Nursing Drugs

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Nursing Drugs
2011-08-13 21:44:46
nnursing Drugs

Antidepresants/antianxiety, antiHTN, nutrition/elimination, resp., analgesics, antiepileptics, opthalmics, antiparkinson's
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  1. Benzodiazepines
    • Diazepam (valium)
    • Lorazepam (ativan)
    • Alprazolam (xanax)
    • Clonazepam (klonopin)

    • Chlordiazepoxide (librium)
    • Midazolam (versed)- •reduces anxiety and pt’s memory of uncomfortable or painful procedures that do not require general anesthesia •* limited to use as sedative and anesthetic during invasive medical or surgical procedures
    • Action:
    • •depress activity in the brainstem and limbic system
  2. misc. antianxiety beta blocker
    • propranolol (inderal) is a commonly used beta blocker- antianxiety for stage fright.
    • bupropion (zyban)-is used for smoking cessation treatment
  3. Second-Generation Antidepressants Medications
    • •Trazodone (desyrel) – frequently prescribed for sleep.* ( need to monitor with males for side effect-priapism-inappropriate or prolonged penile erection)
    • •Bupropion (wellbutrin)
    • •SSRIs
    • •Fluxetine (prozac)
    • •Paroxetine (Paxil)
    • •Sertraline (zoloft)
    • •Fluvoxamine (Luvox)
    • •Citalopram (celexa)
    • •Mechanism of action
    • •Selectively inhibit serotonin reuptake
    • •Little or no effect on norepinephrine or dopamine reuptake
    • •Results in increased serotonin concentrations at nerve endings
    • •ADVANTAGE over tricyclics and MAOIs: little or no effect on cardiovascular system
  4. Third- Generation Antidepressants
    • •Venlafaxine (effexor)
    • •Nefazodone (serzone)
    • •Mirtazapine (remeron)
  5. Barbituarates and misc.
    • •BARBITUARATES – not commonly used in clinical practice for long-term treatment of anxiety due to produces many adverse effects and interactions; habit forming and low-therapeutic index (narrow dose range with in drug effectiveness and above that range is rapidly toxic)
    • •Miscellaneous agent-buspirone (BuSpar) nonsedating and non-habit forming
  6. MAOIs
    • Phenelzine (Nardil)
    • Tranylcypromine (Parnate)
    • Disadvantage: potential to cause hypertensive crisis when taken with tryramine (amino acid found in aged cheese, or other aged, overripe, or fermented foods)
    • Action:
    • •Inhibit the MAO enzyme system in the CNS
    • •Amines (dopamine, serotonin, norepinephrine) are not broken down, resulting in higher levels in the brain
  7. Common Tricyclics
    • •Amitriptyline (elavil, endep)
    • •Doxepin (Sinequan)
    • •Imipramine (tofranil)
    • •Desipramine (norpramine)
    • •Nortriptyline (aventyl, pamelor)
    • Action:
    • •Block reuptake of neurotransmitters causing accumulation at the nerve endings
  8. Adrenergic Drugs: Centrally Acting Alpha2-Receptor Agonists
    •clonidine (Catapres)

    • •methyldopa (Aldomet)
    • –Can be used for hypertension in pregnancy
    • Action:
    • –Stimulate alpha2-adrenergic receptors in the brain
    • –Decrease sympathetic outflow from the CNS
    • –Decrease norepinephrine production
    • –Stimulate alpha2-adrenergic receptors, thus reducing renin activity in the kidneys
    • •Results in decreased blood pressure
  9. •Peripheral alpha1-blockers/antagonists –Block alpha1-adrenergic receptors
    • •doxazosin (Cardura)
    • •terazosin (Hytrin)
    • •Results in
    • –Decreased BP
    • –Increased urinary flow
  10. Beta-blockers
    –Reduce BP by reducing heart rate through
    –Cause reduced secretion of renin
    –Long-term use causes reduced peripheral vascular resistance
    • •ProPranolol
    • •Atenolol
    • •Bystolic
  11. •Dual-action alpha1- and beta-receptor blockers –Block alpha1-adrenergic receptors
    • •Reduction of heart rate (beta1-receptor blockade)
    • •Vasodilation (alpha1-receptor blockade) –carvedilol (Coreg) and labetalol
    • –Result in decreased blood pressure
  12. •Peripherally acting alpha1-receptor agonists
    • –Treatment of hypertension
    • –Some used to relieve symptoms of BPH
    • •tamsulosin (Flomax)
    • –Management of severe HF when used with cardiac glycosides and diuretics
  13. ACE inhibitors
    • Drug of choice for diabetics.
    • •captopril (Capoten)
    • –Very short half-life
    • •enalapril (Vasotec)
    • –Available in oral and parenteral forms
    • •lisinopril (Prinivil and Zestril) and quinapril (Accupril), others
    • –Newer drugs, long half-lives, once-a-day dosing
  14. Ace inhibitor non-prodrugs
    •Captopril and lisinopril are NOT prodrugs

    –Prodrugs are inactive in their administered form and must be metabolized in the liver to an active form so as to be effective

    –Captopril and lisinopril can be used if a patient has liver dysfunction, unlike other ACE inhibitors that are prodrugs
  15. Angiotensin II Receptor Blockers
    • Does not produce dry caugh
    • •losartan (Cozaar, Hyzaar)
    • •valsartan (Diovan)
    • •eprosartan (Teveten)
    • •irbesartan (Avapro)
  16. Calcium channel blockers
    •Cause smooth muscle relaxation by blocking the binding of calcium to its receptors, preventing muscle contraction.

    • •Benzothiazepines
    • –diltiazem (Cardizem, Dilacor)
    • •Phenylalkamines
    • –verapamil (Calan, Isoptin)
    • •Dihydropyridines
    • –amlodipine (Norvasc), bepridil (Vascor), nicardipine (Cardene)
    • –nifedipine (Procardia), nimodipine (Nimotop)
  17. Vasodilators
    • •diazoxide (Hyperstat)
    • •hydralazine HCl (Apresoline)
    • •minoxidil (Loniten)
    • •sodium nitroprusside (Nipride, Nitropress)
  18. loop diuretics
    • —bumetanide (Bumex)
    • —furosemide (Lasix)
    • —torsemide (Demadex)
    • Action:
    • —Act directly on the ascending limb of the loop of Henle to inhibit chloride and sodium resorption
    • —Increase renal prostaglandins, resulting in the dilation of blood vessels and reduced peripheral vascular resistance
  19. Potassium-Sparing Diuretics
    • —amiloride (Midamor)
    • —spironolactone (Aldactone)
    • —triamterene (Dyrenium)
    • Risk of hyperkalemia.
    • Action:
    • —Work in collecting ducts and distal convoluted tubules
    • —Interfere with sodium-potassium exchange
    • —Competitively bind to aldosterone receptors
    • —Block resorption of sodium and water usually induced by aldosterone
  20. Thiazide and Thiazide-like Diuretics
    • —Thiazide diuretics
    • —hydrochlorothiazide HTZ (Esidrix, HydroDIURIL)
    • —chlorothiazide (Diuril)
    • —trichlormethiazide (Metahydrin)
    • —Thiazide-like diuretics
    • —metolazone (Mykrox, Zaroxolyn)
    • Action:
    • —Inhibit tubular resorption of sodium, chloride, and potassium ions
    • —Action primarily in the distal convoluted tubule
    • —Result: water, sodium, and chloride are excreted
    • —Potassium is also excreted to a lesser extent
    • —Dilate the arterioles by direct relaxation
  21. Carbonic Anhydrase Inhibitors (CAIs)
    • acetazolamide (Diamox)
    • methazolamide (Neptazane)

    CAIs block the action of carbonic anhydrase, thus preventing the exchange of H+ ions with sodium and water
  22. osmotic diuretic
    • mannitol (Osmitrol)
    • Action:
    • —Work mostly in the proximal tubule
    • —Nonabsorbable, producing an osmotic effect
    • —Pull water into the renal tubules from the surrounding tissues
    • —Inhibit tubular resorption of water and solutes, thus producing rapid diuresis
  23. Antacids
    • •Adverse effects
    • –G/I-MOM can cause diarrhea, Aluminum and calcium may cause constipation
    • –F/E- can cause metabolic alkalosis
  24. H2 receptor antagonists
    • –cimetidine (Tagamet)
    • –rantidine (Zantac)
    • –famotidine (Pepcid, Pepcid AC)
    • –nizatidine (Axid)
    • •Action
    • –prevents histamine from stimulating the H2 receptors located on the gastric parietal cells
    • –reduces the volume of gastric acid secretion
  25. proton pump inhibitors
    • –lansoprazole (Prevacid)
    • –omeprazole (Prisolec)
    • –pantoprazole (Protonix)
    • –rabeprazole (Aciphex
  26. cytoprotective agents
    • –sucralfate (Carafate)-used to tread stress ulcers
    • –misoprostol (Cytotec)-miscarriage
    • •Mechanism of action
    • –reacts with gastric acid to form a thick paste to selectively adhere to the ulcer surface- these molecules of sulfated sucrose are attracted to and bind with the base of ulcers
    • –decreases gastric acid
  27. bulk forming laxatives
    • –psyllium (Metamucil)-natural
    • –methycellulose (Citrucel)-synthetic
    • Action:
    • –stimulates peristalsis by absorbing water increasing bulk of feces to form emollient gel and causes dilation of intestine initiating reflex bowel activity promoting bowel movement
    • –used for chronic diarrhea
  28. hyperosmotic agents
    • –polyethylene glycol-electrolyte solution (Golytely), lactulose (Enulose), glycerin (fleet suppository)
    • •Mechanism of action:
    • –draws water into the G/I tract increasing fecal water content, resulting in distension, increased peristalsis, and evacuation
  29. Saline/Cathartic
    • –magnesium citrate (Citrate of Magnesia)
    • –magnesium hydroxide (MOM)
    • •Mechanism of action
    • –draws water into the small intestine- are a salt
    • –commonly used for rapid evacuation of the bowel in preparation for some GI diagnostic tests (colonoscopy)
  30. stimulant laxatives
    • castor oil
    • –cascara sagrada
    • –senna/ sennosids (Senokot)/(Ex-Lax Gentile Nature)
    • –bisacodyl (Dulcolax)
    • •Mechanism of action– can affect entire GI tract, action is in proportion to dose, most likely of all laxatives to cause dependence
    • –irritates intestine
    • –stimulates peristalsis
  31. emolients-stool softeners
    • –docusate potassium (Kasof)
    • –docusate calcium (Surfak)
    • –docusate sodium (Colace, Correctol)
    • •Mechanism of action- soften fecal impaction through the passage of water and lipids into fecal matter, facilitate easy bowel movements for patients with anorectal conditions (hemorrhoids), may be used prophalactially to prevent constipation in high risk patients
  32. emolients-lubricants
    • –mineral oil
    • Mechanism of action – eases passage of stool by preventing water from leaving the stool, lubricates the intestines
  33. absorbents-antidiarrheal
    • –bismuth subsalicylate (Pepto-Bismol)
    • –attapulgite (Kaopectate)
    • –activated charcoal
    • •Mechanism of action-
    • –coats the walls of the G/I tract, absorbing the bacteria or toxins causing diarrhea
    • –promotes intestinal adsorption of fluids and electrolytes
  34. Anticholinergics-antidiarrheal
    • –Atropine
    • –Belladonna alkaloids (Donnatal)
    • •Mechanism of action
    • –Antimotility- decrease peristalsis, decrease muscle tone , used in combination with adsorbents and opiates
  35. synthetic opiates-antidiarrheal
    • –Codeine
    • –loperamide
    • –diphenoxylate/atropine
    • •Mechanism of action- decrease bowel motility, secondary- reducing pain related to diarrhea and abdominal cramping, allow for water absorption due to decreased peristalsis
  36. intestinal flora modifiers-antidiarrheal
    • Lactobacillus acidophilus (Bacid, Lactinex)
    • Mechanism of action- suppresses growth of bacteria by restoring the natural flora of the bowel, they are natural organisms obtained from bacterial cultures, may need to be given post antibiotic therapy
  37. antiemetics-anticholinergics
    • –scopolamine
    • •Mechanism of action
    • –depresses the chemoreceptor trigger zone in the CNS- block acetocholine receptors
  38. ANTIEMETICS-antihistamines
    • –meclizine (Antivert)
    • –diphenhydramine
    • •Mechanism of action
    • –blocks HI receptors- inhibit acetocholine by binding with H1 receptors preventing cholinergic stimulation
  39. antiemetics-
    • –thiethylperazine maleate (Torecan)
    • –prochlorperazine (Compazine)
    • •Mechanism of action
    • –Depresses chemoreceptor trigger zone in CNS- block dopamine receptors
  40. antiemetics-prokinetic
    • –Metoclopramide (Reglan)
    • •Mechanism of action
    • –stimulates motility of upper G I tract- blocks dopamine in the CTZ desensitizing CTZ to impulses from the GI tract
  41. antiemetics-
    Serotonin blockers
    • –ondansetron (Zofran)
    • –granisetron (Kytril)
    • Mechanism of action- block serotonin receptors in GI tract, CTZ, and VC
  42. Resp. beta antagonist
    • •Fast acting (beta-2 selective)
    • •albuterol (Proventil, Ventolin) – MDI/nebulizer
    • •metaproterenol (Metaprel, Alupent) – MDI/nebulizer
    • •terbutaline (Brethine, Bricanyl) – PO, SQ, inhaled

    • •epinephrine-adrenaline (alpha, beta1 & 2) IV, SQ, inhaled
    • (Primatene)
    • •isoproterenol (Isuprel) (beta1 & 2) IV, inhaled

    • •Long acting
    • •salmeterol (Serevent) (beta-2 selective) Inhaled
    • •DO NOT use in acute attack because is not fast acting
    • Action:
    • •Bronchodilates à inhibits bronchoconstriction induced by release of histamine/substances during antigen/antibody reactions or anaphylaxis
    • •Relieves bronchospasm
    • •Reduces airway resistance
    • •Increases vital capacity
  43. resp.
    Xanthine "phyllines"
    • •aminophylline (Aminophylline, Palaron) IV, Rectal
    • •oxtriphylline (Choledyl, Apo-Oxtriphylline) PO
    • •theophylline (Bronkodyl) PO
    • •caffeine cup of coffee
    • Action:
    • •Mechanism of Action –
    • •Increase cAMP …
    • Direct effect on smooth muscle around airway … relaxes bronchial muscles around airway so when taking deep breath … à decreased resistance à bronchodilation
    • •Stimulates CNS
    • CARDIAC muscle à increase force of contraction
    • •Produces diuresis- cardiac function, blood flow to the kidneys
    • Inervention:
    • •limit xanthine containing foods- colas, coffee, and chocolate – see same side effects as with caffeine
    •block action of acetylcholine- prevent bronchoconstriction à produce local bronchodilation

    • •ipratropium (ATROVENT) Inhalation
    • •Ipratropium + albuterol (COMBIVENT) Inhalation
  45. resp.-
    • •montelukast (Singulair) PO
    • •zafirlukast (Accolate) PO
    • •zileuton (Zyflo)
    • Action:
    • block leukotriene receptors …prevent constriction/mucous, etc.
  46. mast cells stabilizers
    •cromolyn sodium (Instal)- mouth/nose spray- used for exercise induced asthma

    •nedocromil sodium (Tilade)-

    • •Mechanism of Action
    • •Mast cells: similar to lymphocytes but
    • •Heavily located in tissues of respiratory tract
    • •Stationary (do not circulate in blood stream)
    • •Stabilize the membrane of mast cells to prevent release of histamine
    • •histamine promotes …bronchoconstriction, vasoconstriction
  47. resp.-
    • 1. beclomethasone (Vanceril, Beclovent)
    • 2. budesonide (Pulmicort)
    • 3. flunisolide (AeroBid)
    • 4. fluticasone (Flovent)
    • 5. triamcinolone (Azmacort)
    • 6.dexamethasone (Decadron)
    • given PO or IV (systemic)
    • 7. cortisone (Prednisone) given PO
    • 8. methylprednisolone (Solu-Medrol, Solu-Cortef) given IV- (systemic)
  48. resp.-mucolytics
    acetylcysteine (Mucomyst, Mucosil, Airbron)-
    • •rifampin (Rifadin, Rimactane, Rofact)
    • •isonazid (INH, Nydrazid, Lanizid)
    • •pyrazinamide (PZA) -
    • •Use sunscreen while taking PZA- susceptible to sunburn.
    • •ethambutal (Myambutol)
    • •Streptomycin
    • •rifabutin (Mycobutin)

    •Combination of INH and ethambutol has been found to be safe in pregnancy
  50. Cholinesterase inhibitors (ChEIs)-
    • approved by FDA for symptomatic
    • Treatment of AD
    • acrine- in 1993
    • Donepezil- in 1997
    • Rivastigmine- 2000
    • Galantamine- 2001
    • Cholinergic hypothesis
    • Cholinergic neurons are lost in AD
    • Resulting in decreased levels of
    • acetylcholine
    • Cholinesterase inhibitors (ChEIs)prevent
    • the breakdown of acetylcholine
    • Benefits- increased cognition and day to day function and behavior symptoms
    • Key to benefits from ChEIs- prompt
    • initiation of therapy
  51. opioids analgesics
    • codeine sulfate
    • meperidine HCl (Demerol)
    • methadone HCl (Dolophine)
    • morphine sulfate
    • propoxyphene HCl (Darvon)
    • hydromorphone (Dilaudid)
    • fentanyl (Duragesic)
    • tramadol HCl (Ultram)
    • oxycodone (OxyContin, Roxicodone)
  52. nonopioid analgesics
  53. NSAIDs
    • Acetic acids (Voltaren, Indocin)
    • Carboxylic acids (salicylates) (ASA, Toradol)
    • Propionic acids (Naprosyn, Aleve)
    • COX-2 inhibitors (Celebrex, Vioxx)
    • Fenamic acids (Ponstel)
    • Napthylalkanones (nonacidic) (Relafin) Oxicams (Feldene)
  54. NSAIDs antigout
    allopurinol (Zyloprim)-reduce production of uric acid

    colchicine - reduce inflammatory response to deposits of urate crystals in joint tissue

    • probenecid (Benemid) \ increase excretion
    • sulfinpyrazone (Anturane) / of uric acid in the urine
  55. antirheumatiod
    • auranofin (Ridura)
    • Injectables:
    • adalimumab (Humera)
    • abatacept (Orencia)
    • aurothioglucose }
    • gold sodium thiomalate } (Aurolate)
    • leflunomide (Arava)
  56. sedative-hypnotics
    barbituates, phenobarbitol, pentobarbital
  57. benzodiazepines
    • diazepam Valium
    • lorazepam Ativan *
    • Alprazolam Xanax
    • oxazepam Serax
    • chlordiazepoxide HCl Librium
  58. benzodiazepine-sedative-hypnotics
    • žShort acting
    • ¡temazepam Restoril
    • ¡triazolam Halcion

    • žLong acting
    • ¡estazolam Prosom
    • ¡flurazepam Dalmane
  59. nonbenzodiazepine sedative hypnotics
    • • zalepion Sonata
    • • zolpidem Ambien
    • • eszoplicone Lunesta
  60. classes of nonepileptic drugs
    • ˜Barbitruates
    • Phenobarbitol
    • ˜Hydantoins
    • Phenytoin – Dilantin
    • Fosphenytoin - Cerebyx
    • ˜Iminostilbenes
    • Carbamazepine – Tegretol, Carbatrol
    • Oxcarbazepine – Trileptal
    • ˜Valporic Acid – Depakote, Depakene
  61. misc. newer antiepileptic drugs
    • ˜Gabapentin – Neurontin- also used to treat neuropathic pain
    • ˜Lamotrigine – Lamictal – also used for bipolar disorder
    • ˜Pregabalin – Lyrica – schedule V controlld substance- more commonly used for neuropathic pain.
  62. Cholinergic Drugs- ophthalmics
    • ˜Direct-acting drugs
    • acetylcholine (Miochol-E)-used for surgical miosis-rapid acting-short duration
    • carbachol (Carboptic)
    • pilocarpine (Pilocar) (also ocular insert form)-commonly seen
    • ˜Indirect-acting drugs
    • echothiophate (Phospholine Iodide)
    • Action:
    • ˜Cause pupillary constriction (miosis), which leads to reduced IOP caused by increased outflow of aqueous humor
  63. Sympathomimetics
    • ˜brimonidine (Alphagan)
    • ˜apraclonidine (Iopidine)-used to inhibit perioperative intraocular pressure increases rather than to treat glaucoma
    • ˜epinephryl (Epinal)
    • ˜dipivefrin (Propine)
    • Action:
    • ˜Mimic the sympathetic neurotransmitters epinephrine and norepinephrine
    • ˜Stimulate the dilator muscle to contract
    • Result is increased pupil size (mydriasis)
    • ˜Enhance aqueous humor outflow through the canal of Schlemm
    • IOP is reduced
  64. Beta-Adrenergic Blockers
    • ˜Selective beta1-blocker
    • betaxolol (Betoptic)
    • ˜Nonselective beta1- and beta2-blockers
    • carteolol (Ocupress)
    • levobunolol (Betagan Liquifilm)
    • metipranolol (Optipranolol)
    • timolol (Timoptic, Betimol)-increases the outflow of aqueous humor as well as decrease in its formation.
    • Action:
    • ˜Reduce IOP by
    • Reducing aqueous humor formation
    • Increasing aqueous humor outflow
    • ˜Do not affect pupil size, accommodation, or night vision
  65. Carbonic Anhydrase Inhibitors
    • ˜Topical ophthalmic preparations
    • brinzolamide (Azopt)
    • dorzolamide (Trusopt)
    • ˜Oral forms
    • acetazolamide (Diamox)
    • Action:
    • ˜Available in oral forms for treatment of glaucoma – these would be diuretics and can be used as adjunct to ophthalmic medications
    • ˜Inhibit the enzyme carbonic anhydrase, which reduces aqueous humor formation in the eye
    • ˜Result is decreased IOP
  66. osmotic diuretics- opthalmics
    • ˜Glycerin usually tried first
    • Can cause hyperglycemia
    • ˜Mannitol used if glycerin is unsuccessful
    • ˜Isosorbide and urea may also be used
    • Action:

    • ˜Create ocular hypotension by producing an osmotic gradient
    • ˜Water is forced from the aqueous and vitreous humors into the bloodstream
    • ˜Result is reduced volume of intraocular fluid, thus reduced IOP
  67. Prostaglandin Agonists
    • ˜Newer class of drugs for glaucoma
    • ˜Three drugs
    • latanoprost (Xalatan)
    • •Most popular
    • travoprost (Travatan)
    • bimatoprost (Lumigan)
    • Action:
    • ˜Reduce IOP by increasing the outflow of aqueous fluid-not reducing its production
    • ˜Increase uveoscleral outflow of fluid
    • ˜Used in the treatment of glaucoma

    • ˜Effects on eye color
    • In some persons with hazel, green, or blue/brown eyes, eye color will change permanently to brown
    • Color change occurs even if medication stopped
  68. antiparkinsons
    Direct –Acting Dopamine Receptor Agonists
    • Nondopamine-receptor agonists
    • Ergot: bromocriptine
    • Nonergot: pramipexole, ropinirole, apomorphine

    • Dopamine replacement drugs
    • Carbidopa, carbidopa-levodopa
  69. Indirect-acting dopamine-receptor agonists
    • ˜MAOI inhibitors: selegiline, rasagiline
    • COMT inhibitors: entacapone, tolcapone
    • Presynaptic dopamine release enhancer: amantadine
  70. antiparkinson's anticholinergics, antihistamines
    • ˜Anticholinergic drugs
    • Benztropine, others
    • ˜Antihistamines
    • Diphenhydramine
  71. Selective MAOI Therapy: Selegiline
    • ˜MAOIs break down catecholamines in the CNS, primarily in the brain
    • ˜Selegiline is a selective MAOB inhibitor
    • Causes an increase in levels of dopaminergic stimulation in the CNS
    • ˜Used in combination with levodopa or levodopa-carbidopa
  72. Presynaptic Dopamine Release Enhancer
    • ˜Amantadine (Symmetrel)
    • Action: Indirect-acting
    • Causes release of dopamine from storage sites at the end of nerve cells that are still intact
    • Blocks reuptake of dopamine into the nerve endings, allowing more to accumulate both centrally and peripherally
    • Does not stimulate dopamine receptors directly
  73. COMT inhibitors
    • Tolcapone (Tasmar) and entacapone (Comtan)
    • ˜Inhibit COMT, the enzyme responsible for the breakdown of levodopa, the dopamine precursor
    • ˜Prolong the duration of action of levodopa; reduce wearing off phenomenon
    • ˜Therapeutic effects of COMT inhibitors may be noticed within a few days; it may take weeks with other drugs
  74. Direct-Acting Dopamine Receptor Agonists
    • ˜Nondopamine dopamine receptor agonists (NDDRAs)
    • Ergot derivatives (bromocriptine and pergolide)
    • Nonergot drugs (pramipexole, ropinirole, apomorphine)
  75. Direct-Acting Dopamine Receptor Agonists
    • ˜Nondopamine dopamine receptor agonists (NDDRAs)
    • Ropinirole (Requip)
    • •Newer, nonergot NDDRA
    • •Used for PD and restless leg syndrome
    • Apomorphine (Apokyn)
    • •Newer, nonergot dopamine agonist
    • •Subcutaneous injection
  76. Direct-Acting Dopamine Receptor Agonists (cont’d)
    • ˜Direct-acting
    • Bromocriptine (Parlodel)
    • ˜Directly stimulate dopamine receptors
    • ˜Activate dopamine receptors and stimulate production of more dopamine
    • ˜Pergolide (Permax) is another direct-acting drug with a different mechanism of action
  77. Levodopa therapy
    • •Levodopa and carbidopa are CONTRAINDICATED in patients with angle-closure glaucoma
    • •Common side effects:
    • Cardiac dysrhythmias; hypotension; muscle cramps and GI disturbances.
    • •Do not give with benzodiazepines or MAOIS
    • ˜Levodopa preparations may darken the patient’s urine and sweat
  78. Anticholinergic Therapy
    • ˜benztropine mesylate (Cogentin)
    • Also used to treat extrapyramidal symptoms caused by use of antipsychotic drugs
    • ˜Trihexyphenidyl (generic only)
    • ˜Antihistamines also have anticholinergic properties
    • diphenhydramine (Benadryl)
    • Action:
    • ˜Anticholinergics block the effects of ACh
    • ˜Used to treat muscle tremors and muscle rigidity associated with PD
    • These two symptoms are caused by excessive cholinergic activity
    • ˜Does not relieve bradykinesia (extremely slow movements)

    • ˜ACh accumulates because of the imbalance of dopamine
    • ˜As a result, overstimulation of the cholinergic excitatory pathways occurs
    • Muscle tremors and muscle rigidity
    • Cogwheel rigidity
    • Pill-rolling movement of fingers and head bobbing while at rest