Neuromuscular Drugs
- Cholinergic Blocking Drug
How do they work? “Action” Drugs with Parkinson-like Adverse Reactions
Drugs with cholinergic blocking activity block ACh in the The following drugs can produce symptoms similar
CNS, enhancing dopamine transmission. to Parkinson’s disease, also known as extrapyramidal
symptoms (EPS), which may be treated with
similar drugs to reduce the adverse reactions:
• Antidepressants
Indications • Antiemetics
• Antipsychotics—first generation
Adjunctive therapy in all forms of Parkinson-like • Lithium
symptoms and in the control of drug-induced extrapyra- • Stimulants
midal disorders • Individuals older than 60 years frequently develop
increased sensitivity to anticholinergic drugs and
require careful monitoring. Confusion and
disorientation may occur. Lower doses may be
required.
Adverse Reactions
• Dry mouth
• Blurred vision
• Dizziness, mild nausea, and nervousness
• Skin rash, urticaria (hives)
Nursing management
• Urinary retention, dysuria
• Tachycardia, muscle weakness • If dizziness, drowsiness, or blurred vision occurs,
• Disorientation and confusion
avoid driving or performing other tasks that require
alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy (unless
Contraindications the patient has diabetes) or taking frequent sips of
• Glaucoma (angle-closure glaucoma) water. Consult a dentist if dryness of the mouth
• Pyloric or duodenal obstruction interferes with wearing, inserting, or removing
• Peptic ulcers, prostatic hypertrophy, achalasia (failure of dentures or causes other dental problems.
the muscles of the lower esophagus to relax, causing • Keep all appointments with the primary health care
difficulty swallowing), myasthenia gravis, and megacolon. provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking levodopa.
Vitamin B6 (pyridoxine) may interfere with the
Interactions
action of levodopa.
• Amantadine: Increased anticholinergic effects
• Digoxin: Increased digoxin serum levels
• Haloperidol: Increased psychotic behavior
• Phenothiazines: Increased anticholinergic effects
Generic Trade Use Dose
Parkinson’s disease, 0.5–6 mg/day orally
Benztropine Cogentin
drug-induced EPS Acute dystonia: 1–2 mL IM or IV
Diphenhydramine Benadryl Drug-induced EPS, allergies 25–50 mg orally TID or QID
- Cholinergic Blocking Drug
How do they work? “Action” Drugs with Parkinson-like Adverse Reactions
Drugs with cholinergic blocking activity block ACh in the The following drugs can produce symptoms similar
CNS, enhancing dopamine transmission. to Parkinson’s disease, also known as extrapyramidal
symptoms (EPS), which may be treated with
similar drugs to reduce the adverse reactions:
• Antidepressants
Indications • Antiemetics
• Antipsychotics—first generation
Adjunctive therapy in all forms of Parkinson-like • Lithium
symptoms and in the control of drug-induced extrapyra- • Stimulants
midal disorders • Individuals older than 60 years frequently develop
increased sensitivity to anticholinergic drugs and
require careful monitoring. Confusion and
disorientation may occur. Lower doses may be
required.
Adverse Reactions
• Dry mouth
• Blurred vision
• Dizziness, mild nausea, and nervousness
• Skin rash, urticaria (hives)
Nursing management
• Urinary retention, dysuria
• Tachycardia, muscle weakness • If dizziness, drowsiness, or blurred vision occurs,
• Disorientation and confusion
avoid driving or performing other tasks that require
alertness.
• Avoid the use of alcohol unless use has been
approved by the primary health care provider.
• Relieve dry mouth by sucking on hard candy (unless
Contraindications the patient has diabetes) or taking frequent sips of
• Glaucoma (angle-closure glaucoma) water. Consult a dentist if dryness of the mouth
• Pyloric or duodenal obstruction interferes with wearing, inserting, or removing
• Peptic ulcers, prostatic hypertrophy, achalasia (failure of dentures or causes other dental problems.
the muscles of the lower esophagus to relax, causing • Keep all appointments with the primary health care
difficulty swallowing), myasthenia gravis, and megacolon. provider or clinic personnel because close
monitoring of therapy is necessary.
• Ask your primary health care provider before
buying vitamin supplements when taking levodopa.
Vitamin B6 (pyridoxine) may interfere with the
Interactions
action of levodopa.
• Amantadine: Increased anticholinergic effects
• Digoxin: Increased digoxin serum levels
• Haloperidol: Increased psychotic behavior
• Phenothiazines: Increased anticholinergic effects
Generic Trade Use Dose
Parkinson’s disease, 0.5–6 mg/day orally
Benztropine Cogentin
drug-induced EPS Acute dystonia: 1–2 mL IM or IV
Diphenhydramine Benadryl Drug-induced EPS, allergies 25–50 mg orally TID or QID
