And Pharmacologic Drug
Class
Action Drug Example Indications
(Areas of Use)
Adverse Reactions Side Effects Nursing Implications &
Patient Education
Antiparkinson
Dopamine
replacement
Review Nursing
Process pg. 234 &
Prototype pg. 233
Transmission of
levodopa to brain cells
for conversion to
dopamine; carbidopa
blocks the conversion
of levodopa to
dopamine in the
intestine and
peripheral tissues.
Carbidopa-
levodopa
Treatment of
Parkinson’s
Disease –
reduces tremors
and rigidity
Orthostatic
hypotension
Urinary retention
Hallucinations/
Psychosis & Suicidal
Ideations
Palpitations or
Dysrhythmias
Involuntary movements
Blood Dyscrasias
Dry mouth
Dizziness
Urine discoloration
Nervousness/Anxiety
Urinary Retention
Blurred Vision
Depression
GI Changes/Anorexia
Insomnia/Restlessness
Monitor patients for changes in mood or behavior. Assess
vitals; GI/GU Function. Monitor CBC; liver and renal
function; Safety Precautions; Monitor PD Symptoms.
Administer on time!
Assess nutritional status.
Cautions:
Patients with severe cardiac, hepatic, or renal impairment;
chronic mental illness.
Patients with narrow angle glaucoma
Patient Teaching –
If taking levodopa only – avoid foods high in protein. Take
on empty stomach – OK to take with food if GI upset is
problematic. Do not discontinue abruptly. Anticipate the
need to monitor labs. Sugar free candy – to manage dry
mouth. Take at the same time every day. Avoid MAOIs –
causes BP changes. Anticipate urine discoloration. Monitor
for changes in function – keep a diary of symptoms. Family
to monitor and report behavior changes. Report changes in
urinary and bowel function. Consider use of nutritional
supplements if intake if poor.
Catechol-O-
methyltransferase
(COMT) inhibitor
Review Nursing
Process pg. 234
Blocks enzyme that
inactivates DA.
COMT inhibitors
increase the amount of
levodopa
concentration in the
brain.
tolcapone
Lessens the
“wearing off”
effects of
levodopa
Elevated liver enzymes
- fatal hepatotoxicity
Orthostatic
hypotension
Dyskinesia
Dizziness
Drowsiness
Headache
Confusion
N/V/D
Monitor vital signs and liver enzymes.
Safety precautions.
Patient Teaching –
Given w/carbidopa/levodopa. Avoid ETOH
intake. Avoid driving. Change positions slowly.
s/s of liver failure – jaundice, GI Upset; ABD
pain. Anticipate need for routine lab monitoring.
Report involuntary muscle movements. Do not
discontinue abruptly.
Acetylcholinesterase
inhibitor
Review Nursing
Process pg. 238/244
& Prototype pg.
239/243
Increases
availability of ACh
at the neuron
receptors.
Cholinergic
Agonists
Wet & Leaky!!
Rivastigmine
Pyridostigmine
Management of
Alzheimer’s to
improve
cognitive
function.
Improves
strength in
Myasthenia
Gravis
Orthostatic
hypotension
Bradycardia/HTN
Heart failure/MI
Seizures
COPD/Bronchospasm
Increased
Secretions –
drool/tears/sweat
N/V/D/Anorexia
Peptic Ulcers
Blurred Vision
Headaches
Urinary
Incontinence
Monitor: Liver enzymes, BUN, Creatinine, vital signs; I/O
Multiple drug interactions!!
Atropine is the antidote for Cholinergic Crisis.
Use Cautiously:
Seizures; asthma; bradycardia
Contraindications: Peptic ulcer disease; GI obstructions
Patient Teaching –
Rivastigmine – not a cure; available in patch form if
needed. Apply in a location that patient cannot remove and
rotate sites.
Pyridostigmine – Discuss dose adjustments with provider.
Notify prescribers of medication changes to avoid
interactions. Taken before meals.
Both meds – Change positions slowly. Increase fluid
intake. Take both medications at the same time daily as
prescribed. Do not discontinue abruptly. Report excessive
urination or increased bowel activity. Anticipate need for
lab monitoring. Nutritional assessment and consider
supplements as needed. Monitor BP and HR. Report
shortness of breath or difficulty breathing.
Centrally Acting
Muscle Relaxant
Review Nursing
Process pg. 252 &
Prototype pg. 251
Blocks transmission
of muscle pain
impulses to the
brain.
CNS Depressant
cyclobenzaprine
Short-term
treatment of
muscle spasm
(7-14 days)
Angioedema
Resp. Depression
MI
Seizures
Drowsiness
Dizziness
Decreased Resp.
Dry Mouth
Headache
Confusion
Hypotension
Tachycardia
Blurred vision
Hangover Effect
Constipation
Urinary Retention
Safety precautions! Monitor V/S
Contraindications:
Cardiac patients, diabetes,
hyperthyroidism, hepatic dysfunction.
Patient Teaching –
Avoid ETOH, no driving. Changes
positions slowly. Do not take long-term –
potential for addiction. Avoid other CNS
depressant. Dry mouth management.
Avoid other OTC – read labels (cold
remedies). Report changes in bowel or
bladder function. Constipation
prevention/management. Taper if being
discontinued after long-term use. Report
excess sedation to provider.
