NCMA216 | WEEK 7: DRUGS ACTING 5.

Anti - parkinsonism Agents SUBSTANCES EFFECT CLINICAL EXAMPLE

ON THE Central and Peripheral NEUROTRANSMITTERS Acetylcholine Excitatory or Alzheimer disease -
Nervous System ADRENALINE/EPINEPHRINE (aCh) inhibitory is associated with a
- fight or flight decrease in
Definition of Terms - Produced in stressful situations. Increases acetylcholine-
ACTION POTENTIAL - this is a rapid change in the secreting neurons.
heart rate and blood flow, leading to physical
membrane potential that explains how impulses Myasthenia gravis -
boost and heightened awareness.
weakness of skeletal
are conducted along the nerves NORADRENALINE/NOREPINEPHRINE
muscles
ANXIETY - feeling of fear, tension or apprehension - concentration
from known or unknown reasons - Affects attention and responding actions in the Norepinephrine Excitatory Cocaine and
DEPRESSION - affective disorders characterized brain. (ne) amphetamines
by extreme sadness, hopelessness and - Contract blood vessels, increasing blood flow. increase the release
disorganization GABA and block the
MANIA - characterized by period of extreme over - calming reuptake of
activity and excitement - Calms firing nerves in the central nervous norepinephrine
NEUROTRANSMITTERS - chemicals in the nervous system. Serotonin Generally it is involved with
system that help in the transmission of impulses - High levels improve focus, low levels cause inhibitory mood, anxiety, and
PALLIATIVE TREATEMENT - control of signs and anxiety. sleep induction.
symptoms of the disease Levels of serotonin
- Also contributes to motor control and vision.
PARKINSON'S DISEASE - degenerative disease of are elevated in
ACETYLCHOLINE
the nervous system characterized by lack of schizophrenia
- learning
neurotransmitter called Dopamine - Involved in thought, learning, and memory. Dopamine Excitatory or Parkinson disease
SCHIZOPHRENIA - most common type of Activates muscle action in the body. Also inhibitory (depression of
psychotic disorder that may cause impairment of associated with attention and awakening. voluntary motor
function of an individual in the society DOPAMINE control) results from
SEIZURE - abnormal and excessive impulse - pleasure destruction of
transmission in the brain - Feelings of pleasure, also addiction, dopamine-secreting
SYNAPTIC TRANSMISSION - conduction of movement and motivation. People repeat neurons.
impulses across the junction between neurons behaviors that lead to dopamine release.
SEROTONIN Gamma- Inhibitory Drugs that increase
Classifications of Drugs Affecting the CNS: aminobutyric GaBa function have
- mood
1. Anxiolytic and Hypnotic Agents acid (GaBa) been used to treat
- Contributes to well-being and happiness.
2. Antidepressant Agents epilepsy (excessive
Helps sleep cycle and digestive system
3. Psychotherapeutic Agents discharge of
regulation. neurons).
4. Anti - seizure Agents - Affected by exercise.

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 Anxiolytic and Hypnotic Agents - can cause sedation, hypnosis, anesthesia, - Examples: Diazepam, Lorazepam,
and, in extreme cases, coma. Clonazepam
STATES AFFECTED BY ANXIOLYTIC AND indicated for the relief of the signs and
- Contraindications and Cautions:
HYPNOTIC DRUGS symptoms of anxiety and for sedation, - Clients with allergy to benzodiazepines,
Anxiety - is a feeling of tension, nervousness, insomnia, pre-anesthesia, and the treatment psychosis, clients with acute narrow angle
apprehension, or fear that usually involves of seizures glaucoma, shock, acute alcohol intoxication
unpleasant reactions to a stimulus, whether actual - Parenteral forms: used for the treatment of which may exacerbate the depressant effects
or unknown. acute manic reactions and many forms of of the drugs.
- signs and symptoms of the sympathetic seizures - pregnancy as this is known to possible cause
stress reaction which may include sweating, Contraindications and Cautions: cleft lip or palate, inguinal hernia, cardiac
fast heart rate, rapid breathing, and elevated - pregnant women defects, microcephaly or pyloric stenosis if
blood pressure. - clients with hepatic and renal dysfunction taken during the first trimester.
SEDATION - loss of awareness and reaction to Adverse Effects:
environmental stimuli - elderly or debilitated patients and those with
- CNS depression paradoxical excitement hepatic and renal functions
▪ condition may be desirable in patients who anxiety and hallucinations.
are restless, nervous, irritable, or Adverse Effects:
- Gastrointestinal signs and symptoms like
overreacting to stimuli. - Sedation
nausea, vomiting, constipation, diarrhea and
HYPNOSIS - the extreme state of sedation, in - Drowsiness Depression lethargy
epigastric pain.
which the person no longer senses or reacts to - anticholinergic effects like drying of mouth
- Cardiovascular effects include bradycardia,
incoming stimuli. hypotension and syncope - Constipation
Drugs for anxiety are called Anxiolytic Drugs or BENZODIAZEPINES: used as anxiolytics - Orthostatic hypotension urinary retention
Sedative Hypnotic Agents Benzodiazepines - the most frequently used - Dysrhythmias
➢ Barbiturates anxiolytic drugs, prevent anxiety without causing - blood dyscrasias phlebitis
➢ Benzodiazepines much associated sedation. - Withdrawal syndrome may occur with abrupt
➢ Non - Benzodiazepines - In addition, they are less likely to cause cessation characterized by nausea, headache,
Mechanism of action - to enhance the effect of physical dependence than many of the older vertigo, malaise and headache.
GABA (Gamma Amino Butyric Acid) OTHER ANXIOLYTIC/HYPNOTIC DRUGS
sedatives/hypnotics that are used to relieve
BARBITURATES used as anxiolytic/hypnotics anxiety. Other drugs are used to treat anxiety or to produce
BARBITURATES - were once the sedative/hypnotic Therapeutic Actions and Indications: hypnosis that do not fall into either the
drugs of choice. benzodiazepine or the barbiturate group.
- indicated for the treatment of the following
- adverse effects greater with these drugs than Antihistamines (promethazine - Phenergan,
conditions: anxiety disorders, alcohol
with newer sedative/ hypnotic drugs diphenhydramine - Benadryl) can be very sedating
withdrawal, hyperexcitability and agitation,
Examples: in some people.
and preoperative relief of anxiety and tension
- Phenobarbital (Luminal), Secobarbital
to aid
(Seconal) and Amobarbital (Amytal Sodium)
Therapeutic Actions and Indications:
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 ▪ used as preoperative medications and Depression is a very common affective disorder 3. regulate receptor sites and the breakdown of
postoperatively to decrease the need for involving feelings of sadness that are much more neurotransmitters, leading to an
narcotics. severe and longer lasting than the suspected accumulation of neurotransmitter in the
buspirone (BuSpar) - a newer antianxiety agent, precipitating event, and the mood of affected synaptic cleft.
has no sedative, anticonvulsant, or muscle relaxant individuals is much more intense. ANTIDEPRESSANTS MAY BE Classified into three
properties, - Sad or depressed mood groups
▪ reduces the signs and symptoms of - Loss of pleasure or interest 1. Tricyclic antidepressants (TCAs)
anxiety without many of the CNS effects - Insomnia (or sometimes hypersomnia) 2. MAOIs
Beta Blockers - Propranolol/Metoprolol - Anorexia (or sometimes hyperphagia) 3. Selective serotonin reuptake inhibitors
▪ Decreasing sympathetic effect to lessen (SSRIs)
- Mental slowing and loss of concentration
signs and symptoms of anxiety Other drugs that are used as antidepressants
- Feelings of guilt, worthlessness, helplessness
zolpidem - Used to treat insomnia, metabolized in similarly increase the synaptic cleft concentrations
the liver and excreted in the urine - Thoughts of death and suicide and/or overt of these neurotransmitters
NURSING CONSIDERATIONS suicidal behavior 1. TRICYCLIC ANTIDEPRESSANTS (TCAS)
- Do not administer intraarterially because of - Symptoms must be present most of the day, - Tricyclic antidepressants block the neuronal
possible serious arteriospasm and gangrene nearly every day, for at least 2 weeks reuptake of 2 monoamine transmitters:
may develop Depression occurs due to decreasing norepinephrine (NE) and serotonin.
neurotransmitters, norepinephrine, serotonin and
- Do not mix IV drugs with other drugs - leads to accumulation of these
dopamine.
- Give parenteral forms if oral forms are not neurotransmitters in the synaptic cleft and
Decreasing neurotransmitter in the limbic system
feasible and switch to oral which is safer increased stimulation of post synaptic
which may happen due possibly to:
- Give IV drugs slowly to avoid hypotension receptors
1. Overused of neurotransmitters
effects Examples:
(Norepinephrine, Dopamine and Serotonin)
- Promote safety measures - Amitriptyline (Elavil)
2. Increase effect of Mono Amine Oxidase
- Monitor hepatic and kidney function (MAO) enzyme - Imipramine (Tofranil)
- Taper dose of drugs gradually 3. Increase reuptake of neurotransmitter back - Clomipramine (Anafranil)
- Provide comfort measures to help patient to presynaptic neuron - Nortriptyline (Aventyl)
tolerate the effects of drugs ANTIDEPRESSANT DRUGS used today counteract - Amoxapine (Asendin)
- Provide thorough health teaching about drug the effects of neurotransmitter deficiencies in - TCAs can cause confusion in the elderly.
effects and adverse reactions three ways. (alter the concentration of - Common side effects include anticholinergic
- For overdose of Benzodiazepine - Flumazenil neurotransmitters) effects and weight gain.
must be ready as its antidote. 1. inhibit the effects of MAO, leading to Adverse Effects: CASH
increased NE or 5HT in the synaptic cleft. C - Cardiovascular effects
ANTIDEPRESSANT AGENTS 2. block reuptake by the releasing nerve, A - Anticholinergic effects
leading to increased neurotransmitter levels S - Sedation
DEPRESSION AND ANTIDEPRESSANTS
in the synaptic cleft. H- Hypotension or Hypertension
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2. MONOAMINE OXIDASE INHIBITORS (MAOIS) Example: ▪ Neuromuscular: e.g. Myoclonus, tremor,
- inactivate the enzyme MAO to increase the - Fluoxetine (Prozac), the first SSRI; citalopram grinding teeth, rhabdomyolysis
neurotransmitters in the synapses. (Celexa); duloxetine (Cymbalta) ▪ Autonomic instability: e.g. Fever,
Examples: - newest SSRI; escitalopram (Lexapro), sweating, hyperthermia, tachycardia
- Isocarboxazid (Marplan) fluvoxamine (Luvox); paroxetine (Paxil); and blood pressure changes
- Phenelzine (Nardil) sertraline (Zoloft). ▪ Mental status changes: e.g. Agitation,
- Tranylcypromine (Parnate) SSRIS: Action/Indications: confusion delirium, hallucinations
- action of SSRIs blocking the reuptake of 5HT WHEN SSRIs DON’T WORK:
- Selegiline (Emsam)
increases the levels of 5HT in the synaptic Serotonin- Norepinephrine-
2.2 MONOAMINE NEUROTRANSMITTERS
cleft and may contribute to the antidepressant norepinephrine dopamine reuptake
- After neurotransmitters send a message in the reuptake inhibitor (SNRI) inhibitor (NDRI)
brain, they are absorbed by a protein called and other effects attributed to these drugs.
Venlafaxine (Effexor) Bupropion (Wellbutrin)
monoamine oxidase (monoamine transporter) - Indicated for the treatment of depression,
(smoking cessation)
- If too many monoamines are absorbed, OCDs, panic attacks, bulimia, posttraumatic
chemical imbalance occurs in the brain. stress disorders, social phobias, and social Duloxetine (Cymbalta) - treat anxiety and certain
Contraindication: anxiety disorders types of chronic pain (peripheral neuropathy)
- Tyramine is the building block of SSRIS: Patient Education
norepinephrine and is commonly found in - Effects take 10 to 21 days Psychotherapeutic Agents
foods that are aged. - Wean SSRIs when discontinuing them.
MENTAL DISORDERS AND THEIR
❖ MAOIs inhibit monoamine oxidase, so the - Give with food at bedtime to minimize CLASSIFICATION
body cannot rid itself of excess anticholinergic effects, unless sleep is - Mental disorders were once attributed to
norepinephrine. disturbed environmental influences and life experiences
❖ Raised levels of norepinephrine may lead to a - may increase suicidal tendency early in the such as poor parenting or trauma.
hypertensive crisis after consumption of treatment. - thought to be caused by some inherent
certain types of tyramine-containing foods or SSRIS: Side Effects dysfunction within the brain that leads to
drinks. - Insomnia, anxiety, nervousness abnormal thought processes and
3. Selective serotonin reuptake inhibitors - Headache responses.
(SSRIS) - Sexual dysfunction - Most theories attribute these disorders to
- the newest group of antidepressant drugs, - Weight gain, nausea, Gl distress, dry mouth some sort of chemical imbalance in specific
specifically block the reuptake of serotonin, SEROTONIN SYNDROME areas within the brain.
with little to no known effect on NE. - s/s: Sweating, agitation, confusion, Schizophrenia - Characteristics: hallucinations,
- Do not have the many adverse effects hyperreflexia, hallucinations, fever, tremor, paranoia, delusions, speech abnormalities, and
associated with CAs and MAOls, they are a incoordination, myoclonus, delirium, seizures, affective problems.
better choice for many patients. coma; can lead to death ▪ prevents affected individuals from
- Life threatening: Autonomic Instability functioning in society.

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Mania - characterized by periods of extreme EXAMPLES: - Risperidone is used frequently to treat
overactivity and excitement. Typical antipsychotics Atypical antipsychotics irritability and aggression associated with
Bipolar disorder - involves extremes of depression Chlorpromazine Aripiprazole (Abilify) autistic disorders in children and adolescents
alternating with hyperactivity and excitement. (Thorazine) Adverse Effects: ASHE
Narcolepsy - daytime sleepiness and sudden Fluphenazine (Prolixin) Clozapine (Clozaril), - These are the most common adverse effects
periods of loss of wakefulness. Haloperidol (Haldol) Olanzapine (Zyprexa, of antipsychotic drugs which are manifesting
▪ problems with stimulation of the brain by the Zyprexa Zydis) more in typical antipsychotic than atypical
reticular activating system (RAS) Loxapine (Loxitane) Paliperidone (Invega) antipsychotic drugs
Attention-deficit disorders - conditions Perphenazine (Trilafon) Quetiapine (Seroquel,
A - Anti cholinergic effect
Seroquel XR)
characterized by an inability to concentrate on one S - Sedation
Prochlorperazine Risperidone (Risperdal,
activity for longer than a few minutes and a state of H - Hypotension
(Compazine) Risperdal Conta)
hyperkinesis. E - Extra pyramidal Symptoms
ANTIPSYCHOTIC DRUGS EXTRAPYRAMIDAL MOTOR SYMPTOMS (EPS)
Chlorpromazine and haloperidol can cause
TYPICAL ANTIPSYCHOTIC DRUGS - block
prolonged QT interval. They can also cause
dopamine receptors, preventing the stimulation of
galactorrhea, gynecomastia and menstrual
the postsynaptic neurons by dopamine.
irregularities.
▪ depress the RAS, limiting the stimuli coming Examples:
into the brain.
- Chlorpromazine, one of the older
ATYPICAL ANTIPSYCHOTICS - block both
antipsychotics, is also used to decrease
dopamine and serotonin receptors.
preoperative restlessness; to control nausea,
▪ dual action may help to alleviate some of the
vomiting, and intractable hiccups.
unpleasant neurological effects and - Use of anticholinergic drugs helps decrease
- Haloperidol is frequently used to treat acute
depression associated with the typical pseudoparkinsonism symptoms, acute
psychiatric situations and is available for
antipsychotics dystonia, and akathisia
intravenous (IV)
Typical or Atypical USED IN: - acute dystonia is treated with anticholinergic
- Aripiprazole, one of the newer atypical
- Schizophrenia (primary use) or antiparkinsonism drugs such as
antipsychotics, has been found to be effective
- Bipolar disorder (manic phase) benztropine (Cogentin), benzodiazepine
in treating schizophrenia, major depressive
- Delusional disorders, depressive psychoses, lorazepam (Ativan)
disorder, and bipolar disorders
and drug-induced psychoses - Benzodiazepines, calcium channel blockers,
- Olanzapine and ziprasidone are also used for
- Initial effects may be seen in 2 days, but 2 - 4 or beta blockers - decreasing tardive
bipolar disorders and parenterally to treat
weeks are needed for full effect dyskinesia.
acute agitation.
Antipsychotic medications should not be used to - Akathisia is best treated with a
- Quetiapine is also approved for short-term
treat dementia-related psychoses in the elderly as benzodiazepine (e.g. lorazepam) or a beta
treatment of acute manic episodes associated
they can increase the risk of mortality. blocker (e.g., propranolol).
with bipolar disease.

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NEUROLEPTIC MALIGNANT SYNDROME MOOD STABILIZERS - Ensure that the patient have adequate intake
- is a rare but potentially fatal condition - are used to treat bipolar affective disorder. of salt and fluid
- Symptoms: muscle rigidity, sudden high fever, - Lithium was the first drug used to manage this - Monitor closely especially during the initial
altered mental status, blood pressure disorder. stage of therapy
fluctuations, tachycardia, dysrhythmias, - reduces excitatory (dopamine and glutamate) - Arrange for small and frequent meals with
seizure acute renal failure, respiratory failure, but increases inhibitory (GABA) sugarless lozenges for drying of mouth
and coma. neurotransmission - Provide safety measure like siderails and
Treatment: ▪ has a calming effect but may cause some assistance with ambulation to prevent
- Immediately stop antipsychotic medication memory loss and confusion. potential injury
- Dantrolene direct act in muscle relaxant for ▪ controls any evidence of flight of ideas and - Offer support and encouragement to help
rigidity and elevated temperature hyperactivity. patient cope with drug regimen
- Bromocriptine dopamine receptor agonist to ▪ Takes 2-3 weeks before lithium is effective,
relieve CNS toxicity psychotic patients should be put on ANTI - SEIZURE AGENTS
ANTIPSYCHOTIC DRUG: Nursing Considerations antipsychotic while waiting NATURE SEIZURES
- Do not allow patients to crush or chew the Lithium (Lithobid), carbamazepine (Tegretol), EPILEPSY is characterized by seizures that result
tablet as it decreases absorption of the drugs valproic acid or divalproex (Depakote, Valproate), from sudden discharge of excessive electrical
- Monitor for orthostatic hypotension and lamotrigine (Lamictal) are currently first-line energy from nerve cells in the brain
- Consider warning the patient or the patient's drugs for bipolar disorder
guardian on the risk of tardive dyskinesia • collection of various syndromes, all of
LITHIUM TOXICITY
- Monitor CBC to check signs of bone marrow which are characterized by seizures
- Sedation, confusion, severe tremor, CONVULSION tonic-clonic muscular reaction to
suppression
drowsiness, seizures excessive electrical energy arising from nerve cells
- Provide positioning of legs to decrease
- N/V, diarrhea in the brain
discomfort of dyskinesia o Provide sugarless
- Muscular weakness, loss of coordination ANTIEPILEPTICS, OR ANTISEIZURE AGENTS -
candies for drying of the mouth
- Encourage the patient to void before taking the - side effects of lithium - dry mouth, thirst, drugs that are used to manage epilepsy
dose if urinary retention is a problem increased urination (loss of water and - are sometimes referred to as anticonvulsants
- Provide safety measures such as side rails and sodium), weight gain, bloated feeling, metallic - drug of choice for any given situation depends
assistance in ambulation if there are CNS taste, and edema of the hands and ankles. on the type of epilepsy
effects - Therapeutic range: 0.4-1.3 mEq/L (book: 0.6- - Seizures were formerly categorized as grand
- Provide vison examination to determine ocular 1.2) mal (tonic-clonic seizures) or petit mal
changes o Conduct thorough health teaching - Toxic levels: > 1.5 mEq/L (absence seizures)
on the effects and adverse effects of the drugs Nursing Considerations on Administration of - International Classification of Seizures; two
- Offer support and encouragement to help Lithium main categories: generalized or partial
patients cope with their drug regimen - Daily monitoring of lithium serum levels seizures
- Give the drug with food to alleviate Gl irritation

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TYPES OF SEIZURE - used in the emergency treatment of Examples:
Tonic-clonic seizures - involve dramatic tonic- status epilepticus (a continuous seizure ▪ Ethosuximide the drug of choice for Petit
clonic muscle contractions, loss of consciousness, state). Mal or Absence Seizure with relative few
and a recovery period characterized by confusion Try one, then another, before together adverse effects than other anti-seizure
and exhaustion. - Treatment of epilepsy should begin with a drugs. Methosuximide - should be
Absence seizures - involve abrupt, brief (3- to 5- single drug, increasing the dosage until reserved for the treatment
second) periods of loss of consciousness. seizures are controlled or adverse effects Valproate or Valproic Acid - reduces electrical
Myoclonic seizures - involve short, sporadic become problematic. activity by suppressing calcium influx and
periods of muscle contractions that last for several - Generally, a second alternative should be tried enhancing GABA effects
minutes, often secondary seizures. as monotherapy before considering ▪ drug of choice for treating myoclonic
Febrile seizures - are related to very high fevers combination therapy. seizure
and usually involve tonic-clonic seizures. - Choice of drug treatment depends on the Other anti-seizure drugs include
(frequently occur in children) seizure type, the drug's characteristics, and Carbamazepine, Gabapentin, Lamotrigine,
Jacksonian seizures - are seizures that begin in the patient's preferences. Levetiracetam. Topiramate, pregabalin
one area of the brain and involve one part of the HYDANTOINS - stabilize nerve membranes ▪ Some of these drugs used for partial
body; can develop into generalized tonic-clonic throughout the CNS directly by influencing ionic seizure
seizures channels in the cell membrane, thereby decreasing ▪ used for treatment of neuropathic pain
Psychomotor seizures - are complex seizures excitability and hyperexcitability to stimulation like Carbamazepine is used for treatment
that involve sensory, motor, and psychic of Trigeminal Neuralgia.
▪ Example: Phenytoin (Dilantin), Ethotoin
components. ANTICONVULSANT/ ANTISEIZUREDRUGS
(Peganone), and Fosphenytoin (Cerebyx)
▪ Usually begin with a loss of BARBITURATES - enhanced GABA effect highly Nursing Considerations:
consciousness, and patients have no sedating and they may cause severe - Administer the drug with food to alleviate Gl
memory of the event. CNS depression. irritations
Status epilepticus - most dangerous of seizure Monitor CBC to detect possible bone marrow
▪ used for Generalized Tonic - Clonic -
conditions, rapidly recur again and again with no suppression
Seizure
recovery between seizures.
Benzodiazepines - enhanced GABA effect. - Evaluate therapeutic blood level to prevent
ANTICONVULSANT/ ANTISEIZUREDRUGS
Indications: For status epilepticus and benign toxicity
- inhibit neuromuscular transmission; febrile seizure. - Provide safety measures
prescribed for: ▪ Diazepam is not used for long term - Provide thorough health teaching, including
- long-term management of chronic treatment of seizure. drug name, prescribed dosage and avoidance
epilepsy (recurrent seizures) ▪ Clonazepam is good for treatment of of adverse effects
- short-term management of acute isolated Petit Mal Seizure and Myoclonic Seizure - Suggest that clients wear Medic Alert Bracelet
seizures not caused by epilepsy, such as Succinimides - enhanced effect of GABA, an to alert health care workers about the use of
seizures after trauma or brain surgery inhibitory neurotransmitter. anti-epileptic drugs

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- Offer support and encouragement to help the special receptors in the parasympathetic nervous - amantadine, an antiviral drug with dopamine
patient cone with the drug regimen system. activity
▪ used to treat all forms of parkinsonism. - bromocriptine, dopamine agonist;
Anti - Parkinsonism Agents
▪ most commonly used in the early stages of stimulating the nerves that control movement.
EXCESSIVE EXCITATION caused by cholinergic Parkinson's disease - selegiline, a type B monoamine oxidase (MAO)
activity creates the movement disorders of Examples: Diphenhydramine (Benadryl), inhibitor.
Parkinson's disease Benztropine (Cogentin), Biperiden (Akineton) ADD CARBIDOPA, REDUCE LEVODOPA
FOUR CARDINAL FEATURES (PARKINSON'S Trihexyphenidyl (Artane) - When carbidopa is given with levodopa, the
DISEASE): ❖ Most often used for treatment of Parkinson's dosage of levodopa can be reduced,
➢ muscle rigidity (inflexibility) like syndrome, an adverse effect of anti - decreasing the risk of GI and cardiovascular
➢ akinesia (loss of voluntary muscle. - psychotic drugs. adverse effects.
movement) or Bradykinesia ANTICHOLINERGIC DRUG Nursing - Levodopa is almost exclusively combined with
➢ tremors at rest Considerations: carbidopa as the standard therapy for
➢ disturbances of posture and balance. - Give the drugs with caution in hot weather or Parkinson's disease.
Parkinson's Disease is a degenerative disorder of with exposure to hot environment Tapered treatment
the central nervous system. - Ensure that the patient voids before taking the - amantadine, levodopa, and bromocriptine,
- common among elderly 60 years old and drugs if urinary retention is a problem must be gradually tapered to avoid
above. - Elderly patients, increased sensitivity to precipitating parkinsonian crisis (sudden
- characterized by degeneration of the anticholinergic drugs marked clinical deterioration)
substantia nigra in the midbrain. - Provide ice chips, drinks, or sugarless hard DOPAMINERGIC DRUG Nursing Considerations:
Upsetting the balance candy or gum to relieve dry mouth. Drug -Drug interaction.
- When nerve cells in the brain become - Increase fluid and fiber intake to prevent - Dopaminergic drugs combined with MAOI may
impaired, they can no longer produce constipation as appropriate. increase hypertensive crisis.
dopamine = excess of acetylcholine. DOPAMINERGIC DRUGS COMBINATION of levodopa with Vitamin
ANTI-PARKINSON'S DRUGS should balance the - include drugs that are chemically unrelated. B6 and phenytoin and dopamine antagonists may
effects of the neurotransmitters. - increase the effects of dopamine at receptor lead to decrease effect of dopaminergic drugs.
- to increase Dopamine effect and to sites
decrease Acetylcholine effect Examples include:
- do not cure the disease but control the - levodopa - the metabolic precursor to
symptoms (palliative treatment) dopamine
1. Anticholinergic drugs - carbidopa-levodopa (Sinemet), a
2. Dopaminergic drugs combination drug, best drug for Parkinson's
ANTICHOLINERGIC DRUGS (parasympatholytic disease.
drugs) - inhibit the action of acetylcholine at

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NCMA216 | WEEK 9: Drugs Acting on Disease Spotlight: Common Cold SECOND- cetirizine Zyrtec
the Respiratory System COMMON COLD - Viruses invade the tissues of the GENERATION – levocetirizine Xyzal
OUTLINE upper respiratory tract, initiating the release of have fewer loratadine Claritin
histamine and prostaglandins and causing an anticholinergic
❖ Antihistamines
inflammatory response. effects and a
❖ Bronchodilators and Antiasthmatics lower incidence
❖ Decongestants - AS A RESULT: mucous membranes become
of drowsiness
❖ Expectorants and Mucolytics engorged with blood, the tissues swell, and
❖ Inhaled Steroids Lung Surfactants the goblet cells increase the production of
Antihistamines are indicated for the following:
mucus.
Drugs Acting on the Respiratory Tract - Relief of symptoms of seasonal and perennial
- CC: sinus pain, nasal congestion, runny nose,
allergic rhinitis allergic conjunctivitis,
- respiratory system is essential for survival. sneezing, watery eyes, scratchy throat, and
uncomplicated urticarial, and angioedema.
- brings oxygen into the body, allows for the headache.
- Relief of nasal and non-nasal symptoms of
exchange of gases, and leads to the expulsion ANTIHISTAMINES block the release or action of
seasonal and perennial allergic rhinitis.
of carbon dioxide and other waste products. histamine, a chemical released during
inflammation that increases secretions and - used as adjunctive therapy in anaphylactic
- normal functioning of the respiratory system
narrows airways. reactions.
depends on an intricate balance of the
- H1 blockers or H1 antagonists, compete with - Relief of nausea and vomiting associated
nervous cardiovascular, and musculoskeletal
histamine for receptor sites, preventing a with motion sickness - meclizine
systems.
histamine response. Nursing Implementation with Rationale
- Numerous conditions can affect the
- types of histamine receptors, H1 and H2, - Proper administration. 1 hour before or 2
respiratory tract and interfere with the body's
cause different responses. hours after meals, to increase the absorption.
ability to ensure adequate oxygenation and
gas exchange 1. H1 receptor - extravascular smooth - Relief from dry mouth. suggest sugarless
muscles, including those lining the nasal candies or lozenges to relieve some of the
ANTIHISTAMINE cavity, are constricted. discomforts.
FIRST GENERATION AND SECOND GENERATION 2. H2 receptor - an increase in gastric - Safety measures. to prevent patient injury.
Disease Spotlight: Seasonal Rhinitis secretions (peptic ulcer) - Increase fluid intake. to decrease the
SEASONAL RHINITIS is an inflammation of the Classification Generic name Brand problem of thickened secretions and dry nasal
nasal cavity, commonly called hay fever, that name mucosa.
afflicts many people. FIRST- diphenhydramine Benadryl - Ensure voiding. Have patient void before each
- This condition occurs when the upper airways GENERATION – hydroxyzine Vistaril, dose to decrease urinary retention
respond to a specific antigen (e.g., pollen, cause others - Skin care. to prevent skin breakdown.
mold, dust) with a vigorous inflammatory drowsiness, dry meclizine Antivert
- Avoid alcohol. serious sedation can occur
response, resulting again in nasal congestion, mouth, and other promethazine Phenergan
sneezing, stuffiness, and watery eyes. anticholinergic
symptoms

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 BRONCHODILATORS ANTIASTHMATICS - dilation of the bronchi with increased rate and - Long-term maintenance treatment of
Xanthines, Sympathomimetics, and depth of respiration. bronchoconstriction in COPD.
Anticholinergics Therapeutic Actions: - Treatment of acute bronchospasm in adults
Disease spotlight: Bronchial Asthma - Actions are specific to the beta-receptors and children, although epinephrine is the drug
ASTHMA is characterized by reversible found in the bronchi. of choice.
bronchospasm, inflammation, and hyperactive - systemic effects - increased blood pressure, - Treatment and prophylaxis of acute asthma
airways. increased heart rate, vasoconstriction, and attacks in children more than 6 years old.
- hyperactivity is triggered by allergens or decreased renal and Gl blood flow Anticholinergics
nonallergic inhaled irritants, or by factors such - Epinephrine - (adults and children) Acute - Patients who cannot tolerate the sympathetic
as exercise and emotions, bronchospasm, including that caused by effects of sympathomimetics might respond
- trigger causes an immediate release of anaphylaxis to the anticholinergic drugs ipratropium
histamine, which results in bronchospasm in BETA - SPECIFIC ADRENERGIC AGONISTS (Atrovent) and tiotropium (Spiriva).
about 10 minutes. These drugs, including albuterol (Proventil), Therapeutic actions:
- later response (3-5 hours) is cytokine- bitolterol (Tornalate), isoetharine (generic), - used as bronchodilators because of their
mediated inflammation, mucus production, levalbuterol (Xopenex), metaproterenol (Alupent), effect on the vagus nerve, which sis to block or
and edema contributing to obstruction. pirbuterol (Maxair), salmeterol (Serevent), and antagonize the action of the acetylcholine
- STATUS ASTHMATICUS; this is life-threatening terbutaline (Brethaire), - By blocking the vagal effect, relaxation of
bronchospasm; not respond to usual - Albuterol sulfate (Proventil), a beta2- smooth muscle in the bronchi occurs, leading
treatment adrenergic agonist, is selective for beta2- to bronchodilation.
Xanthines adrenergic receptors, so the response is Indications: Maintenance/treatment of
- A direct effect on the smooth muscles of the relaxation of bronchial smooth muscle and bronchospasm for adults with COPD.
respiratory tract, both in the bronchi and in the bronchodilation. Nursing Implementation with Rationale
blood vessels. - action is more selective (activates only the - Administer oral drug with food or milk to
- work by directly affecting the mobilization of beta2 receptors). relieve GI irritation if Gl upset is a problem.
calcium within the cell - fewer undesired adverse effects - Teach the patients - to use it 30 to 60 minutes
▪ stimulating prostaglandins, resulting in - high dosages of albuterol may affect beta 1 before exercising to ensure peak therapeutic
smooth muscle relaxation receptors, causing an INCREASE IN HEART effects when they are needed.
- inhibit the release of slow-reacting substance RATE - Alert the patient that long-acting adrenergic
of anaphylaxis and histamine Sympathomimetics are indicated for the blockers are not for use during acute attacks
- INDICATIONS: asthmas, chronic bronchitis, following: - Increase oral fluid intake. Ensure adequate
and COPD - Long-acting treatment and prophylaxis of hydration
Sympathomimetic bronchospasm and prevention of exercise- - sugarless lozenges to relieve dry mouth and Gl
- mimic the effects SNS induced bronchospasm in patients 2 years upset.
and older.

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- caution the patient not to exceed 12 Decongestants - decrease the overproduction of well as overinflation of the lungs and poor gas
inhalations in 24 hours to prevent serious secretions by causing local vasoconstriction to the exchange.
adverse effects. upper respiratory tract. 1. Chronic bronchitis is a permanent
Leukotriene Receptor Antagonists - vasoconstriction leads to a shrinking of inflammation of the airways with mucus
- selectively and competitively block swollen mucous membranes and tends to secretion, edema, and post inflammatory
(zafirlukast, montelukast) or antagonize open clogged nasal passages, providing relief defenses...
(zileuton) receptors for the production of from the discomfort of a blocked nose and 2. Emphysema is characterized by loss of
leukotrienes D4 and E4 promoting drainage of secretions and the elastic tissue of the lungs, destruction
- drugs block many of the signs and symptoms improved airflow. of alveolar walls, and resultant alveolar
of asthma: - Topical nasal decongestants, oral hyperinflation with a tendency to collapse
▪ neutrophil and eosinophil migration decongestant, and topical steroid nasal with expiration
▪ neutrophil and monocyte aggregation decongestants are classifications of EXPECTORANTS - drugs that liquefy the lower
decongestants. respiratory tract secretions
▪ leukocyte adhesion
▪ increased capillary permeability (see administration of nose drops and sprays on the last ▪ used for the symptomatic relief of
page) respiratory conditions characterized by a
▪ smooth muscle contraction.
Nursing considerations: dry, nonproductive cough.
- They do not have immediate effects on the
- explain to the patient that it should not be ▪ Guiafenesin (p)
airways and are not indicated for treating
used frequently or prolonged use due to MUCOLYTICS - work to break down mucus to aid
acute asthma attacks.
rebound vasodilation called rhinitis high-risk respiratory patients in coughing up thick,
Decongestants medicamentosa tenacious secretions.
Disease spotlight: Sinusitis - Proper administration. Teach the patient the ▪ Acetylcysteine (p)
Sinusitis occurs when the epithelial lining of the proper administration of the drug to ensure the ▪ Ambroxol
sinus cavities becomes inflamed. therapeutic effect ▪ Carbocisteine
- swelling often causes severe pain due to - monitor blood pressure, pulse and ▪ Dornase alfa
pressure against the bone, which cannot auscultation Indications MUCOLYTICS:
stretch, leading to blockage of the sinus - increase oral fluid intake - adjunctive therapy for abnormal, viscid or
passage. inspissated mucous secretion in acute and
Expectorants Mucolytics chronic bronchopulmonary disorders
- DANGER OF A SINUS INFECTION left
untreated, microorganisms can travel up the Disease Spotlight: Chronic Obstructive - productive cough
sinus passages and into brain tissue. Pulmonary Disease - lessen hepatic injury in cases of
- Symptoms of sinusitis include pain, swelling, - permanent, chronic obstruction of the acetaminophen toxicity
and tenderness around the cheek, eyes, or airways, often related to cigarette smoking. EXPECTORANTS Nursing consideration:
forehead, a blocked nose, reduced sense of - assess respirations and adventitious sounds
- TWO RELATED DISORDERS - both of which
smell, a sinus headache, and a high to evaluate response to the drug effects
result in airflow obstruction on expiration, as
temperature of 38°C. - increase oral fluid intake
EMD
- advise to take small, frequent meals Inhaled steroids - taper systemic steroids carefully during the
- advise to avoid driving or performing Inhaled steroids are used to decrease the transfer to inhaled steroids
dangerous tasks if dizziness and drowsiness inflammatory response in the airway. - have the patient use decongestant drops
occur Therapeutic actions: before using the inhaled steroids
MUCOLYTICS Nursing consideration - Decrease the inflammatory response in the - have the patient rinse the mouth after using
- monitor patient response to the drug airway. the inhaler
- monitor for adverse effects (CNS effects, skin - Increase airflow and facilitate respiration. - monitor the patient for any sign of respiratory
rash, bronchospasm and Gl upset) - Promotion of beta-adrenergic receptor activity infection
- evaluate the effectiveness of comfort and = smooth muscle relaxation and inhibit - instruct the patient to continue to take the
safety measures and compliance with the bronchoconstriction. - drug to reach and then maintain effective
regimen Inhaling the steroid tends to decrease the levels (2 to 3 weeks)
ANTITUSSIVES numerous systemic effects that are associated
- drugs that suppress the cough reflex Lung surfactants
with steroid use.
- act directly on the medullary cough center Disease Spotlight: Respiratory Distress
Indication of Inhaled Steroids:
- of the brain to depress the cough reflex. Syndrome
- Prevention and treatment of asthma.
- Central acting - not the drugs of choice for Respiratory distress syndrome (RDS) causes
- Treatment of chronic steroid-dependent
anyone who has a head injury or who could be obstruction at the alveolar level.
bronchial asthma.
impaired by central nervous system (CNS) - surfactant is necessary for lowering the
- Used as adjunctive therapy for asthma
depression surface tension in the alveoli so that they can
patients who do not respond to traditional
- INDICATED FOR: nonproductive cough. stay open to allow the flow of gases.
bronchodilators.
Patients with asthma and emphysema are - If surfactant levels are low, the alveoli do not
- INHALATIONS/INHALERS
contraindicated - lead to accumulation of expand and cannot receive air, leading to
- METERED-DOSE INHALERS (MDIs) - are
secretions decreased gas exchange, low oxygen levels
handheld devices that deliver medication to
Nursing considerations: - Treatment: to prevent atelectasis and to allow
the lower respiratory tract
- ensure the drug is not taken any longer than 1 the lungs to expand.
- SPACERS: are devices used to enhance the
week - Acute respiratory distress syndrome (ARDS)
delivery of medications from the MDI
- arrange further medical evaluation for coughs is characterized by progressive loss of lung
- NEBULIZER: device that change liquid meds
that persist or are accompanied by high fever, compliance and increasing hypoxia.
into a fine mist or aerosol that has the ability to
rash or excessive secretions Lung surfactants are naturally occurring
reach lower, smaller airways
- provide other measures to help relieve cough compounds or lipoproteins containing lipids and
- Patient position: semi-fowler's or high
like humidity, cool temperatures, fluids, use apoproteins that reduce the surface tension within
fowler's
of topical lozenges the alveoli, allowing expansion of the alveoli for gas
Nursing Considerations:
- increase oral fluid intake exchange.
- advise patient not to use the drug to treat an
Therapeutic actions: Used to replace the
acute asthma attack or status asthmaticus
surfactant that is missing in the lungs of neonates
with RDS.
EMD
Indications of Lung surfactants:
- Rescue treatment of infants who have RDS.
- Prophylactic treatment of infants at high risk
for development of RDS (birth weight of <1,
350g, birth weight >1, 350g who have evidence
of respiratory immaturity).
- tried in the treatment of adult RDS and with
adults after near drowning.
The nursing interventions for patients using lung
surfactants include the following:
- Patient monitoring. Monitor the patient
continuously during administration and until
stable to provide life support measures as
needed.
- Correct endotracheal tube placement.
Ensure proper placement of the endotracheal
tube with bilateral chest movement and lung
sounds to provide adequate delivery of the
drug.
- Review proper administration of drugs. Have
staff view the manufacturer's teaching video
before regular use to review the specific
technical aspects of administration.
- Suction the infant. Suction the infant
immediately after administration, but do not
suction for 2 hours after administration unless
clinically necessary, to allow the drug time to
work.

EMD