_[NUR 213] UNIT 5_ CENTRAL AND PERIPHERAL NERVOUS SYSTEM DRUGS .pdf

NUR 213: PHARMACOLOGY UNIT 5: CENTRAL AND PERIPHERAL NERVOUS SYSTEM DRUGS LEVEL 2: DIVISION OF MATERNAL AND CHILD NURSING D. Dopaminergic OUTLINE...

NUR 213: PHARMACOLOGY UNIT 5: CENTRAL AND PERIPHERAL NERVOUS SYSTEM DRUGS LEVEL 2: DIVISION OF MATERNAL AND CHILD NURSING D. Dopaminergic OUTLINE E. MAO-B F. Dopamine Receptor Antagonists I. CNS DEPRESSANTS ANXIOLYTICS AND G. Dopamine Agonists HYPNOTICS CNS STIMULANTS H. Catechol-o Methyltransferase inhibitors A. Benzodiazepines 1. Alzheimer’s Disease 1. Nursing Management a) Drug of Choice B. Barbiturates b) Other Medications 1. Nursing Management c) NM C. Anesthetics 1. Local Anesthetics a) 5 types of LA b) Examples of LA CNS DEPRESSANTS ANXIOLYTICS AND HYPNOTICS CNS c) Nursing Management STIMULANTS 2. General Anesthetics Anxiety ○ feeling of tension, nervousness, a) Stages of Anesthesia apprehension or fear involving unpleasant b) Nursing Management reaction to stimuli 3. Intravenous Anesthetics Anxiety- unknown cause II. CNS STIMULANTS Sedation ○ loss of awareness and reaction to A. Narcolepsy environmental stimuli 1. Drug of Choice Sedation - reduced responsiveness without full loss of B. ADHD consciousness Hypnosis 1. Drug of Choice ○ CNS depression and sleep C. Analeptics D. Xanthines BENZODIAZEPINES III. ANTICONVULSANTS/ ANTISEIZURE AGENTS Are depressants that produce sedation and A. Two Seizure Categoiries hypnosis, relieve anxiety and muscle spasms, and B. Drug for Tonic-Clonic Seizures reduce seizures Enhances the action of Gamma Amino Butyric Acid 1. Hydantoins (a neurotransmitter in the brain-calming effect), a 2. Barbiturates chemical inducing sedation 3. Benzodiazepines used for anxiety disorders and alcohol withdrawal C. Drugs for Absence Seizures (Petit Mal) ○ Examples: diazepam (Valium) D. Drugs for Partial Seizures (Focal) alprazolam (Xanax) IV. DRUGS FOR NEUROMUSCULAR DISORDERS lorazepam (Ativan) A. Mysathenia Gravis 1. Drugs for MG NURSING MANAGEMENT (BENZODIAZEPINES) 2. Nursing Management 1. Contraindicated in shock, coma, acute alcohol 3. 2 Type of Complication of MG intoxication, pregnancy, and lactation with adverse effects of leukopenia and physical dependence and B. Multiple Sclerosis S/E of drowsiness and dizziness. 1. Drugs for MS 2. Taper the dose slowly per DO. C. Muscle Spasms/Muscle Relaxants 3. No abrupt discontinuation. 1. Drugs for Spasms/ Relaxants 4. Avoid giving it with other CNS depressants such as alcohol barbiturates. V. Centrally Acting Skeletal Muscle Relaxants 5. No with caffeine and tobacco. A. Spasmolytics 6. Avoid operating machineries and automobiles. 1. Nursing Management (CAMR) 7. Watch out for withdrawal symptoms: nervousness, VI. Direct Acting Skeletal Muscle Relaxants insomnia, tremors, and anorexia A. Drugs for DAMR BARBITURATES 1. Nursing Management (DAMR) VII. Neuromuscular Junction Blocking Agents General CNS depressants which has sedation, anesthesia, and hypnotic effect A. Non Depolarizing NMJ Blockers For insomnia and seizure (anticonvulsant B. Depolizaing NMJ Blockers properties) C. Anticholinergics - Example: - phenobarbital - mephobarbital 1  NUR 213: Unit 5 Transition - once their condition stabilizes PO for ongoing NURSING MANAGEMENT (BARBITURATES) pain control 1. Contraindicated in nephritis, respiratory distress NURSING MANAGEMENT (LOCAL ANESTHETICS) with adverse reaction of respiratory depression and 1. Monitor Vital Signs hypersensitivity reaction and S/E hypotension, 2. Standby equipment to maintain airway and dizziness, and drowsiness. ventilation 2. Watch out for physical tolerance and psychological 3. Watch for hypotensive effect dependence. 4. No sudden change of position 3. Taper the dose slowly, per DO. 5. No driving of automobile or danger machinery 4. No driving of automobile and heavy equipment machineries. GENERAL ANESTHETICS 5. Avoid taking with other CNS depressants Depress CNS, alleviate pain, and cause loss of 6. Rise slowly from lying, to sitting, and standing consciousness position. 7. No sudden change of movement and position. Balanced Anesthesia- combination of drugs to achieve analgesia, muscle relaxation, and loss of consciousness for ANESTHETICS fewer adverse reactions Classifies as local and general a. Pre operative medications Added para nd magfull blast ang anesthesia sa patient LOCAL ANESTHETICS ○ Anticholinergics (atropine) block pain at the site where drug is administered, ○ drugs that would control the salivary actions to allowing consciousness to be maintained lessen the saliva produced used for dental procedures, suturing of skin deep ○ increased saliva is risk for aspiration slash and laceration, and short term minor surgery b. Sedative hypnotics Ex. Lidocaine for children c. Antiemetics d. Antihistamine e. Opioids/narcotics 5 TYPES OF LOCAL ANESTHETICS 1. Topical administration STAGES OF ANESTHESIA a medication you apply to your skin or mucosa 1. Analgesia to temporarily numb the area Begins with awake and ends with loss of can reduce pain and itchiness consciousness 2. Infiltration 2. Excitement or delirium accomplished with administration of the local Produces LOC, caused by depression of anesthetic solution (ID, SC, submucosally) cerebral cortex; induction is short across the nerve path that supplies the area of 3. Surgical the body that requires anesthesia Surgical procedure occurs 3. Field block 4. Medullary paralysis local anesthetic is infiltrated around the border Respirations are lost, ventilator assistance of the surgical field, leaving the operative area is necessary undisturbed epinephrine may be added to the anesthetic to INHALATION ANESTHETICS enhance vasoconstriction and prolong the Used during 3rd stage to deliver general anesthesia duration of anesthesia ○ Ex. Gas or volatile liquids administered as 4. Nerve Block gas injection of local anesthetic near specific nerves to decrease pain in a certain part of the a. Anesthetic gas body during and after surgery. 1. nitrous oxide (laughing gas)- blue cylinder It inhibits impulse transmission distally in a 2. cyclopropane- orange cylinder nerve terminal, thus terminating the pain signal 3. ethylene- red cylinder perceived by the cortex. 5. IV regional anesthesia b. Volatile liquids injection of local anesthetic solutions into the 1. halothane (Fluothane) venous system of an upper or lower extremity 2. desflurane (Suprane) that has been exsanguinated by compression or gravity and that has been isolated by means INTRAVENOUS ANESTHETICS of a tourniquet from the central circulation May be used for the induction stage of anesthesia EXAMPLES OF LOCAL ANESTHETIC 1. droperidol (Innovar) 1. procaine HCl (Novocaine) 2. etomidate (Amidate) ester group 3. ketamine HCL (Ketalar) short acting, 30 minutes to 1 hour 4. midazolam (Dormicum) 2. lidocaine (Xylocaine) ○ For induction and maintenance of amide group anesthesia moderate acting, 1 to 3 hours 3. bupivacaine (Macaine) NURSING MANAGEMENT (GENERAL ANESTHETICS) amide group 1. Monitor Vital Signs long acting, 3 to 10 hours 2. Monitor postoperative state of sensorium 3. Watch out for respiratory depression IV pain medication, then PO 2  NUR 213: Unit 5 4. Monitor pre and post op urine output (needed as increase a child’s attention span and cognitive anesthetic can suppress the function; catheter may performance be inserted to aid) best taken in morning or lunch time 5. Stand by equipment to maintain airway Minimizing the risk of insomnia and optimizing attention (endotracheal tube, suction machine, O2 tank, and during peak activity hours like school mechanical ventilator) 6. Health teaching on what to expect and what to do ANALEPTICS before and after the surgical position to include Wide variety of medications used to treat positioning, medications, respiratory exercises, depression, attention deficit hyperactivity disorder, signs to resume diet, wound dressings etc. respiratory depression, and respiratory stimulants Flat on bed- if patient has post op or spinal headache XANTHINES 1. Caffeine MORPHINE PRECAUTIONS CNS and respiratory stimulants Nausea, vomiting, depression, decreased urine Large dose: stimulate respiration output Caffeine SE: palpitation, insomnia, tremors, Flat on bed- post op or spinal headache diuresis, nervousness, restlessness 2. Theophylline ALCOHOLISM Increases respiration in newborns Disulfiram (Antabuse)- “Anti-alcoholic agent Relaxes bronchioles ○ causes unpleasant reaction when given to Premature patients combined with alcohol: headache, dizziness, N/V, sweating, palpitation, and ANTICONVULSANT, ANTIEPILEPTIC AGENTS, hypotension ANTI-SEIZURE DRUGS ○ use as last recourse Epilepsy- sudden discharge if excessive electrical energy from nerve cell within the brain leading to NURSING MANAGEMENT (DISULFIRAM) seizure 1. Avoid alcohol- reaction begins 5-10 minutes if A long-term brain condition combines and is equal to amount of alcohol Seizure- attack or sudden onset of a disease or ingested symptoms 2. Best taken 12 hours after abstaining from alcohol Convulsions- involuntary muscle contraction or 3. No alcohol containing substances: series of sudden pull of muscles ○ Ex. Mouthwash, liniments, OTC cold remedies, menthol, after shave lotion, and When having seizure attack, note the duration of the vinegar attack for the doctor to know what treatment to be 4. Monitor liver function test used CNS STIMULANTS TWO SEIZURE CATEGORIES Also known as psychostimulant, or colloquially as uppers 1. Generalized seizure- within one area of the brain Are a class of drugs that increase the activity of the and rapidly spread throughout both hemispheres of brain the brain Are used for various purposes, such as enhancing alertness, attention, motivation, cognition, mood, a. Tonic- clonic seizures (grand mal) and physical performance. - Tonic clonic muscle contraction, there is loss of consciousness Usually given to children with ADHD b. Absence of seizures (petit mal) - Loss of consciousness 3-5 NARCOLEPSY seconds falling asleep during normal walking activities such as driving a car or talking to someone c. Myoclonic seizures Excessive daytime sleepiness and sudden sleep attacks - Short sporadic period of muscle contraction DRUG OF CHOICE d. Febrile seizures- high fever convulsions 1. Amphetamines e. Status epilepticus- rapidly recurring Stimulate the release of norepinephrine and dopamine from brain and SNS seizure Inhibit the reuptake of this transmitter 2. Partial seizure (local seizure)- involves 1 area of Causes euphoria and alertness the brain and do not spread throughout the brain ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) DRUGS FOR TONIC-CLONIC SEIZURES One of the most common mental disorders affecting children Symptoms of ADHD include inattention (not being HYDANTOINS able to keep focus), hyperactivity (excess a. Phenytoin (Dilantin) movement that is not fitting to the setting) and impulsivity (hasty acts that occur in the moment b. Reduce repetitive neural firing which limits seizure without thought) attacks c. Therapeutic serum level: 10-20mcg/ml DRUG OF CHOICE d. Non-addicting but has teratogenic effect 1. Methylphenidate (Ritalin) 3  NUR 213: Unit 5 NURSING MANAGEMENT 4. Protect from infection and injury 1. Watch out for gingival hyperplasia (reddened and 5. No sudden discontinuation of drug enlarge gims that bleed easily). 2. Massage the gums and do oral care. DRUGS FOR PARTIAL SEIZURES (FOCAL) 3. Watch out for flu-like symptoms cause by 1. carbamazepine (Tegretol) leukopenia and agranulocytosis. Causes drowsiness 4. Prevent and protect from injury due to N thrombocytopenia. NURSING MANAGEMENT 5. Monitor blood sugar level. a. Give oral form with food 6. Increase fluid intake and high fiber diet for b. Monitor CBC and watch out for flu-liek constipation. symptoms caused by bone marrow suppression BARBITURATES (CNS DEPRESSANTS) c. Taper the dose slowly For partial, grand mal, and acute episode of status epilepticus seizures 2. Gabapentin (Neurontin) reduces seizure by enhancing the activity of GABA May cause dizziness and incoordination Causes sedation with side effects of drowsiness and dizziness NURSING MANAGEMENT a. Best taken at bedtime NURSING MANAGEMENT b. Don’t stop drug abruptly 1. Avoid taking it with other CNS depressants (Ex. c. Avoid driving and operating heavy alcohol) machinery. 2. Avoid automobile and heavy machinery operation d. Monitor CBC and watch out for flu-like 3. Watch for drug tolerance symptoms caused by leukopenia. 4. Taper the dose slowly and discontinue drug gradually, per DO DRUGS FOR NEUROMUSCULAR DISORDERS BENZODIAZEPINES (CNS DEPRESSANTS) Potentiate GABA effects that stabilize nerve cell MYASTHENIA GRAVIS (MG) membrane Chronic autoimmune neuromuscular disease “Impairs the transmission of messages at the Act in the limbic system, RAS, and cause muscle neuromuscular junction relaxation and relieve anxiety Symptoms are caused by autoimmune destruction Causes sedation with side effects of drowsiness of acetylcholine (ACh) sites” and dizziness (Pharmacology: A Patient-Centered Nursing Process Approach, Mccuistion et al., 11th Ed, p. 452) Ex. Diazepam (valium) and Clonazepam (klonopin) Decreased acetylcholine, increase DRUGS FOR ABSENCE SEIZURES (PETIT MAL) acetylcholinesterase 1. succinimides With progressive muscle weakness May cause dizziness Suppress the abnormal electrical activity Early signs: Ptosis and Diplopia (double vision) in the brain i. ethosuximide (Zaronfin) DRUGS FOR MYASTHENIA GRAVIS (MG) ○ First line drug Cholinesterase inhibitor drugs ii. methusiximide (Cecontin) Binds to the enzyme cholinesterase temporarily, ○ Second line drug preventing breakdown of acetylcholine, thereby ○ Treatment of seizures increasing muscle strength which are refractory or Increases muscle strength (for MG) resistant to other Can produce pupil constriction (for glaucoma) agents. 2. valproic acid (Depakene) 1. neostigmine (Prostigmin) Reduce abnormal electrical activity in the Short acting brain and increase GABA activity Increased muscle Monitor liver enzyme Given every 2-4 hours Watch out for hepatotoxicity For prevention of Myasthenic Crisis (complication in MG NURSING MANAGEMENT commonly referred as 1. Give oral drug with food underdosing of Cholinesterase 2. Monitor CBC inhibitor) 3. Watch out for flu-like symptoms cause by bone NURSING MANAGEMENT (DRUGS FOR MG) marrow suppression 1. IV form: given alone 4  NUR 213: Unit 5 2. Oral form: before meals 2. Increases phagocytosis and 3. Dosage is adjusted by physician according to activity of suppressor T cells needs 3. Monitor WBC count, it can cause 4. All doses of Cholinesterase inhibitors should be immunosuppression given on time to prevent muscle weakness to arise 4. Avoid crowded places while on 5. Atropine- ready as an antidote to adverse effects therapy and wear mask at all (overdosing) of cholinesterase inhibitors such as times muscle weakness, dyspnea, and dysphagia/. 5. Avoid contact to person with TWO MOST IMPORTANT TYPE COMPLICATION OF MG upper respiratory infection 1. Myasthenia Crisis- underdosing of cholinesterase Chronic progressive inhibitors ○ “Cyclophosphamide” (Cytotoxin) 2. Cholinergic Crisis- overdosing of cholinesterase ○ Nursing Management inhibitors 1. Immunosuppressant which Both have similar symptoms of severe suppress the activity of effector T muscle weakness, dyspnea (difficulty in cells breathing) and dysphagia (difficulty in 2. Monitor WBC count, it can cause swallowing) immunosuppression Edrophonium chloride (tensilon) is used to manage MC to be followed by any DRUGS FOR MUSCLE SPASMS/ MUSCLE RELAXANTS shortingacting cholinesterase inhibitors to Cerebellum and basal ganglia ○ Provide coordination of contraction keep signs and symptoms away Cerebral cortex Atropine sulfate is use as an antidote to ○ Allows conscious thought to regulate CC movement MULTIPLE SCLEROSIS (MS) Extra pyramidal tract ○ Composed of cell from cerebral cortex, an autoimmune disorder that attacks the myelin basal ganglia, and cerebellum sheath of nerve fibers in the brain and spinal cord ○ Allows the body to make automatic causing lesions that are coiled plaques, affecting adjustment in posture, position, and mostly Caucasian women age 20-40 years balance DRUGS/MANAGEMENT FOR MS Muscle spasm ○ overstretching of the muscle, tearing a “No two cases of MS are alike, so the drugs are tailored to tendon or ligaments the disease pattern and manifestations of the patient.” ○ Causes painful involuntary muscle contractions, cutting of blood flow to the (Pharmacology: A Patient-Centered Nursing Process muscle fibers, causing lactic acid to accumulate, resulting to pain Approach, Mccuistion et al., 11th Ed, p. 459) Muscle spasticity ○ damage from neuron within the CNS Acute attack ○ May lead to excessive stimulation of the ○ “Glucocorticoids” muscles with opposing muscle groups to cause contractures and permanent Ex. Prednisone- potent structural changes. anti-inflammatory agent use to suppress inflammatory process Difference between the two: of MS “Spasticity is a symptom that causes your muscles to feel stiff, heavy and difficult to move. A spasm is a sudden, ○ Nursing Management involuntary tightening or contraction of a muscle.“ - 1. Monitor WBC count, it can cause MSAustralia.org immunosuppression 2. Give oral form with meals to decrease GI upset CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS Works in the CNS to interfere with the reflexes that 3. Monitor blood sugar, it can cause cause muscle spasms hyperglycemia “Specifically, it acts on the spinal cord” 4. Monitor blood pressure 5. Monitor patient for increase SPASMOLYTICS sodium level and decrease potassium level in the blood drugs that destroy spasm 1. baclofen (Lioresal) Remission-exacerbation a. For muscle spasticity of multiple sclerosis, ○ “interferon beta”(Betaseron) muscle rigidity, and spinal cord injuries ○ Nursing management 2. carisoprodol (Soma) a. Spasmolytics that is safer in elderly with 1. Pharmacologic agents used to renal or hepatic dysfunction enhance the body’s immune 3. chlorphenesin (Maolate) system. a. With long duration of action 5  NUR 213: Unit 5 NURSING MANAGEMENT OF CENTRALLY ACTING MUSCLE 4. IV drug form should not be mixed with alkaline RELAXANTS (CAMR) solutions (Ex. barbiturates, sodium bicarbonate) 1. Do not stop abruptly 5. Stand by dantrolene sodium for malignant 2. Taper dosage over one week to avoid rebound hyperthermia spasm, per DO 6. Stand by cholinesterase inhibitors to counteract the 3. Watch out for dizziness, drowsiness, or sedation excessive effect of non depolarizing NMJ blockers 4. No driving of automobile or operation of machinery (Ex. neostigmine and pyridostigmine bromide) that require mental alertness 5. For acute spasm, treatment should no longer than 3 DRUGS FOR PARKINSON’S DISEASE AND ALZHEIMER;S weeks DISEASE Parkinsonism DIRECT ACTING SKELETAL MUSCLE RELAXANTS Triad syndrome: ○ Involuntary tremors of the limbs Use in treating general spasticity that directly affects ○ Rigidity of muscles peripheral muscle contraction ○ Slowness of movements 1. dantrolene (Dantrium) Less dopamine in the brain ○ For muscle spasticity of cerebral palsy, “A chronic, progressive neurologic disorder that multiple sclerosis, muscular dystrophy, affects the extrapyramidal motor tract, which polio, tetanus, and quadriplegia controls posture, balance, and locomotion ○ Acts within skeletal muscle fibers, Caused by an imbalance of the neurotransmitters interfering with the release of calcium from dopamine (DA) and acetylcholine (ACh). With less the muscle tubules which prevents DA production, the excitatory response of ACh contraction exceeds the inhibitory response of DA. 2. botulinum toxin type B (Myobloc) Drugs used to treat PD replace the DA deficit and ○ Reduces the severity of abnormal head reduce the symptoms. position and pain of the neck associated with Cervical Dystonia ANTICHOLINERGICS 3. botulinum toxin type A (Botox cosmetics) ○ Relaxes the muscles of the eyebrows, increase the effects of DA in the brain by reducing relieving the appearance of lines the effects of ACh Antiparkinsonian Agents “Increase the effects of DA in the brain by reducing NURSING MANAGEMENT OF DIRECT ACTING MUSCLE the effects of ACh” RELAXANTS (DAMR) 1. Watch out for respiratory infection and flu-like (Pharmacology: A Patient-Centered Nursing symptoms in botulinum toxin type A Process Approach, Mccuistion et al., 11th Ed, p. 2. Assess for muscle weakness. 434) 3. Prevent injury and infection Decrease rigidity and tremors but no effect in slow 4. No vigorous exercise, contact sports, and crowded movement places Ex. 5. Dor dantrolene- report elevated level of liver ○ trihexyphenidyl (Artane) enzymes (CP450) ○ benztropine (Cogentin) 6. Assess for involvement of respiratory muscles ○ biperiden (Akineton) resulting in respiratory depression. Nursing Management NEUROMUSCULAR JUNCTION BLOCKING AGENTS 1. Avoid alcohol, cigarettes, caffeine, and aspirin to Affect normal functioning of the muscles by decrease gastric acidity interfering with the normal process that occurs at 2. Relieve dry mouth with candies, ice chips, or sugarless gum the junction of nerve and muscle cell 3. High fiber diet and increase water intake Use to cause intended paralysis 4. Use sunglasses when walking outdoor (it causes sensitivity to the eye) NON DEPOLARIZING NMJ BLOCKERS 5. Void before taking the drug 6. Contraindicated in clients with glaucoma Block Ach receptor to prevent stimulation Does not cause activation of muscle cells Causes flaccid paralysis DOPAMINERGIC ○ Ex. Tubocurarine, Pancuronium bromide, Levodopa Vecuronium bromide (adjunct to ○ Increasemobility and decrease tremors anesthesia) and rigidity DEPOLARIZING NMJ BLOCKERS “ the blood-brain barrier admits levodopa but not DA ombine with Ach receptors at the motor end plate ○ The enzyme dopa decarboxylase converts which inhibits neuromuscular transmission levodopa to DA in the brain” Causes flaccid paralysis Ex: Succinylcholine (anectine) (Pharmacology: A Patient-Centered Nursing Process ○ Use to produce paralysis of muscles Approach, Mccuistion et al., 11th Ed, p. 437) Carbidopa-levodopa NURSING MANAGEMENT OF NMJ BLOCKERS ○ “Alternative drug of Levodopa because of 1. Monitor VS its side effects and the fact that so much 2. Supplies to maintain airway patency should be on levodopa is metabolized before it reaches standby basis and provide mechanical ventilator if the brain” necessary 3. Watch out for respiratory depression if intended (Pharmacology: A Patient-Centered Nursing Process paralysis will affect the diaphragm Approach, Mccuistion et al., 11th Ed, p. 438) 6  NUR 213: Unit 5 Nursing Management: 1. Assess for weakness, dizziness, and syncope as sign and symptoms of orthostatic hypotension 2. Don’t stop or discontinue drug abruptly 3. It can cause urine discoloration 4. Give the drug with a low-protein diet. High protein diet interferes with drug absorption and distribution 5. Avoid limit intake of diet high in vitamin b6 (it inhibits conversion of levodopa to dopamine MONOAMINE OXIDASE B INHIBITORS (MAO-B) Ex. selegiline Inhibits MAO-B which is responsible for breaking down or catabolism of Dopamine Prolongs the action of levodopa May also inhibit MAO-A if given in large doses which can lead to hypertensive crisis When taking MAO-B inhibitors for Parkinson's disease, avoid foods high in tyramine. This includes fermented foods like sauerkraut, aged cheeses, cured meats, and certain alcoholic beverages such ALZHEIMER’S DISEASE as red wine and beer. Consuming these foods can lead to a hypertensive crisis (sudden and an irreversible neurodegenerative disorder dangerous spike in blood pressure) characterized by a decline in a patient’s activities of daily living (ADL) and cognitive abilities, as well as Nursing management changes in behavior. 1. Give oral form of drug with meals 2. Avoid food high in tyramine content (Ex. aged DRUG OF CHOICE cheese, red wine, chocolate, banana, raisins, preserved food (high in nitrates), salami, soy sauce Rivastigmine – preventing hypertensive crisis) ○ an AChE inhibitor to improve cognitive 3. Monitor BP function with mild to moderate AD 4. Have antihypertensive drug on a standby basis ○ “absorbed faster through the GI tract without food ○ readily crosses the blood-brain barrier” DOPAMINE RECEPTOR ANTAGONISTS (Pharmacology: A Patient-Centered Nursing Process E.g. amantadine (Symmetrel), bromocriptine Approach, Mccuistion et al., 11th Ed, p. 447) mesylate (Pariodel) Stimulate to produce more dopamine Increased mobility decreased rigidity OTHER MEDICATIONS “A synthetic antiviral agent” Brexpiprazole- Atypical antipsychotic Donepezil- Cholinesterase inhibitor (Pharmacology: A Patient-Centered Nursing Process Galantamine- cholinesterase inhibitor Approach, Mccuistion et al., 11th Ed, p. 439) Memantine- NMDA Antagonist (N-Methyl-D-aspartate) Nursing Management ○ a glutamate receptor, the human brain’s 1. Change position slowly to prevent injury from primary excitatory neurotransmitter. hypotension, lightheadedness, and syncope ○ It plays an integral role in synaptic 2. Check heart rate plasticity, a neural mechanism believed to 3. No alcoholic drinks be the basis of memory formation. DOPAMINE AGONIST Memantine and Donepezil (manufactured ropinirole (Requip) combination)- NMDA antagonist pramipexole dihydrochloride Both stimulate dopamine receptor in striatum Side effects: nausea, dizziness, weakness, ALZHEIMER’S DISEASE constipation Mild cognitive impairment Duration: 7 years CATECHOL-O-METHYLTRANSFERASE INHIBITORS Disease begins in Medial COMT inactivates dopamine Temporal Lobe COMT+ Levodopa increases amount of levodopa in Symptom: Short-term the brain memory loss Intensify primary and secondary effects of levodopa= dizziness and orthostatic hypotension Mild Alzheimer’s Duration: 2 years ○ entacapone (Comtan) Disease spreads to Lateral Produce harmless dark yellow to Temporal and Parietal orange urine Lobes Affect liver function Symptoms include: ○ carbidopa, levodopa, entacapone (Stalevo) Reading problems, Poor Decreases wearing off effects of object recognition, Poor levodopa direction sense 7  NUR 213: Unit 5 Moderate Alzheimer’s Duration: 2 years Disease spreads to Frontal Lobe Symptoms include: Poor judgment, Impulsivity, Short attention Severe Alzheimer's Duration: 3 years Disease spreads to Occipital Lobe Symptoms include: Visual Problems NURSING MANAGEMENT (AD DRUGS) 1. Watch out for miosis, blurred vision, headache, dizziness, drowsiness, persistent cough. 2. This drug slows processes. AGEMENT OF CENTRALLY ACTING MUSCLE RELAXANTS (CAMR) NURSING MANAGEMENT OF CENTRALLY ACTING MUSCLE RELAXANTS (CAMR) E RELAXANT 8