What does the EPS in the brain do?

Regulates involuntary movements

What must the EPS have in balance to function properly?

(2)

1. Acetylcholine

2. Dopamine

In PD, cells in the ___  ___ lose their pigmentation, indicating a decline in ___ production, which then results in an imbalance of ___ .

Substantia nigra

DA

ACh

What are the four cardinal symptoms of PD?

1. Tremor

2. Bradykinesia

3. Rigidity

4. Postural instability

How does the imblance on DA and ACh differ in EPSEs from PD

EPSEs are caused by DA receptors being blocked at the end of the DA tracts and in PD DA receptors are blocked at the beginning of the DA tracts

What is the only drug class that is given to treat EPSEs and why?

Anticholinergic because dopaminergics can cause too much DA to be in the brain, causing psychosis

___ drugs cause EPSEs

Antipsychotics

What EPSE?

Subjective feeling of restlessness

Akathesia

What EPSE?

Characterized by restless legs, jittery feelings, and nervous energy

Akathesia

What EPSE?

Responds poorly to treatment and is a major source of noncompliance with medication.

Akathesia

What EPSE?

This is the absence of moving or slowed movement

Akinesia or Bradykinesia

What EPSE?

Responds to anticholinergics and is characterized by weakness, fatigue, painful mjuscles, and anergia

Akinesia or Bradkinesia

What EPSE?

Abnormal postures (freezing) caused by involuntary muscle spasms

Dystonia

What EPSE?

Characterized by sustained, twisted, and contracted positioning of the legs, trunk, neck, or mouth

Dystonia

What EPSE?

Appears early in treatment, usually within the first 3 days.

Dystonia

What EPSE?

Responds to anticholinergics, but may need to be giver parenterally.

Dystonia

What EPSE?

Has types including torticollis, oculogyric crisis, and laryngeal-pharyngeal constrictions

Dystonia

What is torticollis?

Contracted positioning of the neck

What is oculogyric crisis?

Contracted positioning of the eyes upward

If a severe dystonic reaction occurs, what do you do first?

Administer antiparkinsonian drug IM

(Cogentin or Benadryl)

What EPSE?

Characterized by tremor, bradykinesia, and postural instability

Parkinsonism

What EPSE?

Tongue writhing, tongue protrusion, teeth grinding, and lip smacking (stop when sleeping)

Tardive Dykinesia

What EPSE?

Generally apears after 6 months

TD

What EPSE?

Anticholinergics are not used to treat, in fact they make this EPSE worse.

TD

What EPSE?

Often irreversible unless caught in time

TD

What EPSE?

You measure this with AIMS.

TD

What EPSE?

Characterized by hyperthermia (101.1 – 103, but can be as high as 108), rigidity, and autonomic dysfunction

NMS

What EPSE?

Treated with muscle relaxants (Dantrium) and central acting dopaminergics (Parlodel)

NMS

What major routine assessment should you do to predict NMS?

Temperature

What EPSE?

Characterized by leaning to one side and adults are more vulnerable.

Pisa Syndrome

What do antipsychotics do to dopamine?

Block it

Schizophrenia is linked to excessive amounts of ___ .

DA

What antiparkinsonian drug can cause psychosis in schizophrenic patients and why?

Dopaminergics because they can cause too much DA to be released

What do antipsychotics do that causes EPSEs?

Block DA recpetors

What type of antipsychotic cause more EPSEs?

Typical

Are anticholinergics a monotherapy or are they used adjuntively to treat EPSEs?

Monotherapy

What 3 physiological systems are more effected by anticholinergics?

CV, GI, and Urinary

What are some PNS S.E. of anticholinergics?

Dry mouth, urinary retention, constipation, blurred vision, nasal congestion, urinary hesitancy, photophobia, mydriasis, decreased sweating, fever, orthostatic hypotension, reduced breast milk, paralytic ileus

Patient Teaching

Dry mouth

Sugar-less gum, sucking on ice chips, fluid rinses, take before meals

Patient Teaching

Nasal congestion

OTC nasal decongestant if approved by the physician

Patient Teaching

Urinary hesitancy

Run water in the sink, privacy, run water over the perineum

Patient Teaching

Urinary retention

Encourage voiding, catheterization

Patient Teaching

Blurred vision/photophobia

Normal sight should resume in a few weeks, wear sunglasses, eye drops, encourage caution when driving

Patient Teaching

Constipation

Give laxatives, high fiber diet, encourage fluids, encourage walking,

Patient Teaching

Mydriasis

Report to physician immediately if eye pain developes

Patient Teaching

Decreased sweating

Can lead to fever, take temperature, reduce temperature with spong baths

Patient Teaching

Fever

Limit strenuous activity, advise patient to wear protective clothing

What are some CNS S.E. of anticholinergics?

Confusion, cognitive impoverishment, agitation, dizziness, drowsiness, disturbances in behavior

What CN is effected if mydriasis, blurred vision, or impaired accomidation occurs?

III

What CN is effected if dry mouth, decreased tearing, and dry nasal passages occurs?

VII

IX (minus decreased tearing)

What CN is effected if tachycardia, constipation, or dilated bronchi occurs?

X

What are the 3 main interactions with anticholinergics?

CNS depressants (alcohol), antacids, and antidiarrheals

What do antacids and antidiarrheals do to anticholinergics?

Decrease the absorption

What is considered the best drug to treat EPSEs?

Cogentin

What anticholinergic can be administered in an IM form and how long does it take for it to take effect?

Cogentin

20-30 minutes

T or F

It is prefered to have anticholinergics ordered PRN because some EPSEs are life threatening.

False, they are not ordered PRN because the doctor should know what the patient is experiencing before prescribing these drugs.

What drug class is used to treat NMS specifically?

Dopaminergics

How can Cogentin be given?

PO, IM, or IV

What are the 2 most commonly used anticholinergics?

Cogentin and Benadryl

Do dopaminergics increase or decrease DA in the brain?

Increase

What are the three dopaminergic drugs?

1. Symmetrel

2. Parlodel

3. Dantrim

What 2 vitamins are being debated on their usefulness for treatment of EPSEs?

Vitamins E and B6

You should use antiparkinsonians cautiously in...

The elderly, pregnancy, seizure disorders, and hypertension

What 2 drugs would a doctor prescribe together for a person with increased agitation and psychosis because it decreases anticholinergic S.E. and reduces anxiety?

Haldol and Ativan

Patient Teaching

Orthostatic hypotension

Warm, not hot baths, limit exercis on hot days, no hot tubs