Causes include insufficient secretion of acetylcholine, excessive secretion of cholinesterase and unresponsiveness of the muscle fibers to acetylcholine
Anticholinesterase medications increase the amount of acetylcholine available by blocking ACH breakdown at the neuromuscular junction
Antimyasthenic medications are also used to distinguish between a cholinergic crisis from a myasthenic crisis (more on this a little later)
Edrophonium chloride (Tensilon)
Neostigmine bromide (Prostigmin)
-Monitor for signs and symptoms of medication overdose (cholinergic crisis) and underdose (myasthenic crisis).
-Instruct client to take medications on time to maintain therapeutic level, thus preventing weakness. Weakness can impair the client’s ability to breathe and swallow.
-Take with small amount of food to prevent GI symptoms
-Instruct the client to eat 45 to 60 minutes after taking medications to decrease risk for aspiration
-Instruct to wear a Medic-Alert bracelet.
-Instruct patient that therapy for myasthenia gravis is lifelong.
-Evaluate for medication effectiveness, which is based on improvement of neuromuscular symptoms or strength without cholinergic signs and symptoms.
-When administering edrophonium chloride (Tensilon), have emergency resuscitations equipment on hand and atropine sulfate available for a cholinergic crisis
-Parkinson’s disease is a degenerative disease caused by depletion of dopamine, which interferes with the inhibition of excitatory impulses, resulting in a dysfunction of the extrapyramidal system.
-It is a slow, progressive disease that results in a crippling disability.
-The debilitation can result in falls, self-care deficits, failure of body systems, and depression.
-Akinesia (loss or impairment of voluntary activity)
-Handwriting that becomes progressively smaller
-Tremors in hands and fingers at rest
-Rigidity with jerky movements
-Restlessness and pacing
-Blank facial expression
-Difficulty swallowing and speaking
-Loss of coordination and balance
-Shuffling steps, stooped position and propulsive gait
Biperiden hydrochloride (Akineton)
Procyclidine hydrochloride (Kemadrin)
-Increases heart rate, palpitations and dysrhythmias
-Restlessness, confusion, depression and hallucinations
-Photophobia (eye discomfort in bright light)
Carbidopa and levodopa (Sinemet)
Levodopa (Larodopa, Dopar)
Selegiline hydrochloride (Carbex, Eldepryl)
-Slowly taper off of these meds
-Brown-orange urine discoloration (entacapone)
-Life threatening reactions to COMT inhibitors: Acute liver failure
(Reddened gums that bleed easily)
-Sedation and drowsiness
-Rash or pruritis
-Elevated blood glucose level
-Blood dyscrasias: decreased platelet count and decreased WBC count
-When administering phenytoin IV, infuse no faster than 25-50 mg/min. Hypotension and cardiac dysrhythmias may occur if given any faster.
-Monitor the patient’s blood levels; the therapeutic level for phenytoin is 10 to 20 mcg/mL. Signs of toxicity include fever, coma, confusion, nystagmus, lethargy, low BP, ataxia, tremor, uncoordinated movements, slurred speech.
-Monitor CBC every 6 months.
-Don’t mix phenytoin with dextrose 5% in water because it will cause phenytoin to precipitate. Give with normal saline and infuse over 30-60 minutes with an in-line filter.
-Avoid giving phenytoin by IV push into veins on the back of the hand to avoid discoloration known as purple glove syndrome. Inject into larger veins or a central venous catheter, if available.
Instruct to not abruptly stop the medication and to take with food to reduce GI upset.
-Advise patient that phenytoin (Dilantin) decreases the effectiveness of some birth control pills.
-Laryngospasm, respiratory depression and hypotension when given IV
When giving phenobarbital by IV, monitor the patients respirations, don’t give more than 60 mg/min and have resuscitation equipment readily available
Clorazepate (Tranxene)–>adjunct therapy for partial seizures
Diazepam (Valium)–> treats status epilepticus
Lorazepam (Ativan) –> treats status epilepticus
*Benzos also used to treat anxiety and as sedatives and muscle relaxants
-If giving the IV form of diazepam, administer no more than 5 mg/min. have emergency resuscitation equipment at bedside.
-Don’t store IV diazepam solutions in plastic syringes.
-Monitor CBC and liver function tests (hepatotoxic)
-Monitor level of the drug in the blood (therapeutic level is 50-100 mcg/mL).