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NU 150 / NU150 Exam 4 – Pharmacology Review
(Latest 2026/2027 Update) | Galen | Complete Real
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Dopamine (anti-parkinson drug) symptoms of Parkinson's are caused by depletion of this Does PO Dopamine cross the blood brain barrier? No- therefore it's ineffective Levodopa (anti-parkinson drug) crosses the blood brain barrier and converts to Dopamine What converts to Dopamine once it crosses the blood brain barrier? Levodopa What 2 drugs work best together to reach the brain in Parkinson's? Levodopa and Carbidopa (anti-parkinson drugs) Can Carbidopa be given alone and be effective? No Carbidopa and Levopdopa make what drug? Sinemet What is the "gold standard" treatment for Parkinson's? Levodopa Adverse reactions of Levodopa (anti-parkinson drug) Choreiform movements & Dystonic Movements What are Choreiform movements? involuntary twitching of the limbs or facial muscles
What are Dystonic Movements? spasms that affect the tongue, jaw, eyes & neck Contraindications for Dopamine use:
- Known hypersensitivity 2. glaucoma 3. taking MAOI 4. during lactation What type of patients should you use precaution in before prescribing Dopamine? heart disease, asthma, emphysema, peptic ulcer dx, kidney & liver disease What are anticholinergics (anti-parkinson drug)? drugs that inhibit acetylcholine in the CNS; less effective than Dopaminergic drugs. What are Anticholinergics used for? used to control drug-induced extrapyramidal disorders examples of anticholinergic medications? Cogentin, Akineton, Kemadrin, Artan Adverse reaction of anticholinergics? Dry mouth Blurry vision Dizziness Mild Nausea Nervousness Contraindications for use of Anticholinergics Known hypersensitivity Glaucoma Pyloric or duodenal obstruction peptic ulcer prostate hypertrophy achalasia myasthenia gravis megacolon What can Anticholinergics cause in elderly people? Confusion & Disorientation What is the new class of anti-parkinson drugs called? Catechol-O-methyltransferase (COMT)
Dopamine Receptor Agonist are contraindicated in what type pf patients? known hypersensitivity severe ischemic heart disease Peripheral Vascular Disease Use caution in what type of patients before administering Dopamine Receptor Agonist? Dyskinesia Orthostatic hypotension liver or renal impairment Do NOT administer with other CNS Depressants What should your NRSG Assmt include for a person with Parkinson's?
- Symptoms regarding the disorder
- How long have the symptoms been present
- Ability of the person to perform ADLs
- Current mental condition What may happen if someone abruptly stops their antiparkinsonism drugs? It can cause neurological problems What are Anticonvulsant drugs for? mgmt of seizures/convulsion disorders by decreasing the excitability of nerve cells in the brain to either eliminate or decrease intensity & frequency of seizure activity What is a seizure? A periodic attack of disturbed cerebral function What are the main categories for Anticonvulsant drugs? Hydantoins (MOST COMMON)- DO NOT MIX with CNS depressants Dilantin (phenytoin) (MOST COMMON) Carboxylic Acid Derivatives Depakote (Valproic Acid)
- MORE Other not so common preparations? Diamox Tegretol Keppra Benzodiazapindes
Can any Anticonvulsant be used to treat all types of seizures? NO What is a Petit- Mal seizure? Absent seizures What is a Myoclonic seizure? can occur suddenly and are very forceful What is a Toni-Clonic seizure? Alternates contractions (tonic phase) & relaxation (clonic phase) What is a Partial or Focal seizure? occurs in a localized area of the brain What is a Simple seizure? no LOC What is a Psychomotor seizure? Often occurs in children 3 to adolescence What is Idiopathic Origin cause can't be identified (50% of seizures) What is Acquired origin Cause identified- EX: high fever, CVA, trauma, infection What is Epilepsy Permanent, recurrent seizure disorder Adverse reaction of anticonvulsant medications: Nystagmus Ataxia Slurred speech Skin rash N/V Gingival hyperplasia (inform dentist you are on Dilantin) Hepatotoxicity
Recent drug therapy VS for baseline Implement: ECG Ct scan CBC hepatic & Renal Fx test Serum plasm levels of anticonvulsants to monitor for toxicity PT ED: What to do before, during, and after the seizure Do not miss a dose of medication- could result in STATUS EPILEPTICUS Monitor blood levels often What are DMARDs? disease modifying anti-rheumatic drugs What are the different classes of drugs that fall under Skeletal Muscle, Bone & Joint Disorder Drugs? DMARDs Bone resorption inhibitors- bisphosphonates Skeletal muscle relaxants Uric acid inhibitors What do DMARDs do? decrease the autoimmune response- has an effect on Rheumatoid Arthritis (RA) What drugs are used to treat RA? NSAIDs Corticosteroids DMARDs What are DMARDs used to treat? RA, Crohn's disease, and Fibromyalgia What are the different DMARD drugs? Adalimumab (Humira) Infliximab (Remicade) Methotrexate (MTX) Sulfasalazine (Azulfidine) What are the adverse effects of DMARDs
Nausea Stomatitis Alopecia GI upset Mild pancytopenia Injection site irritation DMARD contraindications Hypersensitivity Renal insufficiency Liver Dx Alcohol abuse Pancytopenia Ht failure What do Bone Absorbing Inhibitors Bisphosphonates do? act on the bone to increase bone mineral density helping to reverse the progression of osteoporosis What are bisphosphonates used for? Osteoporosis and Paget's disease What are the adverse effects of Bisphosphonates? Nausea, diarrhea Increased or recurring bone pain H/A Dyspepsia and regurgitation Dysphagia Abdominal pain When are bisphosphonates contraindicated? For patients with hypocalcemia Delayed esophageal emptying Renal impairment What are the name of some Skeletal muscle relaxants? Baclofen (Lioresal) Carisoprodol (Soma) Methocarbamol (Robaxin) What are some adverse effects of muscle relaxants? euphoria, lightheadedness, dizziness, drowsiness, fatigue, muscle weakness
Secobarbital (Seconal) What are 2 examples of Nonbenzodiazepines? Eszopiclone (Lunesta) Zolpidem (Ambien) What are 2 examples of Benzodiazepines Temazapam (Restoril) Triazolam (Halcion) What are barbiturates used for? CNS depressant used to relieve anxiety and induce sleep. TX insomnia and produce sedation What are benzodiazepines used for? anxiety, in large doses can promotes sleep & relaxation What are nonbenzodiazepines used for? insomnia What are cholinesterase inhibitors? help stop acetylcholine from breaking down; they can help brain cells work better, but they dont stop or reverse the destruction of brain cells and loss of acetylcholine that occur in Alzheimer's disease They done prevent the disease from getting worse, but they may slow it down used to treat some symptoms of Alzheimer's disease or other types of dementia What causes dementia? cetylcholine neurotransmitter impairment What medications are used to improve or maintain memory in Dementia? Cholinesterase inhibitors & N-methyl-D-aspartate (NMDA) receptor agonist What % of Dementia is caused by Alzheimer's 60 - 80% Medication examples of Cholinesterase Inhibitors Donepezil (Aricept)
Rivastigmine (Exelon) Galantamine (Razadyne) Medication examples of NMDA Receptor Antagonist Memantine (Namenda) What do cholinesterase inhibitors do? a chemical that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine, thereby increasing both the level and duration of action of the neurotransmitter acetylcholine What do NMDA receptor antagonists do? decrease the excitability of neurotranmission caused by an excess of the amino acid glutamate in the CNS What are cholinesterase inhibitors used for? Treat dementia of Alzheimer's disease Adverse reactions to cholinesterase inhibitors anorexia, nausea, vomiting, diarrhea, dizziness, headache Characteristics of Parkinson's Disease Blank facial expression, Forward tilt to posture, slow monotonous slurred speech, tremor, short shuffle gait Sinemet (levodopa-carbidopa) - actions Used to treat Parkinson's Dopaminergic Drug Levodopa crosses the BBB (blood brain barrier) in small amounts→ converted into dopamine (pleasure) Levodopa if given with carbidopa, ↑ drug level that reaches the brain Carbidopa has no affect when given alone Sinemet is the combination of Levodopa/Carbidopa. Carbidopa-conserves more dopamine Levodopa-leaves more dopamine in the brain Sinemet (levodopa-carbidopa) - Toxic ADRs Face or eyelid twitching Tongue perfusion Face grimacing
Over 20 toxic risk-hold med and notify HCP Routine blood tests Take med same time daily same time narrow therapeutic range Early signs to report to HCP for toxicity Ataxia (unsteady gait) Slurred speech Hand tremor Phenytoin (Anticonvulsant Drugs) - ADR ADRs
- Nystagmus-involuntary movement of the eyeball Ataxia-loss of control of voluntary movements, mainly gait Slurred speech Skin Rash, fatigue, and dyspnea (priority) N/V Gingival hyperplasia-overgrowth of gum tissue (gums bleeding is normal). Important to inform the dentist that you are on Phenytoin (Dilantin). Hepatotoxicity- liver toxic Phenytoin (Anticonvulsant Drugs) - Contraindications Contraindications: hypersensitivity, heart problems, pregnancy, and lactation. DO NOT mix with other CNS depressants, e.g., narcotics, alcohol Precautions: liver & kidney disease, neurological disorders.' Interactions w/ different drugs. It is important to talk with your PHCP about other medications to see if an interaction will occur. No stopping abruptly Phenytoin (Anticonvulsant Drugs) - adverse reactions Drowsiness: common ADR→ assist with ambulation to prevent falls from occurring. blood dyscrasias (abnormal) → lab tests done routinely to monitor and watch for any problems. Hypersensitivity, SJS, hyperglycemia, gingival hyperplasia/gingivitis Signs of toxicity: slurred speech, ataxia, lethargy, dizziness, N/V. Allopurinol (Uric Acid Inhibitors) - uses Gout = A form of arthritis characterized by severe pain, redness, and tenderness in joints. Decreased the production of uric acid→ ↓the level of serum uric acid and the deposits of urate crystals in the joints. = uric acid reducer Prevent acute attacks of gout (prophylaxis)= prevents gout Allopurinol (Uric Acid Inhibitors) - precautions Precautions: avoid clients with kidney and liver disease Not a pain reliever
Allopurinol (Uric Acid Inhibitors) - ADR Stop taking if seen mild rash-notify HCP Increase fluids=to excrete uric acid to prevent kidney stones May take a few months to work Monitor labs- liver, renal function Alendronate Bisphosphonates (Fosamax) - actions Act on the bone by inhibiting normal & abnormal bone resorption→ Treats osteoporosis Osteoporosis (loss of bone mass) → reverses progression of the disease Decrease risk for fracture related to osteoporosis & Paget's disease. Alendronate Bisphosphonates (Fosamax) - ADR Nausea, diarrhea Increased or recurrent bone pain Headache Dyspepsia (GI discomfort), acid regurgitation, dysphagia Abdominal pain Alendronate Bisphosphonates (Fosamax) - Contraindication Hypocalcemia Delayed esophageal emptying Renal Impairment MONITOR BONE DENSITY Alendronate Bisphosphonates (Fosamax) - Patient teaching TAKE WITH 8oz GLASS OF WATER HAVE PATIENT SIT UP 30 MIN AFTER MED ADMINISTRATION TO PREVENT ESOPHOGITIS= SCARRING OF THE ESOPHOGUS Donepezil (Aricept) - uses Cholinesterase inhibitors Drugs used to treat Alzheimer's Disease does not cure the disease but slows the progression of dementia. treat early and moderate stages of dementia related to AD used to strengthen neurotransmission and improve or maintain memory in those with dementia All prevents the breakdown of acetylcholine, ↑levels of acetylcholine→ ↑communication between nerve cells Donepezil (Aricept) - ADR Anorexia, nausea, vomiting, diarrhea Dizziness and headache
DO NOT mix with CNS depressants→ ↑sedation effects Fluoxetine (Prozac) SSRI - Uses Safe, larger therapeutic index, less ADRs, takes 2- 3 weeks to be effective Selective Serotonin Reuptake Inhibitors 1st choice for depressive disorders, OCD, Bulimia nervosa. Off label: PTSD, GAD, migraines, DM neuropathy, Raynaud's disease Fluoxetine (Prozac) SSRI - ADR Somnolence (sleepiness or drowsiness) vs. insomnia (trouble falling or staying asleep), dizziness, headache, tremors, weakness, constipation, dry mouth, urinary retention Serotonin Syndrome Fluoxetine (Prozac) SSRI - Contraindications 2 weeks difference between starting SSRI & discontinuing MAOI. Should not be taken with grapefruit or its juice. Do not take with st johns wart or mix with other anti-depressants Mechanism of action of levodopa and carbidopa Number one drug for Parkinson's disease Levodopa leaves more dopamine in the brain Carbidopa conserves more dopamine Dopamine is the "happy hormone" "you can't jump rope if you don't have dope" Levodopa - cross the BBB in small amounts→ converted into dopamine. If given with carbidopa, ↑ drug level that reaches the brain. Carbidopa - has no effect when given alone Neurotransmitter imbalances in Parkinson's degenerative disorder, deficiency in dopamine and excess acetylcholine resulting in loss of cells in the substantia nigra. Neurotransmitter imbalances in Alzheimer's Reduction in acetylcholine. Amyloid plaques destroy neurons Neurotransmitter imbalances in Dementia caused by Alzheimer's Neurotransmitter imbalances in Depression Low noradrenaline, dopamine, and serotonin.
Neurotransmitter imbalances in Schizophrenia very high dopamine and glutamate Neurotransmitter imbalances in Anxiety low GABA Extrapyramidal signs and symptoms. Pseudo parkinsonism-stooped posture, shuffling gait Acute dystonia-facial grimacing, involuntary upward eye movement Akathisia-restless, trouble standing still, paces the floor Tardive dyskinesia-protrusion and rolling of the tongue, sucking and smacking movements of the lips Expected outcomes and common ADRs among patients taking AntiParkinson's drugs. ADRS Dry mouth Dysphagia Anorexia N/V Abdominal pain Constipation Hard tremor Increase headache Dizziness MOST SERIOUS Choreiform movements-involuntary twitching Dystonic movements - face spasms Serious ADRs for patient's taking hydantoins (phenytoin). Precautions: liver & kidney disease, neurological disorders Early signs to report to HCP for toxicity Ataxia (unsteady gait) Slurred speech Hand tremor Nursing considerations for patients at high risk for developing seizures, (seizure precaution management). Turn client to side Prepare for suctioning NEVER insert anything in the mouth! NEVER restrain or "Hold down arms Call for help & Stay with Client #1 Drug = STOP the Seizure Lorazepam (brand: Ativan) Diazepam (brand: Valium) Rectal or IV
Patient education for Phenytoin long lasting anticonvulsant, inform dentist is using this medication. Need to be aware of ADRs that can occur with particular drug. Patient education for Bisphosphonates helps maintain Ca in bones, may lead to osteoporosis Administer bisphosphonate with a glass of water in upright position Patient education Antigout Take each dose with a full glass of water. To reduce your risk of kidney stones forming, drink 8 to 10 full glasses of fluid every day, unless your doctor tells you otherwise. Take with food if allopurinol upsets your stomach. You may have gout attacks more often when you first start taking allopurinol. Common ADRs in patients taking central nervous system acting skeletal muscle relaxer. Drowsiness. Dizziness. Agitation. Irritability. Headache. Nervousness. Dry mouth. Decreased blood pressure. Medications for treatment of rheumatoid arthritis. Disease-Modifying Antirheumatic Drugs (DMARDS) adalimumab (Humira) infliximab (Remicade) methotrexate (MTX) sulfasalazine (Azulfidine) abatacept (Orencia) Nursing considerations before, during and after giving anti-anxiety medication such as benzodiazepines or barbiturates. Assess family history, obtain recent drug therapy, baseline VS, Review labs, obtain serum plasma levels Drowsiness common ADR→ assist with ambulation to prevent falls from occurring Normal values of phenytoin level 10 - 20 mcg/dl is the therapeutic range Anything over 20+ is toxic
Below 10 report to HCP for seizure risk Expected time frame of the therapeutic effects of anti-depressant drugs. 2 - 4 weeks Contraindications and serious ADRS of patients taking Antipsychotic drugs and ADRs that need immediate reporting to HCP. Sedation, headache, hypotension Dry mouth, nasal congestion Photosensitivity and photophobia Agranulocytosis with typical antipsychotics Hyperactivity, paranoid reactions, agitation and confusion EXTRAPYRAMIDAL SYNDROME (EPS) Serious: Neuroleptic malignant syndrome and Extrapyramidal symptoms (Call HCP) - discontinue immediately Precautions to be considered among patients taking anti-anxiety medications. Do not change dose unless prescribed, no driving or performing other hazardous activities, rise slowly, no alcohol, do not discontinue abruptly Patient education on the need to taper drugs such as anti-anxiety drugs. Do not discontinue use of the drug abruptly because withdrawal symptoms may occur. To prevent withdrawal, gradual decrease in dosage is done when it comes to long term use, e.g., > 3 months. Withdrawal symptoms occurrence ranges from 5 to 28 days with peak at the second week. Food that are high in tyramine levels. Aged cheeses Pepperoni Wine Pickled foods Yogurt Coffee chocolate Other Non-psychiatric illness indication of antidepressants. Important: DM neuropathy neuropathic pain chronic neuropathic pain Others:
