan hydrobrominde, other MAOI’s, serotoner GI c antidepressants, oxcarbazepine, - Reduced sele GI line clearance = toxicity o carbamazepine, oral contraceptives - uncertain mechanism (Hypertension): Buspirone hydrochloride Notes: - Unlikely to cause the cheese effect if 180/120 - Medical emergency Goals of antihypertensive tx - Reduce cardiovascular and renal morbidity - BP < 140/90 o Hypertension with diabetes < 130/80 o Hypertension with chronic kidney disease < 140/90 o Older adults need to be a bit higher ANS - Parasympathetic nervous system o Rest and digest o Stimulates smooth muscles, cardiac muscles, glands - Sympathetic nervous system o Stress o Caused by epinephrine o Stimulates heart, blood vessels and skeletal muscles Indicators  All for high BP  Glaucoma  BPH: doxazosin, prasozin, terazosin Nursing implications - Monitor Bp prior to administering medication - Apical hr < 60, or/ and SBP ,