Pain Management
Adverse effects: darifenacin, oxybutin, solifenacin
mydriasis, blurred vision, dry eyes, dry mouth, urinary retention, constipation
Mitoxantrone (immunosuppressant) adverse effects
myelosuppression, cardiotoxicity, fetal harm
Antipsychotics: black box warning
Increases risk of death in the elderly when used to treat dementia-related psychosis Death is mostly contributed by CV (heart failure, sudden death) and infection (pneumonia) factors
A client, residing in an assisted living facility, is diagnosed with Parkinson disease and the health care provider prescribes selegiline (Eldepryl). What precaution should the nurse teach the client? Change positions slowly. Take the medication between meals. Perform self-blood glucose monitoring. Withhold the next dose if nausea occurs.
Change positions slowly.
A client newly diagnosed with myasthenia gravis is to begin taking pyridostigmine (Mestinon), a cholinesterase inhibitor. Two days later the client develops loose stools and increased salivation. The nurse concludes that these signs are: Indicative of a myasthenic crisis Cholinergic effects A temporary response Toxic effects of the medication
Cholinergic effects
SSRI Drugs
Citalopram (Celexa) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Paroxetine (Paxil) Sertraline (Zoloft)
Adverse effects of SGAs
Common: sedation, weight gain, ortho hypoTN, dry mouth, blurred vision, urinary retention, constipation, tachycardia Rare: neuroendocrine effects, EPS and TD
A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The practitioner prescribes the anticholinergic medication benztropine (Cogentin) 2 mg daily. What should the nurse assess the client for daily when administering these medications together? Constipation Hypertension Increased salivation Excessive perspiration
Constipation
Monoamine Oxidase A
Inactivates NE and S-HT Inhibitors: antidepressants: PANAMA PAmate NArdil MArplan
A nurse is educating a client who is taking clozapine (Clozaril) for paranoid schizophrenia. What should the nurse emphasize about the side effects of clozapine? Risk for falls Inability to sit still Increase in temperature Dizziness upon standing
Increase in temperature
Adverse effects of MAO B inhibitors
Insomnia, Ortho hypoTN, HTN crisis (due to high doses, tyramine, sympathomimetic drugs)
Levadopa
Most effective in PD when combined with carbidopa Dopamine restoration (increases dopamine levels in the brain that are depleted in Parkinson disease)
The nurse explains to the family of a client suspected of having myasthenia gravis that edrophonium (Enlon) is used to establish the diagnosis. An increase in which factor will confirm the diagnosis? Symptoms Consciousness Blood pressure Muscle strength
Muscle strength
A client is receiving doxepin (Sinequan). For which most dangerous side effect of tricyclic antidepressants should a nurse monitor the client? Mydriasis Dry mouth Constipation Urine retention
Mydriasis
Antidepressants
SSRIs, SNRIs, TCAs, MAOIs, Atypical antidepressants, St. John's Wort 1-3 wks initial response; max response takes up to 12 wks (NOT PRN) first line: SSRIs, SNRIs, bupropion, mirtazapine second line: MAOIs and TCAs (old drugs)
SGAs (Atypicals)
Safer than FGAs less EPS and TD effects Serious metabolic effects: weight gain, diabetes, dyslipidemia Other adverse effects: sedation ortho hypoTN, increased risk of death in elderly -zapine, -ridone, Quetapine, Aripiprazole, Ziprasidone
What should the nurse include when teaching a client with severe Parkinson disease about carbidopa-levodopa (Sinemet)? Multivitamins should be taken daily Alcohol consumption should be in moderation The medication should be taken with meals A high-protein diet should be followed
The medication should be taken with meals (reduces nausea and vomiting)
Antipsychotics
Therapeutic effects takes MONTHS FGAs - Nuroleptics - causes high rates of extrapyramidal side effects (EPS) and tardive dyskenesia SGAs - Atypical - Lesser daverse effects than FGAs, serious metabolic effects
serotonin syndrome
overstimulation of peripheral serotonin receptors begins 2 - 72 hours after onset of treatment
Positive symptoms
overt symptoms that should not be present: hallucinations, delusions, disorganized thought
More adverse effects of Levodopa
postural hypoTN (increase Na and water, alpha agonist) Dysrhythmias visual hallucinations, nightmaires, paranoid ideation (FGAs decrease psychotic symptoms but increase PD, SGAs are preferred --> clozapine and quetapine) Dark sweat and urine color
An antidepressant is prescribed for a depressed older client. After 1 week the client's son expresses concern that there does not seem to be much improvement. How should the nurse respond? "Antidepressant therapy requires several weeks before it becomes effective." "Antidepressant therapy will be more effective as the physical condition improves." "Additional medications may be required before behavioral changes will be observed." "Additional time is needed for the medication to become effective because of the prolonged depression."
"Antidepressant therapy requires several weeks before it becomes effective."
Therapeutic uses of SGAs
Schizophrenia (last resort since it causes fatal agranulocytosis) Levodopa-induced psychosis
A nurse is interviewing a client in the mental health clinic. Which statement by the client indicates an irreversible adverse response to long-term therapy with an antipsychotic medication? "My mouth is always dry." "I can't seem to sleep at night." "I don't have much of an appetite." "My tongue seems to move by itself."
"My tongue seems to move by itself."
FGAs
Blocks dopamine (causes EPS and prolactin release), histamine (weight gain, sedation), cholinergic receptors (dry mouth, blurred vision, urinary retention, constipation), and alpha1 receptors (otho hypoTN, reflex tachycardia)
SNRIs
Blocks reuptake of serotonin and NE Venlafaxine (Effexor) Desvenlafaxine (Pristiq) Duloxetine (Cymbalta)
Drugs for neuropathic pain in MS
AEDs (carbamezepine (Tegretol), gavapentin (neurontin), oxcarazepin (Trileptal) TCAs (amitriptyline (Elavil), nortriptyline (Pamelor)
Treatment for EPS
Acute Dystonia: antiCHOLinergic drugs (eg, benztropine) IM or IV Parkinsonism: antiCHOLinergic drugs (eg, benztropine, diphenhydramine), amantadine, or both Akathisia: Benzodiazepine, beta blockers, antiCHOLinergic Tardive Dyskinesia (TD): No reliable treatment
More adverse effects of FGAs
Anticholinergic effects, orthostatic hypoTN, sedation, neuroendocrine effects (increase levels of prolactin which leas to gynecomastia and galactorrhea), seizures Sexual dysfunction, agranulocytosis (check and monitor WBCs), severe dysrhythmias
Drugs for OAB
Anticholinergics: Darifenacin, Oxybutin, Solifenacin, Festerodine, Tolterodine, Trospium
FGA drug interactions
Anticholinergics: antihistamines, OTC sleep aids CNS Depressants: antihistamines, BZDs, barbiturates Levodopa and direct DA receptor agonists (most Parkinson medications) - counteract antipsychotic effects
A practitioner prescribes an antidepressant for a hospitalized client who has been severely depressed. Eight days later the nurse notes that the client is neatly dressed and well groomed. The client smiles at the nurse and says, "Things sure look better today." What nursing response is appropriate in light of the client's statement? Complimenting the client's appearance Starting preparations for the client's discharge Arranging for constant supervision of the client Adding privileges to the client's plan of care as a reward
Arranging for constant supervision of the client
Non-motor PD symptoms
Autonomic: constipation (fluid, fiber, stool softener, laxative), urinary incontinence (oxybutynin, anticholinergic), ortho HTN (Na and fluids, steroids), erectile dysfunction (PDE5 inhibitor - sildenafil) Insomnia (levodopa/carbidopa) Excessive daytime sleepiness (modafinil) Depression, dementia, psychosis
Drugs for BPH alpha1 blockers Selective: Silodosin, Tamsulosin Nonselective: Alfuzosin, Doxazosin, Terazosin
Block alpha1 receptor reducing BPH symptoms RAPIDLY but does not delay progression Adverse effects include abnormal ejaculation (volume, failure, retrograde), risk of floppy iris syndrome during cataract surgery hypoTN, fainting, dizziness, nasal congestion
Parkinson's Disease
Chemical imbalance (low dopamine and high acetylcholine)
Drug therapy for MS
DZ modifiers: immunomodulators and immunosupresants Tx of acute relapse: high dose IV glucocorticoids and IV gamma globulin Symptom management: bladder dysfunction, bowel dysfunction, fatiqgue, depression, sexual dysfunction, neuropathic pain
Depression
Decreased norepinephrine, dopamin, and serotonin
TCAs (block NE)
Desipramine (Norpramin) Maprotiline Nortriptyline (Pamelor) Protriptyline (Vivacti
Drugs for bladder dysfunction in MS
Detrusor hyperreflexia (overactiv bladder): tolterodine, oxybutynin, darifenacin, solifenacin Flaccid bladder (urinary retention): bethanechol (urecholine)
Treatment managements of antidepressants
Dose should be low Drugs should be continued for 4-8 wks to assess efficacy Tx should continue at least 4 - 9 months to prevent relapse ADHERENCE IS CRITICAL discontinuation done SLOWLY
Adverse effects of FGAs (EPS)
EPS -> movement disorders -> too little DA and too much ACh Early reactions (hrs to days) - acute dystonia (abnormal muscle tone), parkinsonism, akathisia (restlessness) Late reaction (months to yrs) - tardive dyskinesia
Carbidopa
Enhances Levodopa Prevents decarboxylation of levodopa in the intestine and peripheral tissues --> increasing levodopa availability most effective PD therapy: levodopa + carbidopa = Sinemet or Parcopa
MAO B
Inactivates DA Inhibitors: anti-Parkinson (giline) Selegiline Rasagiline
COMT inhibitors
Inhibit metabolism of Ldopa in the periphery --> increases Ldopa half life in the BBB Entacapone Tolcapone
Drug-drug interaction of Levodopa
Levodopa + MAOI = HTN crisis
Drugs for sexual dysfunction in MS
Lubricants (vaginal dryness) PDE-5 inhibitors (Sildenafil (Viagra), vardenafil (Levitra) for erectile dysfunction
Neostigmine (Prostigmin) therapeutic uses
MG Reversal of Neuromuscular blockade
Food-drug interactions of Levodopa
Meals high in protein interfere with absorption from the intestine and across the BBB
Managing adverse effects of Levodopa
Presence of dyskinesia will need a decrease in L dopa, give amentadine, or surgery and electrical stimulation
AntiCHOLinergic Parkinson Drugs
Reduce tremor and possibly rigidity Benztropine Trihexyphenidyl (Artane)
The health care provider prescribes neostigmine (Prostigmin) for a client with myasthenia gravis. The nurse evaluates that the client understands the teaching about this drug when the client says, "I should: Keep the drug in a container in the refrigerator." Take the drug at the exact time that is listed on the prescription." Plan to take the drug between meals to promote absorption." Expect that the onset of the action of the drug will occur several hours after I take it."
Take the drug at the exact time that is listed on the prescription."
A 62-year-old patient who has Parkinson's disease is taking bromocriptine (Parlodel). Which information obtained by the nurse may indicate a need for a decrease in the dose? The patient has a chronic dry cough. The patient has four loose stools in a day. The patient develops a deep vein thrombosis. The patient's blood pressure is 92/52 mm Hg.
The patient's blood pressure is 92/52 mm Hg.
CHOLinesterase Inhibitors
prevents breakdown of ACh by inhibiting AChE Cannot cure or stop the progression of Alzheimer's DZ For mild-moderate symptoms Therapeutic affect is mild and short-lasting (exception of donepezil) Rivastagmine Galantamine Donepezil
Natalizumab
progressive multifocal leukoencephalopathy, liver injury
Adverse effects of SGAs (Agranulocytosis)
Agranulocytosis: causes gram negative septicemia (monitor WBC and neutrophil q2 weeks for 6 months, then monthly stop clozapine if WBC < 3000; ANC < 1500 Teach patient to monitor s/s of infection
TCAs (block NE and S-Ht)
Amitriptyline (Elavil) Clomipramine (Anafranil) Doxepin (Silenor) Imipramine (Tofranil) Trimipramine (Surmontil)
A health care provider prescribes tolterodine (Detrol) for a client with an overactive bladder. What is most important for the nurse to teach the client to do? Maintain a strict record of fluid intake and urinary output. Chew the extended release capsule thoroughly before swallowing. Report episodes of diarrhea or any increase in respiratory secretions. Avoid activities requiring alertness until the response to medication is known.
Avoid activities requiring alertness until the response to medication is known. Because tolterodine an antispasmatic may cause dizziness and blurred vision which increases risk for injury
Drugs for bowel dysfunction
Bulk-forming laxative: psyllium Enema Stool softeners (docusate sodium) Fatigue (Amantatide, modafinil)
N-methyl-D-aspartate receptor antagonist (NMDA)
Blocks calcium influx by modulating glutamate Well tolerated memantine (moderate-severe)
A client with myasthenia gravis has been receiving neostigmine (Prostigmin) and asks about its action. What information about its action should the nurse consider when formulating a response? Stimulates the cerebral cortex Blocks the action of cholinesterase Replaces deficient neurotransmitters Accelerates transmission along neural sheaths
Blocks the action of cholinesterase
Fingolimod
Bradycardia, infection, liver injury Macular edema
Neostigmine (Prostigmin) pharmacologic effects
CNS - Therapeutic dose causes mild stimulation Toxic dose depresses the CNS (including respiratory)
Entacapone
COMT-I combined with levodopa to enhance effects by inhibiting metabolization of levodopa and increasing availability
Anti-Parkinson Drugs
Cannot reverse neuronal damage. Only treats symptoms 2 broad classes of drugs: Dopaminergic agents and anticholinergic agents (anticholinergic = antimuscarinic = parasympathetic)
A client is to receive donepezil (Aricept) for treatment of dementia of the Alzheimer type. The nurse sits down with the primary caregiver and the client and reviews the purpose of the drug, its dosage, and the usual side effects. What side effect identified by the caregiver leads the nurse to conclude that further teaching is needed? Nausea Dizziness Headache Constipation
Constipation
Neuroleptic malignant syndrome is a potentially fatal reaction to antipsychotic therapy. What signs and symptoms of this syndrome should the nurse identify? Select all that apply. Jaundice Diaphoresis Hyperrigidity Hyperthermia Photosensitivity
Diaphoresis Hyperrigidity Hyperthermia
A client who is taking clozapine (Clozaril) calls the nurse in the psychiatric clinic to report the sudden development of a sore throat and a high fever. What should the nurse instruct the client to do? Stay in bed, drink fluids, take a dose of aspirin, and ask the health care provider to reduce the dosage of clozapine. Discontinue the medication immediately and see the health care provider as soon as an appointment becomes available. Continue the medication, drink fluids, take aspirin, and see the health care provider in a few days if the symptoms do not improve. Discontinue the medication and, if the health care provider is unavailable today, go to the emergency department for evaluation.
Discontinue the medication and, if the health care provider is unavailable today, go to the emergency department for evaluation.
AntiCHOLinergic Parkinson Drugs adverse effects
Dry mouth, blurred vision, constipation, urinary retention, tachycardia
Adverse effects of neostigmine
Excessive muscarinic stimulation neuromuscular blockade (paralysis of respiratory muscle can be fatal)
Drug therapy for Schizophrenia
FGAs and SGAs are equally effective (except clozapine is the most effective of all) FGAs = increased risk of EPS SGAs = greater risk of metabolic effects FGAs are cheaper Routes: oral (preferred) or IM (for severe, acute schizo and long term therapy) 12 months maintenance therapy; 102 days symptoms resolve (full response takes several wks to months) TAPER to discontinue
CHOLinesterase Inhibitors drug interactions
First gen antihistamines, TCA, conventional antipsychotics
MAO B Inhibitors
First line (modest result) Reduces "wear off" effect of Ldopa Increases DA by inhibiting MAO-B enzymes Selegiline Rasagiline
DA Agonists
First line for PD Pramipexole (Mirapex) Ropinirole (Requip) Bromocriptine (Parlodel)
Adverse affects of DA agonists
Nausea, postural hypoTN (dizziness), hallucinations, daytime sleepiness, "sleep attack", fetal injury, impulse control disorders
Adverse effects of Levodopa
Nausea, vomiting Dyskinesia (paradoxical effect) - head bobbing, tics, grimace, chorea movement
CHOLinesterase Inhibitors adverse effects
Nausea, vomiting, diarrhea dyspepsia, dizziness, headache Bronchoconstriction (caution in Asthma and COPD) Bradycardia, hypoTN, syncope (fall risk)
Cholinesterase inhibitors for MG
Neostigmine, pyridostigmine, endrophonium
Implementation: administration
Oral route Assist with administration if needed Involve family in medicating outpatients Inform patients that levodopa ma be taken with food to reduce n/jv but high-protein should be avoided Inform patients that benefits of levodopa may be delayed for weeks to months
Pramipexole
Oral, nonergot DA agonist First line for PD motor symptoms used alone in early PD and combined with levodopa in advanced PD Relieves motor PD symptoms by direct DA receptor in the striatum
Neostigmine (Prostigmin) Precaution
Prevention of Aspiration: teach patient to take meds on time especially BEFORE meals to prevent aspiration
Neostigmine (Prostigmin)
Prevents the breakdown of ACh by AChE
Selegiline (Eldepryl) is prescribed for a client with Parkinson disease who is having an inadequate response to dopar (Levodopa) therapy. When teaching the client about the addition of this drug to the regimen, the nurse should explain that the: Primary health care provider should be contacted immediately if a severe headache occurs. Therapeutic blood level of the drug should be monitored each month. Dosage of the drug can be adjusted daily depending on the client's response that day. Side effects of dopar will decrease when the Eldepryl and dopar are taken concurrently
Primary health care provider should be contacted immediately if a severe headache occurs.
S/S of Myasthenia Gravis
Ptosis Difficulty swallowing Weakness of skeletal muscle (including respiratory muscles)
A client with a tentative diagnosis of myasthenia gravis is scheduled to receive edrophonium (Enlon) to confirm the diagnosis. What response should the nurse anticipate will confirm myasthenia gravis? Brief exaggeration of symptoms Improvement in ptosis of the eyelids Prolonged symptomatic improvement Rapid but brief symptomatic improvement
Rapid but brief symptomatic improvement
Drugs for BPH: PDE-5 Inhibitors Tadalafil
Relaxes smooth muscle in the bladder, prostate, and urethra Adverse effects include HypoTN and priapism (persistent and painful erection)
A nurse is caring for a group of clients on the psychiatric unit. What clinical findings should alert the nurse that serotonin syndrome has developed in one of the clients? Continuous involuntary movement of the tongue and jaw Extremely high blood pressure with headache and flushing Blurred vision, urine retention, dry mouth, and constipation Restlessness, tachycardia, fever, diarrhea, and altered mental status
Restlessness, tachycardia, fever, diarrhea, and altered mental status
Antipsychotic drugs can cause extrapyramidal side effects. Which responses should the nurse document as indicating pseudoparkinsonism? Select all that apply. Rigidity Tremors Mydriasis Photophobia Bradykinesia
Rigidity Tremors Bradykinesia
A health care provider prescribes antipsychotic medication, and the nurse teaches the client about the possible side effects of the drug. The nurse concludes that the client needs further teaching about these side effects when he states that he should call the clinic if he experiences: Tremors Constipation Blurred vision Ringing in the ears
Ringing in the ears
Drugs for Depression in MS
SSRIs (fluoxetine (Prozac), sertraline (Zoloft0, Buproprion (Wellbutrin), TCAs (treat pain, insomnia, incontinence) -->amitriptyline (Elavil), Nortripyline (Pamelor)
The nurse is caring for a client with myasthenia gravis. The nurse expects which test to be ordered to differentiate a myasthenic crisis from a cholinergic crisis? CBC Tensilon Lumbar puncture Magnetic resonance imaging (MRI)
Tensilon
A client is to take an antipsychotic drug twice a day. Two thirds of the daily dose is given in the evening and one third in the morning. What should the nurse tell the client is the rationale for this schedule? To facilitate dreaming To maintain the daily sleep rhythm To reduce sedation during the daytime To decrease assaultiveness in the evening
To reduce sedation during the daytime
A nurse is caring for several clients who have severe psychiatric disorders. What is the major reason that a health care provider prescribes an antipsychotic medication for these clients? To improve judgment To promote social skills To diminish neurotic behavior To reduce the positive symptoms of psychosis
To reduce the positive symptoms of psychosis
A 76-year-old patient is being treated with carbidopa/levodopa (Sinemet) for Parkinson's disease. Which information is most important for the nurse to report to the health care provider? Shuffling gait Tremor at rest Cogwheel rigidity of limbs Uncontrolled head movement
Uncontrolled head movement
Carbidopa-levodopa (Sinemet) is prescribed for a client with Parkinson's disease. The nurse monitors the client for which side effects of the medication? Select all that apply. Vomiting Anorexia Slow heart rate Changes in mood Peripheral edema
Vomiting Anorexia Changes in mood
Metabolic adverse effects of SGAs
Weight gain (monitor every 4 wks until wk 12 then every 3 months) New onset of DM (check fasting blood glucose before therapy, 12 wks later, then yearly Dyslipidemia - increased total LDL and TG but decreased HDL (monitor fasting lipid before therapy, 12 wks later, then every 5 years)
s/s of serotonin syndrome
altered mental status (agitation, confusion, disorientation, anxiety, hallucinations, poor concentration), incoordination, myoclonus, hyper-reflexia, excessive sweating, tremor, fever
Psychotherapeutic drugs
antipsychotics, antidepressants, mood stabilizers, sedative hypnotics, anti anxiety
Multiple sclerosis
autoimmune, usually women are affected, hereditary S/S: nystigmus, tinnitus, diplopia, blurred vision, dysarthria, dysphagia, urinary retention, spastic bladder, constipation, weakness may progress to paralysis, ataxia, vertigo Onset in the 20s-40s
TCAs
block reuptake of NE, S-HT; also block cholinergic, alpha1, histamine and pain long 1/2 life Therapeutic uses: major depression, bipolar, fibromyalgia, neuropathic pain
Neostigmine (Prostigmin) muscarinic effects
bradycardia, bronchoconstriction, urinary urgency, increased GI motility, miosis (excessive constriction of the pupil)
Overactive bladder
detrusor muscle contracts before the bladder is full. do not confuse with incontinence
Symptoms of cholinergic crisis (DUMB BELS)
diarrea urination miosis bronchorrea bradycardia emesis lacrimation salivation/sweating
Cognitive deficits
difficulties with following aspects of cognition can make it heard to live a normal life or earn a living memory attention planning decision making
Memantine interactions
do not combine with other NMDAs (amantadine, ketamine)
Interferon beta adverse effects
flu-like symptoms, liver injury, myelosuppression
Dyskenesia
impaired movement
Pre-administration assessment
increase ability to perform ADLs Assess motor symptoms Skin assessment (levodopa + MAOi --> malignant melanoma) Special consideration to patients with cardiac dz, psychiatric disorders, and patients taking MAOIs
Immunomodulators
interferon beta natalizumab (also used in Chron's dz) Fingolimod
negative symptoms
lack of characteristics that should be present: reduced speech, even when encouraged to interact Lack of emotional and facial expression (affective flattening) Diminished ability to begin and sustain activities (avolition) decreased ability to find pleasure in everyday (anhedonia) Social withdrawal (asociality)
Neostigmine Drug-drug interactions
muscarinic antagonists: atropine --> antidote for neostigmine OD; reverses excessive muscarinic stimulation caused by neostigmine neuromuscular blockade (pancuronium) --> reverses muscle relaxation induced by pancuronium
Adverse effects of FGAs Neuroleptic Malignant Syndrome
muscle rigidity, sudden high fever, sweating dysrhythmia and fluctuations in BP Seizure, coma, respiratory failure TX: Dantrolene (direct-acting muscle relaxant), bromocriptine (relieves CNS toxicity)
Myasthenia Gravis
neuromuscular disorder (PNS) characterized by fluctuating muscle weakness and rapid fatique
TCAs adverse effects
ortho hypoTN, anticholinergic effect, diaphoresis, sedation, cardiotoxicity, seizures, CNS toxicity, hypomania, suicide risk
Drugs for BPH (S alpha reductase inhibitors) dutasteride finasteride
reduce dihydrotestosterone (DHT) production delaying BPH progression (takes months to develop) Adverse Effects include decreased ejaculation, bolume and libido teratogenic to male fetus
Benign prostatic hyperplasia
restricted urine flow due to enlarged prostate
FGAs therapeutic uses
schizophrenia, bipolar disorder, Tourette's syndrome, prevention of emesis
SSRIs adverse effects
sexual dysfunction, insomnia/agitation, GI toxicity, risk for upper GI bleed, nausea, weight gain, ortho hypoTN, serotonin syndrome, withdrawal syndrome (sysphoria, dizziness, GI distress, fatigue, chills, myalgia), suicide risk
Minimizing "wear off" of levadopa
shorten dose interval give a drug that prolongs levadopa's half life (COMT-1) give a direct dopamine agonist
Symptoms of Parkinson's Disease
slow slurred monotonous speech, blank face, rigidity and tremor of extremities and head forward tilt to posture, reduced arm swinging, short shuffling gait
adverse effects: festerodine, toterodine
somnolence, vertigo, dizziness, dry mouth tachycardia mydriasis, blurred vision, dry eyes, dry mouth, urinary retention, constipation
Neostigmine (Prostigmin) neuromuscular effects
therapeutic dose increases the force of contraction Toxic dose decreases the force of contraction
Edrophonium
ultra short-acting cholinergic causes symptom alleviation in Myasthenic crisis causes worsened symptom in cholinergic crisis
Reducing affects of anticholinergic drugs
use long acting formulations (extended release capsule or transdermal patch) Use drugs that don't cross the BB Use drugs that are selective for muscarinic receptors in the bladder