Republic of the Philippines

Bulacan State University

City of Malolos

NCM 106 - Pharmacology

Drugs acting on the CNS and PNS

Prepared by:

Christopher E. Olipas, Ph.D.

Carmina O. Fabonan, RN

Marlyn Molina, MAN

A.Y. 2020-2021- 1st Semester

Introduction

The brain is one of the most powerful organs in the body. It controls your feelings
and emotions and releases different chemical signals that the body reacts from different
stimuli/situations. This module will focus on drugs affecting the central nervous system
and peripheral nervous system. It is a wide range of medications classified accordingly
base on the treatment of certain diseases. The module focuses on each drug
classification expanding to drug therapeutic action/Indication, side effects,
pharmacokinetics, possible drug interaction, and to utilize the nursing process in giving
medications. You need to have this knowledge because nurses deal with medication most
of the time. You are responsible to validate doctor’s order to ensure the client's safety and
prevent any possible errors regarding medication.

This particular module is divided into 9 lessons:

Lesson 1 Anxiolytic and Hypnotic agents
Lesson 2 Antidepressant agents
Lesson 3 Psychotherapeutics
Lesson 4 Antiepileptic agents
Lesson 5 Antiparkinsonism agents
Lesson 6 Muscle relaxants
Lesson 7 Narcotics and anti-migraine drugs
Lesson 8 General and Local Anesthetics
Lesson 9 Neuromuscular Blocking agents
The module includes a pre-test, and post-test, that help you assess and evaluate
your understanding of each lesson. You are encouraged to take time in answering the
question. It will also help you to build your study style along the way.

Objectives/Competencies
Upon completion of this module, you are expected to:
1. Explain the importance of the different drugs based on their classification, it’s
identified therapeutic actions, side effects, and adverse effects.
2. Apply the nursing process in drug therapy and patient safety.
3. Formulate a health teaching plan
Pre Test
Let’s have some warm-up. Answer the crossword below.
Down:
1. The underlying experience of
feeling, emotion, or mood.
2. Common and serious medical
illness that negatively affects how you
feel, the way you think, and how you
act.
Across:
3. A neurotransmitter that is important
for attentiveness, emotions, sleeping,
dreaming, and learning
4. Feeling of unease, such as worry or
fear, that can be mild or severe
5. Monoamine neurotransmitter that
regulates mood, happiness, and
anxiety.
6. Drugs used to alleviate the
symptoms of anxiety and associated
disorders
Title of the Lesson: Anxiolytic and Hypnotic agents

Duration: 2 hours
During a situational crisis, most of the people develop anxiety, including this time
that we are facing a pandemic. Everyone is struggling with their new normal. Including
this new face of learning. You wouldn’t deny that you have felt anxious before your class
start but then resolve over time. Anxiety range to mild to severe cases, and in
overwhelming severe cases where therapeutic interventions are needed, anxiolytic and
hypnotics agents are used to regain a balanced body.
Anxiolytic agents are used in treating anxiety or symptoms caused by anxiety.
These drugs are generally classified by chemical structure. The two largest groups of
drugs are the barbiturates and benzodiazepines. See the table below that summarized
anxiolytic agents. Notice that most of the benzodiazepines end with –“pam” or –“lam”.
The patient may develop withdrawal syndrome characterized by nausea, headache,
vertigo, malaise, and nightmares in abrupt cessation of this drug. While most of the
Barbiturates end with –“barbital”. The development of physical tolerance and
psychological dependence is more likely with the barbiturates.
Table 4.1 Anxiolytic agents

Benzodiazepines Generic Name

Alprazolam Chlordiazepoxide
Clorazepate
Clonazepam Diazepam
Estazolam
Flurazepam Lorazepam
Midazolam
Oxazepam Quazepam
Temazepam
Triazolam

Actions Act in the limbic system and the RAS to make gamma-
(Pharmacodynamics) aminobutyric acid (GABA) more effective, causing
interference with a neuron firing.

Works to treat Anxiety disorders, alcohol withdrawal,

hyperexcitability and agitation, and preoperative relief of
anxiety and tension to aid in balanced anesthesia.

Pharmacokinetics Absorbed from the GI

Metabolized in the liver
Cross the placenta and enter breast milk
Excreted in the urine
Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
any benzodiazepine
● Patient with acute narrow-angle glaucoma, shock,
coma, or acute alcoholic intoxication
● Pregnancy and lactating woman
Caution
● Caution with elderly patients.

Adverse Effect Nervous system effects

Sedation, drowsiness, depression, lethargy, blurred vision,
“sleep-driving” and other complex behaviors, headaches,
apathy, lightheadedness, amnesia, and confusion.
Gi effects
Dry mouth, constipation, nausea, vomiting, and elevated
liver enzymes
Cardiovascular effects
Hypotension, hypertension, arrhythmias, palpitations, and
respiratory difficulties.
Hematological effects
Blood dyscrasias and anemia
Genitourinary effects
Urinary retention and hesitancy, loss of libido, and changes
in sexual functioning.

Drug-Drug Increased risk of CNS depression if used with alcohol or

Interaction CNS depressant.
Increased benzodiazepines effects if combined with
cimetidine, oral contraceptives, or disulfiram
Decreased effect with theophyllines.

Barbiturates Generic Name

Amobarbital Butabarbital Pentobarbital
Phenobarbital Secobarbital

Actions Inhibit neuronal impulse conduction in the ascending RAS,

(Pharmacodynamics) depress the cerebral cortex, alter cerebellar function, and
depress motor output.
Used for relief of the signs and symptoms of anxiety and
sedation, insomnia, pre-anesthesia, and the treatment of
seizures.

Pharmacokinetics Absorbed from the GI

Metabolized in the liver
Cross the placenta and enter breast milk
Excreted in the urine
 Contraindication/ Contraindication
Caution ● Contraindicated in the presence of known allergy to
any barbiturate.
● Patient with hepatic impairment or nephritis
● Pregnancy and lactating woman

Adverse Effect CNS effect

Drowsiness, somnolence, lethargy, ataxia, vertigo, a feeling
of “hangover,” thinking abnormalities, paradoxical
excitement, anxiety, and hallucinations.
GI effects
nausea, vomiting, constipation, diarrhea, and epigastric pain
Hypersensitivity reactions
rash, serum sickness, and Stevens-Johnson syndrome
Cardiovascular effects
bradycardia, hypotension

Drug-Drug Increased risk of CNS depression if used with alcohol or

Interaction CNS depressant, antihistamines, and other tranquilizers
Increased serum levels and effects with monoamine
oxidase (MAO) inhibitors

Other Anxiolytic and Hypnotic Drugs include Buspirone, Dexmedetomidine,

Diphenhydramine, Eszopiclone, Meprobamate, Promethazine, Ramelteon, Suvorexant,
Tasimelteon, Zaleplon, and zolpidem. See the table below about the nursing process in
giving anxiolytic agents.
Table 4.2 Nursing Process for Anxiolytic agents

Nursing Assessment
Process 1. Assess for known allergy to drugs
2. history of addiction to sedative-hypnotic drugs
3. Current pregnancy or lactation status.
4. Assess vital signs
5. Monitor renal and hepatic function tests

Nursing Diagnosis (Possible)

● Disturbed thought processes and disturbed sensory perception
(visual, auditory, kinesthetic, tactile) related to CNS effects
● Risk for injury related to CNS effects
● Impaired gas exchange related to respiratory depression
● Deficient knowledge regarding drug therapy

Planning
 ● The patient will receive the best therapeutic effect from the drug
therapy.
● The patient will have limited adverse effects on drug therapy.
● The patient will have an understanding of the drug therapy,
adverse effects to anticipate, and measures to relieve
discomfort and improve safety.

Implementation
1. Do not administer these drugs
intraarterially
2. Do not mix IV drugs in solution
with any other drugs
3. Give IV medications slowly
4. Taper dose gradually after long-
term therapy
5. Provide comfort measures to
relieve possible side effects
6. Provide thorough patient
teaching, including drug name,
prescribed dosage, measures
for avoidance of adverse
effects, and warning signs that
may indicate possible problems.
Instruct patients about the need
for periodic monitoring and
evaluation
Rationale
1. Serious complication
may occur
2. Avoid potential drug-
drug interactions
3. Rapid administration
can lead to cardiac
problems
4. Prevent withdrawal
syndrome
5. Help the patient to
tolerate the drug
6. Increase knowledge
about drug therapy
and to increase
compliance with the
drug regimen.

Evaluation
● Monitor patient response to the drug (alleviation of signs and
symptoms of anxiety, sleep, sedation, reduction in seizure
activity).
● Monitor for adverse effects (sedation, hypotension, cardiac
arrhythmias, hepatic or renal dysfunction, skin reactions,
dependence).
● Evaluate the effectiveness of the teaching plan (patient can
name drug, dosage, possible adverse effects to watch for, and
specific measures to help avoid adverse effects).
● Monitor the effectiveness of comfort and safety measures and
compliance with the therapeutic regimen.
Self-Check 1

1. A nurse is preparing to administer diazepam (valium) by intravenous (IV) route to

a client who is having a seizure. The nurse plans:

a. Administer the prescribed dose over at least 60 minutes.

b. Administer prescribed dose by IV push directly into the vein
c. Dilute the prescribed dose in 50 ml of 5% dextrose in water
d. Mix the prescribed dose into the existing IV of 5% dextrose in normal
saline.

2. Explain the mechanism of action of benzodiazepines and barbiturates including

the disadvantages and advantages of using the drug.

Benzodiazepines Barbiturates

Mechanism of Mechanism of
Action:_____________ Action:_____________
_________________ __________________

___________________ __________________
___________________ __________________
________________ __________________

___________________ ___________________
___________________ ___________________
_______________ ________________

Great! Hope you answered the question correctly. For further reading, you can
check Chapter 20 of the book entitled “Focus on nursing pharmacology” (7th ed.). by
Karch, A. M., (2013) or other references. You can also watch the video about
Pharmacology - Sedative, hypnotic, Anxiolytic Drugs
https://www.youtube.com/watch?v=XzCvs3zFnvA for a quick review.
Title of the Lesson: Antidepressant agents

Duration: 2 hours
Depression is the feeling of sadness that may lead to a lack of interest in any
activities you usually do. Depression is a common and serious mental disorder in some
individuals who developed symptoms like loss of appetite, lack of energy that interferes
with their daily lives causing obvious physical changes in the body. Nonetheless,
depression is among the most curable mental disorder. Antidepressant is prescribed to
alter brain chemicals that control emotion, combine with psychotheraphy to provide a
good prognosis of depression. Antidepressants are classified into three major groups the
tricyclic antidepressant (TCAs) works to block the reuptake of serotonin and
norepinephrine, the monoamine oxidase inhibitors (MAOIs) prevent the breakdown of
dopamine, norepinephrine, and serotonin, and the selective serotonin reuptake inhibitors
(SSRIs) specifically block the reuptake of serotonin. See table below for summarized
antidepressant agents
Table 4.3 Antidepressant agents

Tricyclic Generic name

antidepressants Amitriptyline Amoxapine Clomipramine
(TCA) Doxepin
Imipramine Trimipramine Desipramine
Nortriptyline
Protriptyline Maprotiline

Actions ● inhibit presynaptic reuptake of the neurotransmitters

(Pharmacodynamics) serotonin and norepinephrine
● Indicated for the relief of symptoms of depression.

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in Urine
Cross the placenta and enter breast milk

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to any drug
component
● Patient with recent myocardial infarction
● Pregnancy and lactating woman
Caution
● Patient with a preexisting cardiovascular disorder

Adverse Effect CNS effect

Sedation, sleep disturbances, fatigue, hallucinations,
disorientation, visual disturbances, difficulty in
concentrating, weakness, ataxia, and tremors
 GI effect
dry mouth, constipation, nausea, vomiting, anorexia,
increased salivation, cramps, and diarrhea

CV effects
orthostatic hypotension, hypertension, arrhythmias,
myocardial infarction, angina, palpitations, and stroke

Withdrawal syndrome may occur if abruptly stopped

manifested by nausea, headache, vertigo, malaise, and
nightmares.

Drug-Drug An increase in TCA levels results with cimetidine, fluoxetine,

Interaction or ranitidine
Higher serum levels of the anticoagulants and increased risk
of bleeding with oral anticoagulants
Increased risk of arrhythmias and hypertension with
sympathomimetics or clonidine
Combination of TCAs with MAOIs leads to a risk of severe
hyperpyretic crisis with severe convulsions, hypertensive
episodes, and death

Monoamine tranylcypromine (Parnate)

Oxidase Inhibitors phenelzine (Nardil)
(MAOI) isocarboxazid (Marplan)

*Memory trick – MAOI went to PA-NA-MA

Actions Blocking the breakdown of the biogenic amines

(Pharmacodynamics) norepinephrine, dopamine, and serotonin
Indicated for the treatment of the signs and symptoms of
depression

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in UrineCross the placenta and enter breast milk

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to any of
these antidepressants
● Patient with renal or hepatic impairment
Caution
● Patients with seizure disorders or hyperthyroidism
● Pregnancy and lactating woman
Adverse Effect risk of suicidality in patients using these drugs
Dizziness, excitement, nervousness, mania, hyperreflexia,
tremors, confusion, insomnia, agitation, and blurred vision

GI effects
Liver toxicity, nausea, vomiting, diarrhea or constipation,
anorexia, weight gain, dry mouth, and abdominal pain.
Urinary retention, dysuria, incontinence, and changes in
sexual function

CV effects
Orthostatic hypotension, arrhythmias, palpitations, angina,
and the potentially fatal hypertensive crisis.

Drug-Drug-Food potentially life-threatening serotonin syndrome with SSRIs

Interaction hypertensive crisis, coma, and severe convulsions with TCA
additive hypoglycemic effects with insulin or oral antidiabetic
agents

Patients who take MAOIs should avoid the tyramine-

containing
Foods (cheese, yeast, wine, soy sauce, processed food)

Selective Serotonin Fluoxetine Citalopram Vilazodone

Reuptake Inhibitors Fluvoxamine Escitalopram
Paroxetine
Sertraline
Vortioxetine

Actions ● Blocking the reuptake of serotonin increases the

(Pharmacodynamics) levels of serotonin in the synaptic cleft.
● Indicated for the treatment of depression, OCDs,
panic attacks, bulimia, premenstrual dysphoric
disorder (PMDD), posttraumatic stress disorders,
social phobias, and social anxiety disorders.

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in Urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to the drug
component
● Pregnancy and Lactation
Caution
● Patients with impaired renal, hepatic function or
diabetes
 Adverse Effect CNS effects
headache, drowsiness, dizziness, insomnia, anxiety,
activation of mania/hypomania, tremor, agitation, and
seizures
GI effects
nausea, vomiting, diarrhea, dry mouth, anorexia,
constipation, and changes in taste
GU effects
Painful menstruation, cystitis, sexual dysfunction, urgency,
and impotence.
Respiratory effect
cough, dyspnea, upper respiratory infections, and
pharyngitis

Drug-Drug SSRIs with TCAs results in increased therapeutic and toxic

Interaction effects
Risk of serotonin syndrome if SSRIs are used with MAOIs
Increased risk of bleeding if these drugs are combined with
aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs),
antiplatelet drugs, or drugs that affect coagulation

Other antidepressants include Bupropion, Desvenlafaxine, Duloxetine,

Levomilnacipran, Milnacipran, Mirtazapine, Nefazodone, Selegiline, Trazodone,
Venlafaxine most effective in treating depression in patients who do not respond to other
antidepressants

Self-Check 2
1. A nurse is developing a teaching plan for Lola Anita who will be receiving phenelzine
sulfate (Nardil). The nurse plans to tell the client to avoid:

a. Vasodilators
b. Aged cheese
c. Digitalis preparations
d. Cherries and blueberries.
2. Fill in the table below based on the case scenario given in the above question.

Patient Name: Diagnosis:

Drug Name: (generic) (brand name)

Drug Classification Action:

Nursing Process

Pre-Administration Post Administration Nursing Consideration/Health

Assessment Evaluation Teaching

Take a break for a while. If you need further reading you can check Chapter 21 of
the book entitled “Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or
other references. You can also watch the video about Antidepressants
https://www.youtube.com/watch?v=T25jvLC6X0w
Title of the Lesson: Psychotherapeutics
Duration: 2 hours
Mental disorder is the third most prevalent form of morbidity according to National statics
office in the Philippines. The society is still fighting against its social stigma brought by
these mental illness. Nonetheless, this illness is controlled by the use of antipsychotic
drugs. That can control psychotic symptoms (delusions, hallucinations, and thought
disorders) that can occur with schizophrenia, mania, and other psychoses. See table
below for a detailed discussion.
Table 4.4 Psychotherapeutics agents

Antipsychotics Generic name

drugs Typical antipsychotics
Chlorpromazine, Fluphenazine, Haloperidol, Loxapine,
Perphenazine, Pimozide, Prochlorperazine, Thiothixene,
Trifluoperazine

Atypical antipsychotics
Aripiprazole, Asenapine, Clozapine, Iloperidone,
Lurasidone, Olanzapine, Paliperidone, Quetiapine,
Risperidone, Ziprasidone

Actions ● Block dopamine receptors, preventing the stimulation

(Pharmacodynamics) of the postsynaptic neurons by dopamine

Indicated for schizophrenia and manifestations of other

psychotic disorders, including hyperactivity, combative
behavior, and severe behavioral problems in children (short-
term control); some of them are also approved for the
treatment of a bipolar disorder.

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in bile and Urine
Cross the placenta and enter breast milk

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to any drug
component
● Patients with (CNS) depression, circulatory collapse,
Parkinson’s disease, coronary disease, severe
hypotension, bone marrow suppression, and blood
dyscrasias.
● Elderly patients with dementia
● Pregnancy and lactating woman
 Caution
● Patient with glaucoma, peptic ulcer, and urinary or
intestinal obstruction

Adverse Effect CNS effect

Sedation, weakness, tremor, drowsiness, extrapyramidal
side effects, pseudoparkinsonism, dystonia, akathisia,
tardive dyskinesia, and potentially irreversible neuroleptic
malignant syndrome
Risk for the development of diabetes mellitus and
weight gain when these drugs are used

Drug-Drug Antipsychotics with beta-blockers may lead to an increase in

Interaction the
Effect of both drugs

Antipsychotic–alcohol combinations result in an increased

risk of cns depression

Antipsychotic– anticholinergic combinations lead to

increased anticholinergic effects

Drugs for Bipolar Generic Name

Disorder (Manic Lithium
Episodes)

Actions Alters sodium transport in nerve and muscle cells; inhibits

(Pharmacodynamics) the release of norepinephrine and dopamine, but not
serotonin, from stimulated neurons; increases the
intraneuronal stores of norepinephrine and dopamine
slightly; and decreases intraneuronal content of second
messengers.

Treatment for Manic episodes of Bipolar disorder.

Pharmacokinetics Absorbed from the GI tract

Slowly crosses the blood–brain barrier.
Excreted from the kidney
Crosses the placenta and enters breast milk

Contraindication/ Contraindication
Caution ● Contraindicated with a history of hypersensitivity to
lithium
● Patient with renal or cardiac impairment, history of
leukemia; metabolic disorders, including sodium
depletion; dehydration; and diuretic use
● Pregnancy and lactating woman
Adverse Effect Serum levels of <1.5 mEq/L: CNS problems
Serum levels of 1.5 to 2 mEq/L: Intensification of all CNS
reactions, with ECG changes.
Serum levels of 2 to 2.5 mEq/L: Possible progression of CNS
effects
Serum levels >2.5 mEq/L: Complex multiorgan toxicity, with
a significant risk of death.

Drug-Drug-Food Lithium–haloperidol combination may result in an

Interaction encephalopathic syndrome, consisting of weakness,
lethargy, confusion, tremors, extrapyramidal symptoms,
leukocytosis, and irreversible brain damage

Lithium is given with carbamazepine, increased cns toxicity

may occur, and a lithium–iodide salt combination results in
an increased risk of hypothyroidism.

Thiazide diuretic–lithium combination increases the risk of

lithium toxicity

Central Nervous Generic Name

System Stimulants Methylphenidate, Dexmethylphenidate,
Dextroamphetamine; Lisdexamfetamine, Modafinil
Armodafinil,
Atomoxetine, Guanfacine

Actions Cortical and RAS stimulants, possibly by increasing the

(Pharmacodynamics) release
Of catecholamines from presynaptic neurons, leading to an
increase in stimulation of the postsynaptic neurons.

Treatment of attention deficit syndromes, narcolepsy and

improvement of wakefulness in people with various sleep
disorder
Lisdexamfetamine was also approved for the treatment of
binge-eating disorders

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in Urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to the drug
component
● Patient with Marked anxiety, agitation, or tension and
severe fatigue or glaucoma
● Pregnancy and Lactation
 Caution
● Patients with history of seizures, drug dependence
and alcoholism

Adverse Effect CNS effects

Nervousness, insomnia, dizziness, headache, blurred
vision,
And difficulty with accommodation
GI effects
Anorexia, nausea, and weight loss
Cardiac effects
Hypertension, arrhythmias, and angina. Sudden cardiac
Death

Drug-Drug CNS stimulant with a monoamine oxidase inhibitor leads to

Interaction an increased risk of adverse effects and increased toxicity

CNS stimulant with guanethidine, which results in a

decrease in antihypertensive effects

CNS stimulants with tricyclic antidepressants or phenytoin

leads to a risk of increased drug levels

Self-Check 3
1. Lolo Ambo client is given a prescription for haloperidol (Haldol). The nurse instructs the
client and family to report any signs of pseudoparkinsonism and tells the family to monitor
for:
a. Tremors and hyperpyrexia
b. Motor restlessness and aphasia
c. Stooped posture and a shuffling gait.
d. Muscle weakness and decreased salivation.
2. Formulate a drug teaching plan for Lolo Ambo

Learning Objectives Learning Content Strategies Time Allotment Resources Evaluation

If you need further reading you can check Chapter 22 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Pharmacology – Antipsychotics
https://www.youtube.com/watch?v=nKkIh1B2Js
Title of the Lesson: Antiseizure Agents

Duration: 2 hours
Epilepsy is one the prevalent neurological disorder, characterized by a sudden
impulse of electrical firing in the brain leads to involuntary contraction of the muscle of the
body. The drugs that are used to manage epilepsy are called antiepileptics, or antiseizure
agents, and are sometimes referred to as anticonvulsants. The table below explained this
agents in details.

Table 4.5 Antiseizure Agents

Drugs for Treating

Generalized Hydantoins Ethotoin (Peganone),
Seizures Fosphenytoin (Cerebyx),
Phenytoin (Dilantin)
Barbiturates and Phenobarbital (Solfoton,
Barbiturate-like Drugs Luminal)
Primidone (Mysoline)
Benzodiazepines Clobazam (Onfi),
Clonazepam (Klonopin),
Diazepam (Valium)
Succinimides Ethosuximide (Zarontin)
Methsuximide (Celontin)
Other Drugs for Treating Acetazolamide (Diamox),
Absence Seizures Valproic Acid (Depakene)
Zonisamide (Zonegran).

Actions Used to treat generalized seizures stabilize the nerve

(Pharmacodynamics) membranes by blocking channels in the cell membrane or
altering receptor sites

Affect the entire brain and reduce the chance of sudden

electrical outburst.
Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in Urine
Ethosuximide and methsuximide cross the placenta and
enter breast milk

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to the drug
component
● Pregnancy and Lactation
Caution
● Patients with renal or liver function, elderly or
debilitated patients

Adverse Effect Depression, confusion, drowsiness, lethargy, fatigue,

constipation, dry mouth, anorexia, cardiac arrhythmias and
changes in blood pressure, urinary retention, and loss of
libido.

Drug-drug Risk of CNS depression is increased with alcohol

interaction
Succinimides with primidone may cause a decrease in
serum levels of primidone

Acetazolamide increases the serum levels of quinidine,

tricyclic antidepressants, and amphetamines and may
increase salicylate toxicity when given with salicylates

Zonisamide levels and toxicity are increased if it is combined

with carbamazepine

Valproic acid can increase serum levels and potential toxicity

of phenobarbital, ethosuximide, diazepam, primidone, and
zidovudine

Drugs for Treating Carbamazepine (Tegretol, Epitol, and Others)

Partial Seizures Clorazepate (Tranxene, Gen-Xene, and Others)
Ezogabine (Potiga)
Felbamate (Felbatol)
Gabapentin (Neurontin)
Lacosamide (Vimpat)
Lamotrigine (Lamictal)
Levetiracetam (Keppra)
Oxcarbazepine (Trileptal)
Pregabalin (Lyrica)
Rufinamide (Banzel)
 Tiagabine (Gabitril)
Topiramate (Topamax)
Vigabatrin (Sabril)

Actions Used to control partial seizures stabilize nerve membranes

(Pharmacodynamics) by
● directly, by altering sodium and calcium channels, or
● indirectly, by increasing the activity of GABA, an
inhibitory neurotransmitter
thereby decreasing excessive activity

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in Urine

Contraindication/ Contraindication
Caution ● Contraindicated with a history of allergy to the drug
component
● Patient with bone marrow suppression, severe
hepatic dysfunction
● Pregnancy and Lactation

Adverse effect Drowsiness, fatigue, weakness, confusion, headache, and

insomnia
Nausea, vomiting, and anorexia; and upper respiratory
infections. These antiepileptics can also be directly toxic to
the liver and the bone marrow, causing dysfunction

Drug-Drug CNS depressants or alcohol a potential for

Interaction increased CNS depression exists

Hormonal contraceptives may lose effectiveness if

combined with rufinamide
Self-Check 4
Explain the mechanism of action and nursing responsibilities in giving antiseizure drugs

Drugs for Treating Generalized
Seizures
Mechanism of
action:_____________________________
__________________________
Nursing
Responsibilities:_____________________
__________________________

Mechanism of
action:_____________________________
Drugs for Treating Partial
__________________________
Seizures
Nursing
Responsibilities:_____________________
__________________________

If you need further reading you can check Chapter 23 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Pharmacology – Antiepileptics
https://www.youtube.com/watch?v=c-Cf1xkKofg
Title of the Lesson: Antiparkinsonism agents

Duration: 2 hours
Antiparkinsonism drug is an important part of the treatment of Parkinson’s disease,
a progressive neurologic disorder clinically manifested by muscle rigidity (inflexibility),
akinesia (loss of voluntary muscle movement), tremors at rest and disturbances of
posture and balance. The purpose of drug therapy is to provide symptom relief and
maintain the patient’s independence and mobility.
Table 4.6 Antiparkinsonism agents

Dopaminergic Generic Name

Agents Amantadine
Apomorphine (Apokyn)
(Sinemet)
Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Rasagiline (Azilect)
Levodopa
Carbidopa–Levodopa
Rotigotine (Neupro)
Ropinirole (Requip)

Actions Act in the brain to improve motor function in one of two ways:
(Pharmacodynamics) by increasing the dopamine concentration or by enhancing
the neurotransmission of dopamine.

Relief of the signs and symptoms of idiopathic parkinson’s

disease

Pharmacokinetics Dopaminergic drugs are metabolized extensively in various

areas of the body and are eliminated by the liver, the
kidneys, or both

Adverse Effect Adverse effects of levodopa include nausea and vomiting,

orthostatic hypotension, anorexia, neuroleptic malignant
syndrome, arrhythmias, irritability, confusion.
Adverse effects of amantadine include orthostatic
hypotension and constipation.
Adverse effects of bromocriptine include persistent
orthostatic hypotension, ventricular tachycardia,
bradycardia, worsening angina.
Adverse effects of ropinirole and pramipexole include
orthostatic hypotension, dizziness, confusion, insomnia.

Drug-Drug The effectiveness of levodopa can be reduced when taking

Interaction pyridoxine phenytoin, benzodiazepines, reserpine, and
papaverine.

Risk of hypertensive crisis with a MAO inhibitor

 Antipsychotics, such as phenothiazines, thiothixene,
haloperidol, and loxapine, reduce the effectiveness of
levodopa.

Reduce the absorption of levodopa. With Amantadine may

potentiate anticholinergic adverse effects of anticholinergic
drugs, such as confusion and hallucinations,

Meperidine taken with selegiline at higher-than-

recommended doses can cause a fatal reaction.

Anticholinergic Benztropine (Cogentin)

Agents Diphenhydramine (Benadryl)
Trihexyphenidyl

Actions Inhibit the action of acetylcholine at special receptors in the

(Pharmacodynamics) parasympathetic nervous
Anticholinergics are used to treat all forms of parkinsonism.
Used in the early stages of Parkinson’s disease

Pharmacokinetics Absorbed from the GI tract

Cross the blood-brain barrier to their action site in the brain.
Metabolized in the liver
Excreted by the kidneys as metabolites or unchanged drug

Adverse Effect Dry mouth may be a dose-related reaction to

trihexyphenidyl.

Confusion, restlessness, agitation and excitement,

drowsiness or insomnia, tachycardia, palpitations,
constipation, nausea and vomiting, urine retention,
increased intraocular pressure (IOP), blurred vision, pupil
dilation, and photophobia.

Drug-Drug Amantadine can cause increased anticholinergic adverse

Interaction effects
Decreased absorption of levodopa
Alcohol increases CNS depression.

Adjunctive Agents such Entacapone (Comtan), Tolcapone (Tasmar), Selegiline

(Eldepryl) used to increase the responsiveness of the cells to dopamine. They act to
decrease the breakdown of dopamine, leaving it on the receptor for longer periods of
time.
Self-Check 5

1. Lola Anita was diagnosed with Parkinson’s disease. The doctor ordered levodopa
125 mg twice a day. The nurse is giving patient education to Lola Anita. Which of the
following statement made by Lola Anita needs further understanding ?

a) “Levodopa cannot cure Parkinson's disease but it can improve the

quality of my life”
b) “I will take Levodopa with food to reduce nausea and vomiting”
c) “I will inform the doctor if I feel an increased pressure in my eye”
d) “I can take phenelzine with levodopa when I feel depress”

2. Fill in the table below based on the case scenario given in the above question.

Patient Name: Diagnosis:

Drug Name: (generic) (brand name)

Drug Classification Action:

Nursing Process

Pre-Administration Post Administration Nursing Consideration/Health

Assessment Evaluation Teaching

Great! For further reading you can check Chapter 24 of the book entitled
“Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other
references. You can also watch the video about Pharmacology - Drugs for
Parkinson’s Disease https://www.youtube.com/watch?v=Z84iypHdftQ for a quick
review.
Title of the Lesson: Muscle relaxants

Duration: 2 hours
Skeletal muscle relaxants relieve musculoskeletal pain or spasms and severe
musculoskeletal spasticity. They’re used to treat acute, painful musculoskeletal
conditions and muscle spasticity associated with multiple sclerosis, Cerebral palsy, and
stroke. Muscle relaxants are classified into two: centrally acting, direct-acting, muscle
relaxants. See table below for an in depth discussion of each classification.
Table 4.7 Muscle relaxants agents

Centrally Acting Generic Name

Skeletal Muscle Baclofen (Lioresal),
Relaxants Chlorzoxazone(Parafon),
Cyclobenzaprine (Amrix),
Metaxalone (Skelaxin),
Flexon),
Methocarbamol (Robaxin)
Carisoprodol (Soma),
Diazepam (Valium)
Tizanidine (Zanaflex)
Orphenadrine (Banflex,

Actions Used to treat acute muscle spasms caused by such

(Pharmacodynamics) conditions as anxiety, inflammation, pain, and trauma. They
also treat spasticity from such conditions as MS and cerebral
palsy

Pharmacokinetics Absorb in GI
Metabolized in liver
Excreted in kidney

Adverse Effect Physical and psychological dependence occur. Abrupt

cessation of these drugs can cause severe withdrawal
symptoms.

Dizziness and drowsiness. Severe reactions include allergic

reactions, arrhythmias, and bradycardia

Drug-Drug Centrally acting skeletal muscle relaxants interact with other

Interaction CNS depressants causing increased sedation, impaired
motor function, and respiratory depression

Direct-Acting Generic Name

Skeletal Muscle Dantrolene (Dantrium),
Relaxants Onabotulinumtoxin A (Botox, Botox Cosmetic)
Incobotulinumtoxin A (Xeomin)
Rimabotulinumtoxin B (Myobloc)

Actions Acts directly on muscle to interfere with calcium ion release

(Pharmacodynamics) from the
 Sarcoplasmic reticulum and weaken the force of
contractions

Used to help manage several types of spasticity

Adverse Effect High therapeutic doses are toxic to the liver.

Drowsiness, dizziness, malaise, and muscle weakness.

More serious adverse effects include bleeding, seizures, and
hepatitis.

Drug-Drug CNS depressants and alcohol can increase the depressive

Interaction effects
Estrogens, when given with dantrolene, can increase the risk
of liver toxicity.

Self-Check 6
1. Patient Ana is taking Baclofen 5 mg thrice a day for 3 days, for multiple sclerosis.
Baclofen belongs to the class Centrally Acting Skeletal Muscle Relaxants. Which of the
following statement made by Patient Ana needs further understanding?

a. “I will swallow the whole tablet with a glass of water or milk.”

b. “Baclofen may cause dizziness, drowsiness, and suddenly falling asleep
during my daily activities such as eating and watching television. If I’m
affected, I will not drive or take part in any activity in which I need to be
alert.”
c. “I can take alcohol while on baclofen”
d. “I will inform my doctor if I have stomach ulcers.”
2. Complete the diagram below summarizing the mechanism of action of the Muscle
relaxants agent including nursing responsibilities in administering the medication.

Muscle relaxants agent

Centrally Acting Skeletal Muscle Relaxants Direct-Acting Skeletal Muscle Relaxants

_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________
_____________________________________

Take a break for a while. If you need further reading you can check Chapter 25 of
the book entitled “Focus on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or
other references. You can also watch the video about Muscle Relaxant Drugs
https://www.youtube.com/watch?v=NSq0baJ8YA8
Title of the Lesson: Narcotics and Anti-migraine Drugs

Duration: 2 hours
Pain occurs any time that tissue is injured and various chemicals are released and
triggered opioid receptors. Narcotic drugs used vary with the type of opioid receptors with
which they react to alleviate pain sensation. The table below discuss different narcotics
drug available.
Table 4.8 Narcotics agents

Narcotic Agonists Generic Name

Codeine Tramadol (Ultram)
Sufentanil (Sufental) Oxymorphone
Opium (Paregoric) Meperidine (Demerol)
Methadone (Dolophine) Hydromorphone
(Dilaudid)
Evorphanol Remifentanil (Ultiva)
Tapentadol (Nucynta) Fentanyl (Actiq,
Duragesic)
Oxycodone (Oxycontin) Morphine (Roxanol,
Astramorph)
Hydrocodone (Hysingla Er, Zohydro Er)

Actions Act at specific opioid receptor sites in the CNS to produce

(Pharmacodynamics) analgesia, sedation, and a sense of well-being.
They also are used as antitussives and as adjuncts to
general anesthesia to produce rapid analgesia, sedation,
and respiratory depression.
Indications for narcotic agonists include relief of severe
acute or chronic pain, preoperative medication, analgesia
during anesthesia, and specific individual indications,
depending on their receptor affinity

Contraindication/ Contraindication
Caution ● Contraindicated in a patient with hypersensitivity to
any component of the drug
Caution
● Pregnancy and lactating woman

Adverse Effect Apnea, cardiac arrest, and shock may result from narcotic-
induced respiratory center depression
Sweating and dependence may occur

Drug-drug Respiratory depression, hypotension, and sedation or

Interaction coma is increased with barbiturate general anesthetics
Narcotic Agonists– Generic Name
Antagonists Uprenorphine (Buprenex), Butorphanol
Nalbuphine (Generic) Pentazocine
(Talwin).

Actions Act at specific opioid receptor sites in the CNS to produce

(Pharmacodynamics) analgesia, sedation, euphoria, and hallucinations
Relief of moderate to severe pain
Adjuncts to general anesthesia
Relief of pain during labor and delivery

Contraindication/ Contraindication
Caution ● Contraindicated in a patient with hypersensitivity to
any component of the drug

Adverse Effect Light-headedness, dizziness, psychoses, anxiety, fear,

hallucinations, and impaired mental processes may occur

Drug-drug Respiratory depression, hypotension, and sedation or

Interaction coma is increased with barbiturate general anesthetics

Narcotic Generic Name

Antagonists Naloxone (Evzio)
Naltrexone (ReVia).

Actions Block opioid receptors and reverse the effects of opioids,

(Pharmacodynamics) including respiratory depression, sedation, psychomimetic
effects, and hypotension.

Contraindication/ Contraindication
Caution ● Contraindicated in a patient with hypersensitivity to
any component of the drug

Adverse Effect nausea, vomiting, sweating, tachycardia, hypertension,

tremulousness, and feelings of anxiety
 A migraine, an episodic headache disorder, is one of the most common primary
headache disorders. Anti-migraine agents is classified into two: ergot derivatives, and the
triptans
Table 4.9 Anti-migraine agents

Ergot Derivatives Generic Name

Dihydroergotamine (Migranal, D.H.E. 45)
Ergotamine (Ergomar)

Actions Block alpha-adrenergic and serotonin receptor sites in the

(Pharmacodynamics) brain to cause a constriction of cranial vessels, a decrease
in cranial artery pulsation, and a decrease in the
hyperperfusion of the basilar artery bed

Contraindication/ Contraindication
Caution ● Contraindicated in a patient with hypersensitivity to
any component of the drug
● Patient with CAD, hypertension, or peripheral
vascular disease

Adverse Effect Numbness, tingling of extremities, and muscle pain.

Ergotism syndrome causes nausea, vomiting, severe thirst,
hypoperfusion, chest pain, blood pressure changes,
confusion, drug dependency,and a drug withdrawal
syndrome.

Drug-drug Risk of peripheral ischemia and gangrene is increased with

Interaction beta-blockers

Triptans Generic Name

Almotriptan (Axert), Eletriptan (Relpax), Frovatriptan
(Frova),
Naratriptan (Amerge), Rizatriptan (Maxalt, Maxalt-
MLT), Sumatriptan (Imitrex), Zolmitriptan (Zomig,
Zomig-ZMT)

Actions Bind to selective serotonin receptor sites to cause

(Pharmacodynamics) vasoconstriction of cranial vessels, relieving the signs and
symptoms of migraine headache

Contraindication/ Contraindication
Caution ● Contraindicated in a patient with hypersensitivity to
any component of the drug
● Patient with active CAD

Adverse Effect Numbness, tingling, burning sensation, feelings of coldness

or strangeness, dizziness, weakness, myalgia, and vertigo
 Drug-drug Combining triptans with ergot-containing drugs results in a
Interaction risk of prolonged vasoactive reactions.

Self-Check 7
Case Scenario:
Lola Anita an 88-year-old woman without any significant medical history, visit your
hospital for complaint of severe headache. She is experiencing migraine after the doctor's
evaluation. The doctor prescribed Rizatriptan 10 mg by mouth. Formulate a Drug study
for Lola Anita.

Date Route of
Mechanis
ordered/ Administration/Dosa Contraindica Clients Nursing
Medication m of Indication
Given/ ge/ tion Response Responsibilities
Action
Taken Frequency

Generic Date Dosage: Before:

Name: ordered:

Brand Name: Date

Route; During:
given:

Classification
s: Date
Taken: Frequency: After:

If you need further reading you can check Chapter 26 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Pharmacology – Opioids
https://www.youtube.com/watch?v=t2tKyjj7u5Y and Pharmacology - Anti-migraine Drugs
https://www.youtube.com/watch?v=bvS646hm5v8
Title of the Lesson: General and Local Anesthetics

Duration: 2 hours
Anesthetics are drugs that are used to cause a complete or partial loss of
sensation.

Patients receiving general anesthetics must be constantly monitored because the

CNS depression can cause respiratory arrest, CV reactions including hypotension, and
alterations in GI activity that can lead to nausea and vomiting.

Barbiturate
Methohexital (Brevital)
General Anesthesia
IV drugs used to induce rapid
anesthesia, then maintained with an
inhaled drug

Nonbarbiturate anesthetics
parenteral drugs used for intravenous
Droperidol, Etomidate, Ketamine, administration in anesthesia
Midazolam, Propofol

Gas Anesthetics a potent analgesic, it is used frequently

nitrous oxide (blue cylinder) for dental surgery

Volatile Liquids outpatient surgery as an induction

Desflurane, Enflurane, Isoflurane, agent and israpidly cleared for quick
Sevoflurane recovery

Local anesthesia refers to a loss of sensation in limited areas of the body to prevent
the patient from feeling pain for varying periods after the agents have been administered
in the peripheral nervous system.

Table 4.1 Local anesthesia agents

Local anesthesia
Esters Benzocaine
Chloroprocaine
Tetracaine
 Amides Bupivacaine
Dibucaine
Lidocaine
Mepivacaine
Prilocaine
Ropivacaine
Other Ramoxine

Actions ● temporary interruption in the production and

(Pharmacodynamics) conduction of nerve impulses

Contraindication/ Contraindication
Caution ● Patient with a history of allergy to any one of these
agents or parabens
Caution
● Pregnancy and lactating woman

Adverse Effect Headache, nausea and vomiting

Self-Check 8
You are working as an operative nurse to Lola Anita, complete the chart below regarding
the administration of anesthesia

Patient Name:

Nursing Responsibilities

Pre-Administration Post Administration Nursing

Assessment Evaluation Consideration

If you need further reading you can check Chapter 27 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about General and Local Anesthetics
https://www.youtube.com/watch?v=wx3dZmv5pM0
Title of the Lesson: Neuromuscular Blocking agents
Duration: 2 hours

The neuromuscular junction is the point at which a motor neuron communicates

with a skeletal muscle fiber. Drugs that affect the NMJ can be divided into two groups:
nondepolarizing neuromuscular junction blockers, prevent depolarization of muscle cells,
and depolarizing neuromuscular junction blockers causing stimulation of the muscle cell
and staying on the receptor site, preventing it from repolarizing

Neuromuscular Blocking agents

Nondepolarizing Action Depolarizing Action
Atracurium ● Serve as an Succinylcholine Attaches to
adjunct to general the
Cisatracurium
anesthetics acetylcholine
RocuroniumPancuronium during surgery. receptor site
● Facilitate on the muscle
mechanical cell, causing a
Vecuronium intubation by prolonged
preventing depolarization
resistance to the of the muscle.
passing of the This
endotracheal depolarization
tube. causes
● Facilitate various stimulation of
endoscopic the muscle
diagnostic and muscle
● Facilitate contraction
electroconvulsive and then
therapy flaccid
paralysis.

Adverse effects of NMJ blockers, such as prolonged paralysis, inability to breathe,

weakness, muscle pain and soreness, and effects of immobility, are related to muscle
function-blocking.
Provide thorough patient preoperative teaching about this drug because most
patients who receive the drug will be receiving teaching about a particular procedure and
will be unconscious when the drug is given. Teaching includes drugs to be given,
administration method, effects of the drug, and safety precautions.

Self-Check 9
Lola Anita will undergo a major operation, and the anesthesiologist plan to use
Pancuronium as a muscle relaxant in general anesthesia. Formulate a health teaching
plan to Lola Anita regarding Pancuronium administration.
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_______________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
__________________________________________________________

If you need further reading you can check Chapter 28 of the book entitled “Focus
on nursing pharmacology” (7th ed.). by Karch, A. M., (2013) or other references. You can
also watch the video about Neuromuscular Blocking agents
https://www.youtube.com/watch?v=cp_CZpCBVpk
Post test
1. A home care nurse visits a client. Clonazepam has been prescribed for the client, and
the nurse teaches the client about the medication. Which statement by the client indicates
that further teaching is necessary?
a) “if I experience slurred speech, it will disappear in about 8 weeks”
b) “My drowsiness will decrease over time with continued treatment”
c) “I should take my medicine with food to decrease stomach problems”
d) “I can take my medication at bedtime if it tends to make me feel drowsy”

2. A client who is taking tranylycypromine sulafate (Parnate) request information about

foods that are acceptable to eat while taking the medication. The nurse tells the client that
it is safe to eat:
a) Yougurt
b) Raisins
c) Oranges
d) Smoked fish
3. A client has been started on monoamine oxidase inhibitor (MAOI). Which of the
following should the nurse include when teaching the client about the medication?
a) This medication can cause severe drowsiness.
b) The client must avoid foods that contain tyramine.
c) The medication is associated with a high rate of abuse.
d) The medication will begin to alleviate symptoms of depression almost immediately.
4. A client who is receiving haloperidol (Haldol) at bedtime is prescribed to receive
benztropine mesylate (Cogentin) at the same time. The nurse explains to the client that
the benztropine mesylate is given to:
a) Enhance sleep
b) Enhance the effcts of haloperidol
c) Combat extrapyramidal syndrome.
d) Enhance anticholinergic effects of the medication.
5. A client who is taking chlorpromazine (Thorazine) is preparing for diacharge. Whwn
developing a health promotion plan for the client, the nurse instructs the client to:
a) Avoid prolonged exposure to the sun
b) Adhere to strict tyramine-restricted diet.
c) Recognizes the sign and symptoms of a relapse depression.
 d) Have therapeutic blood levels drawn, because the medication has a narrow
therapeutic range.
6. Haloperidol (Haldol) has been prescribed for a client with Tourette syndrome, and the
nurse instructs the client about the medication. Which statement by the client indicates
the need for further instruction?

a) “It may take 6 weeks before the medication works”

b) “ I need to avoid alcohol while taking this medication”
c) “The drowsiness will probably go away as I continue the medication”
d) “I should stop the medication immediately if my vision becomes blurred”

7. Fluoxetine hydrochloride (Prozac) is prescribed for a client with depression. The nurse
provides instructions to the client regarding the administration of the medication. Which
statement by the client indicates an understanding about administration of the
medication?

a. “I should take the medication with my evening meal”

b. “I should take the medication at noon with antacid”
c. “ I should take the medication in the morning when I first arise”
d. “ I should take the medication right before bedtime with snacks”

8. A client is admitted to the mental health with a diagnosis of panic disorder. The nurse
anticipates that the physician will prescribe a benzodiazepine and checks the physician’s
order sheet for which medication order?
a. Alprazolam (Xanax)
b. Doxepin (Sinequan)
c. Imiptamine (tofranil)
d. Bupropion ( Wellbutrin)

9. A client with a psychotic disorder is being treated with haloperidol (Haldol). The nurse
monitors the client for which of the following that indicates the presence of an adverse
effect of this medication?

a. Nausea
b. Hypotension
c. Blurred vision
d. Excessive salivation

10. Phenelzine sulfate (Nardil) is being administered to a client with depression. The client
suddenly complains of a severe occipital headache radiating frontally, and neck stiffness
and soreness, and is vomiting. On further assessment, the client exhibits signs of
hypertensive crisis. Which medication would the nurse prepare anticipating that it will be
prescribed as the antidote for hypertensive crisis?

a. Vitamin K
b. Phentolamine
c. Protamine sulfate
d. Calcuin gluconate
Final Requirement:
Case Scenario
Lolo Ambo 88 years old went to your clinic complaining that she noticed her arms
is not swing when she walks. During the assessment you notice her slurred speech, and
even the tone of the voice is worried her face shows little expression. She also has
tremors in her hands and stooped posture. Base on the presenting symptoms of Lolo
Ambo, the doctor suspect that Lolo ambo has clinical sign of Parkinson’s disease. The
doctor prescribed Carbidopa–Levodopa (Medolev 125 tab Carbidopa 25 mg, levodopa
100 mg) once a day by mouth. Formulate A Drug Study and a Health Teaching Plan for
Lolo Ambo. (Use a separate paper)
Drug Study

Date
order Route of
ed/ Administrati Mechanism Clients Nursing
Medication Indication Contraindication
Given on/Dosage/ of Action Response Responsibilities
/ Frequency
Taken

Generic Date Dosage: Before:

Name: order
ed:

Brand Name:
Route; During:
Date
given:

Classifications
:
Date Frequency: After:
Taken
:

Health Teaching Plan

Learning Objectives Learning Content Strategies Time Allotment Resources Evaluation
Suggested Readings and Website
Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Hasudungan, A. (2016). Pharmacology - Antiepileptics [YouTube Video]. In YouTube.

https://www.youtube.com/watch?v=c-Cf1xkKofg
Med Made Sirius-ly easy. (2019). Pharmacology- Sedative, Hypnotic, Anxiolytic drugs,
GABA A receptor- CNS- MADE EASY! [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=XzCvs3zFnvA
Medical Mania. (2019). Muscle Relaxant Drugs Made Easy| STEP NCLEX COMLEX
[YouTube Video]. In YouTube. https://www.youtube.com/watch?v=NSq0baJ8YA8
PhysioPathoPharmaco. (2020). Migraines - Pathophysiology & Treatment (Described
Concisely) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=bvS646hm5v8
Speed Pharmacology. (2016). Pharmacology - ANTICHOLINERGIC &
NEUROMUSCULAR BLOCKING AGENTS (MADE EASY) [YouTube Video]. In
YouTube. https://www.youtube.com/watch?v=cp_CZpCBVpk
Speed Pharmacology. (2016). Pharmacology - ANTIDEPRESSANTS - SSRIs, SNRIs,
TCAs, MAOIs, Lithium ( MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=T25jvLC6X0w
Speed Pharmacology. (2018). Pharmacology - ANTIPSYCHOTICS (MADE EASY)
[YouTube Video]. In YouTube. https://www.youtube.com/watch?v=nKkIh1B2Js8
Speed Pharmacology. (2019). Pharmacology - DRUGS FOR PARKINSON’S DISEASE
(MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=Z84iypHdftQ
Speed Pharmacology. (2018). Pharmacology - GENERAL & LOCAL ANESTHETICS
(MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=wx3dZmv5pM0
Speed Pharmacology. (2019). Pharmacology - OPIOIDS (MADE EASY) [YouTube
Video]. In YouTube. https://www.youtube.com/watch?v=t2tKyjj7u5Y

References:

Falconer, A., Mary W., Patterson, H. R., & Gustafson (1978), The Drug, The Nurse, the
Patient. 5th Edition, Philadelphia: JB,Lippincott,

Karch, A.M. (2019), Focus on Nursing Pharmacology, 7th Edition. Wolters Kluwer

Kizior, Robert J., Hodgson, K.J., (2019) Saunders Nursing Drug Handbook 2019. Elsivier

Spratto,George R., and Woods, Adrienne I.; PDR Nurses Drug Handbook; The
Information Standard for Prescription Drugs and Nursing Considerations, 2007 ed;
New York Thompson Delmar Learning, 2004.

Hasudungan, A. (2016). Pharmacology - Antiepileptics [YouTube Video]. In YouTube.

https://www.youtube.com/watch?v=c-Cf1xkKofg
Med Made Sirius-ly easy. (2019). Pharmacology- Sedative, Hypnotic, Anxiolytic drugs,
GABA A receptor- CNS- MADE EASY! [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=XzCvs3zFnvA
Medical Mania. (2019). Muscle Relaxant Drugs Made Easy| STEP NCLEX COMLEX
[YouTube Video]. In YouTube. https://www.youtube.com/watch?v=NSq0baJ8YA8
PhysioPathoPharmaco. (2020). Migraines - Pathophysiology & Treatment (Described
Concisely) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=bvS646hm5v8
Speed Pharmacology. (2016). Pharmacology - ANTICHOLINERGIC &
NEUROMUSCULAR BLOCKING AGENTS (MADE EASY) [YouTube Video]. In
YouTube. https://www.youtube.com/watch?v=cp_CZpCBVpk
Speed Pharmacology. (2016). Pharmacology - ANTIDEPRESSANTS - SSRIs, SNRIs,
TCAs, MAOIs, Lithium ( MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=T25jvLC6X0w
Speed Pharmacology. (2018). Pharmacology - ANTIPSYCHOTICS (MADE EASY)
[YouTube Video]. In YouTube. https://www.youtube.com/watch?v=nKkIh1B2Js8
Speed Pharmacology. (2019). Pharmacology - DRUGS FOR PARKINSON’S DISEASE
(MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=Z84iypHdftQ
Speed Pharmacology. (2018). Pharmacology - GENERAL & LOCAL ANESTHETICS
(MADE EASY) [YouTube Video]. In YouTube.
https://www.youtube.com/watch?v=wx3dZmv5pM0
Speed Pharmacology. (2019). Pharmacology - OPIOIDS (MADE EASY) [YouTube
Video]. In YouTube. https://www.youtube.com/watch?v=t2tKyjj7u5Y