Summary PHARM 101 - Exam 3 Study Guide.

Drugs for Degenerative Diseases of the Nervous System
 Parkinson’s disease
o Degeneration and destruction of dopamine-producing neurons
o Symptoms of disease
 Tremors
 Muscle rigidity
 Bradykinesia
 Postural instability
 Affective flattening
o Goals:
 Restore balance of dopamine and acetylcholine
o Medications
 Dopaminergic examples
 Levodopa
o Mechanism of action: increases biosynthesis of dopamine within
nerve terminals
o Primary use: to restore dopamine function or stimulate dopamine
receptors within the brain
o Several months to reach max effects!
o Adverse effects: uncontrolled and purposeless movements,
involuntary movement, loss of appetite, nausea, vomiting
o Early signs of toxicity: spasmodic winking and muscle twitching
o Slow withdrawal*
o Contraindicated in narrow-angle glaucoma
o Contraindications:
 Narrow-angle glaucoma
 Concurrent use with MAOIs
 Seizure disorders
 Melanoma or hx of melanoma
 Concurrent use with Haldol or Phenothiazines
o Seizure threshold is lowered
 Anticholinergic Agents
 benztropine (Cogentin)
o Mechanism of action: blocks excess cholinergic stimulation of
neurons in corpus striatum; inhibit over activity in brain
o Adverse effects: dry mouth, blurred vision, photophobia, urinary
retention, constipation, tachycardia, glaucoma
o Centrally acting
o Block acetylcholine
 Inhibit overactivity in brain
o Not as effective as dopaminergics
o Used in early stages of PD therapy
 Key teaching points/Role of the Nurse
 Increase fiber and fluids
 May take several months for full effect

,  Abruptly stopping the drug may cause parkinsonism crisis
 Relieve dry mouth with frequent drinks or sugarless hard candy
 Take with food or milk to prevent GI upset
 Avoid alcohol
 High Protein diet can decrease effects of levodopa; space out protein
intake
 Alzheimer’s disease
o Degenerative disease of CNS
o Progressive loss of brain function
 Memory loss, confusion, dementia
 Affects memory, cognitive function, and behavior
 Life expectancy 5-10 years post dx
o Symptoms
 Impaired memory and judgment
 Confusion and disorientation
 Inability to recognize family and friends
 Aggressive behavior
 Depression
 Psychoses, including paranoia and delusions
 Anxiety
o Medications
 Acetylcholinesterase (AChE) Inhibitors
 donepezil hydrochloride (Aricept)
o Mechanism of Action: prevents breakdown of acetylcholine;
enhance transmission in neurons
o Advantage: long half-life, once daily
o Disadvantage: therapeutic effects are short lived
o Adverse effects: N/V/D;
 less commonly dizziness and headache, abnormal
dreams, irritability, darkened urine
o Nursing Considerations:
 Taper dose
 Assess baseline vitals
 Monitor for hypotension
 Monitor for change in mental status or mood
 Monitor for dizziness, insomnia, anorexia
Seizures
 Abnormal or uncontrolled neuronal discharges in the brain
 Affect
o Consciousness
o Motor activity
o Sensation
 Convulsions: Involuntary violent spasm of large muscles of face, neck, arms, and legs
 Eclampsia: Severe hypertensive disorder of pregnancy, characterized by seizures, coma, and
perinatal mortality

,  FDA warning: suicidal behavior and ideation
 Goal: suppress neuronal activity to prevent abnormal or repetitive firing
 Medications
o Stimulating an influx of chloride ions-Drugs that potential GABA
o Act by changing the action of gamma-aminobutyric acid (GABA), the primary inhibitory
neurotransmitter in the brain
 Benzodiazepines
 Prototype drug: diazepam (Valium) and lorazepam (Ativan)
 Mechanism of action: similar to that of barbiturates but safer
 Primary use: for short-term seizure control
 Adverse effects: drowsiness and dizziness
o High dose or IV dose:
o Antidote:
o Schedule IV
o Preg Cat D
 Nursing care and/or Patient Teaching for Benzos
o Avoid alcohol, OTC drugs, and herbal medications
o Avoid nicotine
o Avoid driving and hazardous activities
o Rebound seizures if discontinued abruptly
o Take with food
o Drug often used illegally
o Other examples: Gabapentin (Neurontin)

Infections
 -Cidal (bactericidal, fungicidal)
 -Static (bacteriostatic, fungistatic)
 Medications
o Beta lactam abxs
 Beta lactam ring
 Penicillin
 Cephalosporin
 Beta lactamase or Penicillinase can split beta lactam ring
 Cross-sensitivity
o Penicillin’s
 Natural penicillins (Narrow spectrum), first generation: penicilling G potassium
and penicillin V
 Penicillinase-resistant penicillins (Antistaphylococcal): only category resistant to
beta lactimase
 Aminopenicillins (broader spectrum penicillins)
 Extended-spectrum penicillins (Antipseudomonals)
 penicillin (Penicillin G, PCN V)
 Action: Bactericidal by inhibiting cell-wall synthesis during
multiplication
 Adverse effects: lowered red/white blood cell and platelet levels
 N/V/D most common ADR