Subiaga, Keishey F.

BSN 2A

Drug Diary
(ANTI-PARKINSONISM)

Anti-Parkinsonism: Dopaminergics
Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1. carbidopa- - It works by - indicated in - dizziness, - Assess
levodopa being the treatment loss of therapeutic
converted to of Parkinson's appetite, response.
dopamine in disease, post- diarrhea, - Monitoring for
the brain. encephalitic dry mouth, side-effects,
Carbidopa is in parkinsonism, mouth and including mental
a class of and throat pain, state
medications symptomatic constipation, assessment and
called parkinsonism change in blood pressure
decarboxylase that may follow sense of taste, measurement.
inhibitors. It carbon forgetfulness - Care should
works by monoxide or confusion, be taken to
preventing intoxication or nervousness, avoid confusion
levodopa from manganese nightmares, with the
being broken intoxication. difficulty falling antihypertensive
down before it asleep or medication
reaches the staying asleep, methyldopa.
brain. This headache, - Levodopa can
allows for a weakness cause false
lower dose of results in urine
levodopa, tests for sugar
which causes and ketones.
less nausea
and vomiting.

Anti-Parkinsonism: Anticholinergics
Name of the Mode of Indication Side effect Nursing
Drug Action Considerati
on
1. Benztropine - exhibits - treatment of - drowsiness, - Monitor
(Cogentin) anticholinergi all forms of dizziness, confusion,
c properties Parkinson's headache, hallucinations
(blocks disease, loss of appetite, , depression,
 acetylcholine) including drug- nausea, and other
in the CNS to induced stomach upset, psychologic
reduce rigidity extrapyramidal vision changes, problems.
and tremors effects and sleeplessness Repeated or
acute dystonic excessive
reactions. symptoms
may require
change in
dose or
medication.
2. biperiden - The - is an - dry - Monitor
(Akineton) mechanism of anticholinergic mouth/nose/thro confusion,
action of antiparkinson at, hallucinations
centrally agent used to blurred vision, , depression,
active treat the drowsiness, and other
anticholinergi stiffness, euphoria or psychologic
c drugs such tremors, disorientation, problems.
as spasms, and urinary retention, Repeated or
AKINETON poor muscle dizziness when excessive
(biperiden) is control of standing up, symptoms
considered to Parkinson's constipation, may require
relate to disease. nausea change in
competitive dose or
antagonism of medication.
acetylcholine
at cholinergic
receptors in
the corpus
striatum,
which then
restores the
balance.
3.trihexyphenid - - indicated as - dry mouth, - Advise
yl (Artane) Trihexyphenid an adjunct in nervousness, patient to
yl belongs to the treatment of drowsiness, avoid driving
a class of all forms of dizziness, or other
medication parkinsonism large pupils, activities that
called (postencephaliti blurred vision, require
anticholinergi c, difficulty alertness
cs that work arteriosclerotic, urinating, until
by blocking a and idiopathic). constipation, response to
certain natural It is often useful medication is
substance as adjuvant known.
(acetylcholine therapy when Caution
). This helps treating these patient to
decrease forms of change
 muscle parkinsonism positions
stiffness, with levodopa. slowly to
sweating, and minimize
the orthostatic
production of hypotension.
saliva, and Instruct
helps improve patient that
walking ability frequent
in people with rinsing of
Parkinson's mouth, good
disease. oral hygiene,
and
sugarless
gum or candy
may
decrease dry
mouth.

Anti-Parkinsonism: Dopamine Agonists

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1.Amantadine - Antiviral The - indicated in the - Blurred - Monitor signs
(Symmetrel) mechanism treatment of vision, of leukopenia
by which idiopathic nausea, or neutropenia
amantadine Parkinson's stomach including fever,
exerts its disease upset, sore throat,
antiviral (Paralysis drowsiness, and signs of
activity is not Agitans), dizziness, infection.
clearly postencephalitic headache, Report these
understood. It parkinsonism, dry mouth, signs to the
appears to and symptomatic constipation, physician. Be
mainly parkinsonism nervousness, alert for
prevent the which may follow or trouble anxiety,
release of injury to the sleeping may confusion,
infectious nervous system occur. If any depression,
viral nucleic by carbon of these psychosis, or
acid into the monoxide effects other
host cell by intoxication. persist or alterations in
interfering worsen, mental status.
with the notify your Notify
function of doctor or physician
the pharmacist promptly if
transmembra promptly. these
ne domain of
 the viral M2 symptoms
protein. develop.
2.Bromocriptine - is in a class - indicated for the - mild - Monitor
(Parlodel) of treatment of headache, respiratory
medications dysfunctions depression, function at rest
called associated with dizziness, and during
dopamine hyperprolactinemi spinning exercise. Notify
receptor a including sensation, physician if
agonists. It amenorrhea with tired feeling, patient
treats or without drowsiness, experiences
hyperprolacti galactorrhea, sleep signs of
nemia by infertility or problems pulmonary
decreasing hypogonadism. (insomnia), infiltrates or
the amount of nausea. effusion,
prolactin in including
the body. It cough,
treats shortness of
acromegaly breath, chest
by pain, or
decreasing labored
the amount of breathing.
growth
hormone in
the body. It
treats
Parkinson's
disease by
stimulating
the nerves
that control
movement.
3.Pergolide - is an ergot - indicated as - dyskinesia, - Monitor
(Permax) derivative adjunctive hallucinations carefully for
similar to treatment to , disturbance orthostatic
bromocriptine levodopa/ of sleep, loss hypotension
which acts as carbidopa in the of appetite, and syncope
a dopamine management of nausea, when initiating
receptor the signs and hypotension, therapy.
agonist. symptoms of and
Pergolide, Parkinson’s tachycardia.
unlike disease.
bromocriptine
, has agonist
activity on
both D1 and
D2 dopamine
 receptors and
acts directly
on the
substantia
nigra
4.Pramipexole -stimulates - indicated for the -muscle -Monitor for
(Mirapex) dopamine treatment of the spasm or S&S of
receptors in signs and muscle orthostatic
the brain. The symptoms of weakness; hypotension,
exact idiopathic drowsiness, especially
mechanism of Parkinson's dizziness, when the
action of disease. weakness; dosage is
pramipexole confusion, increased.
in Parkinson's memory -Monitor
disease is problems; cardiac status,
unknown. dry mouth; especially in
However, nausea, those with
treatment constipation; significant
benefits are increased orthostatic
thought to be urination; or. hypotension.
related to the sleep
stimulation of problems
dopamine (insomnia),
receptors in unusual
the area of dreams.
the brain
known as the
striatum.

Anti-Parkinsonism: Monoamine Oxidase- B inhibitor

Name of the Mode of Action Indication Side effect Nursing
Drug Consideratio
n
1. - enzyme blocker - indicated as an - fainting, - Advise
Selegiline (MAO inhibitor) adjunct in the dry mouth, patient to
(Eldepryl) that works by management of nausea, avoid alcohol
slowing the Parkinsonian vomiting, because of the
breakdown of patients being heartburn, increased risk
certain natural treated with diarrhea, of sedation
gas,
substances in the levodopa/carbidop and adverse
constipation
brain a who exhibit effects.
.
(neurotransmitter deterioration in the Instruct patient
s such as quality of their to report other
dopamine, response to this troublesome
therapy. side effects
 norepinephrine, such as
and serotonin). severe or
prolonged
sleep loss,
vivid dreams,
or GI reactions
(nausea,
abdominal
pain, dry
mouth).
2.Rasagilin -a highly selective -indicated in adults -depressed -Assess signs
e (Azilect) and potent for the treatment of mood; and symptoms
propargylamine idiopathic sleep of Parkinson's
inhibitor of Parkinson's problems disease
monoamine disease as (insomnia), (tremor,
oxidase (MAO) monotherapy strange muscle
type B. Like other (without levodopa) dreams; weakness and
similar or as adjunct involuntary rigidity, ataxic
propargylamine therapy (with muscle gait) prior to
inhibitors, levodopa) in movements; and during
rasagiline binds patients with end loss of therapy.
covalently to the of dose appetite, -Monitor BP
N5 nitrogen of the fluctuations. The weight loss; periodically
flavin residue of recommended indigestion, during
MAO, resulting in dose of rasagiline stomach therapy.
irreversible is 1 mg (one tablet pain, -Assess skin
inactivation of the of AZILECT) once nausea, for melanomas
enzyme. daily, to be taken vomiting, periodically
with or without constipation during
levodopa. ; therapy.
joint pain or
stiffness;
rash;
cough or
other flu
symptoms

Anti-Parkinsonism: Cathecol- o- Methyltransferase (COMT)

Name of the Mode of Action Indication Side effect Nursing
Drug Consideration
1. Tolcapone - is unknown, but - indicated as - sleep - Do not engage
(Tasmar) it is believed to an adjunct to disturbances. in hazardous
be related to its levodopa and excessive activities until
ability to inhibit carbidopa for dreaming. response to drug
COMT and alter the treatment diarrhea. is known.
 the plasma of the signs dizziness.
pharmacokinetics and vomiting.
of levodopa, symptoms of increased
resulting in an idiopathic sweating.
increase in Parkinson's
plasma levodopa disease.
concentrations.
2.Entacapone - its ability to -indicated as -nausea, -Assess any
(Comtan) inhibit COMT in an adjunct to vomiting, muscle pain,
peripheral levodopa/ diarrhea, tenderness, or
tissues, altering carbidopa to constipation, weakness,
the plasma treat patients unwanted/ especially if
pharmacokinetics with idiopathic uncontrolled accompanied by
of levodopa. Parkinson's movements, fever, malaise,
Disease who increased and dark-colored
experience sweating, urine. Advise
the signs and drowsiness, patient that these
symptoms of dizziness. symptoms may
end-of-dose represent drug-
“wearing-off” induced
myopathy, and
that myopathy
can progress to
severe muscle
damage
(rhabdomyolysis).

(MUSCLE RELAXANTS)

Muscle Relaxant: Centrally Acting Muscle Relaxant

Name of the Mode of Action Indication Side effect Nursing
Drug Consideration
1. Baclofen - is a GABA - indicated for - dizziness. - Monitor patient
agonist, and its the relief of weakness. closely during
primary site of spasticity of confusion. initial (test) doses
action is the voluntary headache. and titration. ...
spinal cord, muscle nausea. -Monitor sudden
where it reduces resulting from constipation. changes in
difficulty falling spasticity,
the release of such disorders
asleep or muscle strength,
excitatory as multiple
staying asleep. or CNS
neurotransmitters sclerosis, other tiredness.
and substance P spinal lesions symptoms
(confusion,
 by binding to the e.g. tumors of somnolence,
GABA-B the spinal cord, agitation,
receptor. syringomyelia, hallucinations)
motor neuron that might
disease, indicate pump
transverse malfunction.
myelitis,
traumatic
partial section
of the cord.

Muscle Relaxant: Direct Acting Muscle Relaxant

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1.Dantrolene - depresses - indicated in - Drowsiness, - Report promptly
sodium excitation- controlling the dizziness, the onset of
(Dantrium) contraction manifestations weakness, jaundice: yellow
coupling in of clinical tiredness, skin or sclerae;
skeletal muscle spasticity nausea, and dark urine, clay-
by binding to resulting from diarrhea may colored stools,
the ryanodine upper motor occur as your itching,
receptor 1, and neuron body adjusts to abdominal
decreasing disorders (e.g., this medication discomfort.
intracellular spinal cord and usually
calcium injury, stroke, lessen after
concentration. cerebral palsy, several days.
Ryanodine or multiple Headache,
receptors sclerosis). constipation,
mediate the slurred speech,
release of and drooling
calcium from may also
the occur. If any of
sarcoplasmic these effects
reticulum, an persist or
essential step worsen, tell
in muscle your doctor or
contraction. pharmacist
Bioavailability promptly.
is 70%.
 (NARCOTICS AND ANTI-MIGRAINE)

Narcotics: Narcotics Agonist

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1. Morphine - binding to - indicated for - breathing - Monitor patient's
opioid the relief of problems; respiratory rate
receptors severe acute drowsiness, prior to
blocks and severe dizziness; administration.
transmission of chronic pain. constipation, Reassess pain
nociceptive nausea, after
vomiting;
signals, signals administration of
sweating; or.
pain- morphine.
numbness,
modulating Monitor for
tingling, or cold
neurons in the respiratory
feeling in your
spinal cord, depression and
hands and
and inhibits hypotension
feet.
primary frequently up to
afferent 24 hours after
nociceptors to administration of
the dorsal horn morphine. Place
sensory call light signal
projection close to patient.
cells. Morphine
has a time to
onset of 6-30
minutes.

Narcotics: Narcotic Agonists - Antagonists

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1.Pentazocine - both an - used to - feeling very - Report balance
opioid agonist relieve tired. problems and
and antagonist moderate to lightheadedness. functional
that induces severe pain. drowsiness. limitations to the
analgesia by Pentazocine is mood changes. physician and
stimulating the in a class of headache. nursing staff, and
upset stomach.
kappa and medications caution the
constipation.
sigma opioid called opiate patient and
stomach pain.
receptors. (narcotic) family/caregivers
Naloxone is an analgesics. It to guard against
 opioid works by falls and trauma.
antagonist that changing the Monitor injection
displaces way the brain site for pain,
opiates at and nervous swelling, and
opiate- system irritation. Report
occupied respond to prolonged or
receptor sites pain. excessive
in the CNS. injection-site
Therapeutic reactions to the
Effect: physician.
Pentazocine:
induces
analgesia.

Narcotics: Narcotics Antagonists

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1.Naloxone - binding to mu- - indicated for - body aches, a - assessed for
receptors in the complete fever, other causes of
the brain that or partial sweating, altered mental
opioids use to reversal of runny nose, status and/or
produce their opioid sneezing, respiratory
effect on pain depression, goose bumps, depression such
and other including yawning, as hypoxia,
symptoms. By respiratory weakness, hypoglycemia,
binding to mu depression, shivering or head injury,
receptors, induced by trembling, shock and stroke.
naloxone natural and nervousness,
reverses opioid synthetic restlessness or
activity in the opioids, irritability,
body. including diarrhea,
propoxyphene, nausea or
methadone vomiting,
and certain stomach
mixed agonist- cramps, fast
antagonist heartbeat, and
analgesics: increased
nalbuphine, blood
pentazocine, pressure.
butorphanol,
and
cyclazocine.
 2.Naltrexone - blocking the - is an opioid - Abdominal or - Instruct patient
effect of opioid antagonist stomach to report
receptors and used to treat cramping or bothersome side
decreasing alcohol use pain (mild or effects such as
cravings and disorder and moderate) severe or
urges to use opioid anxiety, prolonged
alcohol or dependence. nervousness, headache, cough,
opioids. This restlessness or nasal problems,
allows people trouble palpitations,
who take the sleeping. erectile
medication to headache. dysfunction, skin
control urges nausea or rash, chills, or GI
to use and help vomiting. problems
maintain unusual (nausea,
abstinence tiredness. vomiting,
from these diarrhea,
substances. constipation,
abdominal
cramps,
decreased
appetite,
increased thirst).

Anti-Migraine: Ergot derivatives:

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1. Ergotamine - selectively - used to treat - sudden - Monitor adverse
binds and a migraine numbness or GI effects.
activates type weakness, -Monitor patients
serotonin (5- headache. especially on with PVD
HT) 1D This one side of the carefully for
receptors medication will body; development of
sudden
located on only treat a peripheral
headache,
intracranial headache that ischemia.
confusion,
blood vessels, has already problems with -Monitor long-
including those begun. It will vision, speech, term
on arterio- not prevent or balance; effectiveness.
venous migraine fast or slow
anastomoses, headaches or heart rate;
thereby reduce the muscle pain in
resulting in number of your arms or
vasoconstriction attacks. legs;
and reducing leg weakness.
the blood flow
 in cerebral
arteries that
may lead to
relieve of
vascular
headaches.

(GENERAL AND LOCAL

ANESTHETICS)

General anesthetics: Midazolam

Name of the Mode of Action Indication Side effect Nursing
Drug Consideration
1.Benzodiazepine - in the central - - drowsiness. - Maintain
nervous system administration light- patients who
is by potentiation include, but headedness. receive
of the inhibitory are not confusion. parenteral
effect of γ- limited to, unsteadiness benzodiazepines
aminobutyric anxiety (especially in in bed for at least
older people,
acid on neuronal disorders, 3 hours to ensure
who may fall
transmission. All insomnia, patient safety.
and
benzodiazepines acute status experience Monitor patient
have hypnotic, epilepticus, injuries) response to
anticonvulsant, induction of dizziness. drugs through
muscle relaxant, amnesia, slurred vital signs,
amnesic, and spastic speech. weight, serum
anxiolytic disorders, muscle electrolytes and
properties. seizure weakness. hydration to
disorders, memory evaluate
and agitation problems. effectiveness of
drug therapy.

local anesthetic: Ester

Name of the Mode of Indication Side effect Nursing
Drug Action Consideration
1. Procaine - acts mainly by - is a - skin rash, - Report any skin
inhibiting combination of hives, reaction at the site
sodium influx an injectable hypersensitivity of injection.
through antibiotic and reactions,
voltage gated local including chills,
sodium anesthetic. fever,
swelling,
channels in the Indications for
joint pain,
neuronal cell use are quite
membrane of varied but and weakness.
peripheral include the
nerves. When treatment of all
the influx of stages of
sodium is syphilis, mild to
interrupted, an moderate
action potential pneumococcal
cannot arise pneumonia,
and signal and as an
conduction is adjunctive in
thus inhibited the treatment
of diphtheria
along with
intramuscular
(IM) antitoxin.
 (NEUROMUSCULAR
BLOCKING AGENTS)

Neuromuscular blocking agents

Name of the Mode Indication Side effect Nursing
Drug ofAction Consideration
1.depolarizing: -A depolarizing - indicated as -Abnormal/ -Ensure patient
succinylcholine neuromuscular an adjunct to irregular is fully
( Anectine) blocking agent, general heartbeats ventilated on a
succinylcholine anesthesia, to (cardiac controlled rate
adheres with facilitate arrhythmias) of breathing
post-synaptic tracheal Breakdown of before
muscle tissue
cholinergic intubation, and administration
(rhabdomyolysis)
receptors of to provide of a
Cardiac arrest.
the motor skeletal Excessive Neuromuscular
endplate, muscle salivation. Blocker (NMB).
inducing relaxation Fast or slow -Patient
continuous during surgery heart rate. requires an
disruption that or mechanical High blood arterial line
results in ventilation. potassium. and End Tidal
transient High or low CO2 -
fasciculations blood pressure. Monitoring.
or involuntary Increased eye Ensure ECG,
muscle pressure. oxygen
contractions saturation, End
and Tidal CO2 and
subsequent arterial
skeletal pressure
muscle alarms are on
paralysis. with
appropriate
alarm settings.

2.nondepolarizing: -A short acting, -It is one of the -nausea, -What is a

rocuronium non- many non- vomiting, nursing
depolarizing depolarizing swelling or consideration
neuromuscular neuromuscular discomfort at the for a
blocking agent blockers used injection site, neuromuscular
that directly but has the sleepiness or blocking
competes with distinct lightheadedness, agent?
acetylcholine advantage of mild itching or Ensure patient
on the being fast- skin rash, or. is fully
neuromuscular acting and ventilated on a
receptors. reversible. The high or low blood controlled rate
Indications: major pressure of breathing
Used for rapid indications for (hypertension or before
and smooth its use are: hypotension). administration
endotracheal Provide airway of a
intubation muscle Neuromuscular
when paralysis to Blocker (NMB).
succinylcholine facilitate Patient
is endotracheal requires an
contraindicated intubation in arterial line
or unavailable. elective as and End Tidal
well as CO2
emergent Monitoring.
conditions. Ensure ECG,
oxygen
saturation, End
Tidal CO2 and
arterial
pressure
alarms are on
with
appropriate
alarm settings.