Generic

Classification

name (Brand
name)
Levodopa

Antiparkinsoni

(Madopar)

an drug
(Dopaminergic
s)

Indications,

Mechanism of

dosage and

action

frequency
Parkinsons

disease
tablet
BID
alternate
with
tablet BID

Block central

Side effects

CNS: confusion,

cholinergic

headache,

receptors or

dizziness,

inhibit prolactin

fatigue, light-

secretion; also

headedness,

may act as

drowsiness,

dopamine

nervousness,

receptor

insomnia,

agonists

nightmares,

activating

mania,

postsynaptic

delusions,

dopamine

seizures, CVA
CV: hypotension,

receptors.
Drug is a

palpitations,

metabolic

extrasystole,

precursor of

bradycardia.

dopamine, a

arrhythmias,

catecholamine
neurotransmitter
. Unlike

Acute MI
EENT: diplopia,
blurred vision,

Nursing interventions

Give with food to reduce

nausea. Absorption is
decreased with highprotein meals.
Crush tablets or empty
capsule content into fruit
juice as needed.
Store in tight, lightresistant containers.
Monitor vital signs,
particularly during period
of dosage adjustment.
Report alterations in BP,
pulse, and respiratory
rate and rhythm.
Supervise ambulation as
indicated. Orthostatic
hypotension is usually
asymptomatic, but some
patients experience
dizziness and syncope.
Tolerance to this effect

dopamine,

burning

levodopa readily

sensation of

crosses the

eyes, nasal

bloodbrain
barrier. Precise

congestion
GI: nausea,
vomiting,

mechanism of
-

diarrhea,

action unknown.
Levodopa

constipation,

restores

abdominal

dopamine levels

cramps, dry

in

mouth, anorexia,

extrapyramidal
centers

GI hemorrhage
GU: urinary
incontinence,

(believed to be

frequency or

depleted in

retentions,

parkinsonism)

dieresis, erectile
-

dysfunction
Hepatic:

hepatic failure
Musculoskeleta
l: leg cramps.

numb fingers
Skin: urticaria,

usually develops within

a few months of therapy.
Make accurate
observations and report
adverse reactions and
therapeutic effects
promptly. Rate of
dosage increase is
determined primarily by
patients tolerance and
response to drug.
Monitor all patients
closely for behavior
changes.
Monitor patients with
chronic wide-angle
glaucoma for changes in
intraocular pressure.
Monitor diabetics for
loss of glycemic control.
Lab tests: Monitor blood
glucose & HbA1C, CBC,
Hgb and Hct, serum
potassium, and liver &
kidney function

pale, cool fingers

and toes, facial

and arm rash,

-

alopecia
Other:
hyperthermia,
heat stroke

periodically.
Report promptly muscle
twitching and spasmodic
winking
(blepharospasm); these
are early signs of
overdosage. Patients on
full therapeutic doses for
>1 y may develop such
abnormal involuntary
movements as well as
jerky arm and leg
movements. Symptoms
tend to increase if
dosage is not reduced.
Report to physician any
S&S of the onoff
phenomenon sometimes
associated with chronic
management: Rapid
unpredictable swings in
intensity of motor
symptoms of
parkinsonism evidenced
by increase in

bradykinesia (attacks of
leg freezing or slow
body movement).
Monitor mental status for
S&S of drug-induced
neuropsychiatric
adverse reactions.

Contraindications: Known
hypersensitivity to
levodopa; narrow-angle
glaucoma patients with
suspicious pigmented lesion
or history of melanoma;
acute psychoses, severe
psychoneurosis, within 2 wk
of use of MAO
INHIBITORS. Safe use
during pregnancy (category
C), lactation, or in children
<2 y is not established.

Generic

Classification

name (Brand
name)
Ropinirole
HCl (Requip)

Antiparkinsoni

an drug
(Dopamine
agonist)

Indications,

Mechanism of

dosage and

action

frequency
Parkinsons
disease
OD

Unknown.

Side effects

CNS: confusion,

Thought to

headache,

stimulate

dizziness,

dopamine

fatigue, light-

receptors in the

headedness,

brain.

drowsiness,
neuralgia,
amnesia,

Nursing interventions

hyperesthesia,
yawning,
dystonia,
increased
dyskinesia,
hyperkinesias,
akathisia,
hallucinations,
abnormal
thinking, poor
concentration,
syncope, vertigo,

Monitor vital signs,

especially orthostatic
hypotension. Assess for
peripheral edema.
Assess neurologic
status.
Monitor nutritional and
hydration status
Do not stop medication
abruptly. Dosage must
be tapered.
Assess for swelling of
hands or feet.

myoclonus,
asthenia,
malaise, sleep
-

attacks
CV: orthostatic
hypotension,
hypertension,
palpitations,
extrasystole,
peripheral
edema,
peripheral
ischemia, chest
pain,
tachycardia,
atrial

fibrillations
EENT: abnormal
vision, rhinitis,
sinusitis,

pharyngitis
GI: nausea,
vomiting,

flatulence,
abdominal pain,
dyspepsia, dry
-

mouth, anorexia
GU: UTI,
decreased,
erectile

dysfunction
Respiratory:
bronchitis,

dyspnea
Skin:
diaphoresis,

flushing
Other: viral
infection, pain
edema

Generic

Classification

name (Brand
name)
Citicoline
(Zynapse)

Indications,

Mechanism of

dosage and

action

Side effects

Nursing interventions

frequency
-

Generic

Classification

name (Brand
name)
Rivastigmine tatrate
(Exelon
patch)

Cholinester -

Indications,

Mechanism of

dosage and

action

frequency
Mild to

Unknown.

Side effects

CNS:

ase

moderate

Thought to

depression,

inhibitor
Anti-

dementia of

enhance

confusion,

alzheimers

cholinergic

headache,

disease

function by

dizziness,

and

elevating

fatigue,

parkinsons

acetylcholine

drowsiness,

disease.

levels in brain

hallucinations,

Rivastigmin

through

syncope,

e does not

reversible

asthenia,

cure either

inhibition of its

insomnia,

of these

hydrolysis by

psychosis,

diseases,

cholinesterase.
Works by

anxiety, tremors
CV:

alzheimer
drug

but it may
improve
memory,
awareness,
and the
ability to
perform

restoring the

hypertension,

balance of

peripheral

natural

edema, chest

substances
(neurotransmitte
rs) in the brain.

pain
EENT: rhinitis,

pharyngitis
GI: nausea,

Nursing interventions

Monitor patients
nutritional and hydration
status, especially at start
of therapy.
Assess vital signs and
CV status. Stay alert for
chest pain and
peripheral edema.
Closely monitor
cognitive status,
particularly memory.
Report significant
decline or improvement.
Assess temperature.
Watch for fever and
other S&S of infection.
Apply to clean, dry,
hairless intact skin.
Rotate application site.

daily

vomiting,

functions
OD, patch

diarrhea,
constipation,

place in

flatulence,

alternate

abdominal pain,

chest

eructation,
dyspepsia,
-

anorexia
GU: UTI,
decreased,
urinary

incontinence
Musculoskeleta
l: back pain, joint
pain, bone

fractures
Respiratory:
URTI, bronchitis,

cough
Skin: rash,

diaphoresis
Other: weight
loss, pain, flulike
symaptoms

Generic

Classification

name (Brand
name)
Glucerna

Enteral/nut

Indications,

Mechanism of

dosage and

action

frequency
Complete

ritional

and

products

balanced
nutrition
formulated
for people
with
-

diabetes.
190 cc H2o
+ 6 scoops
of powder.
6 feedings

Side effects

Nursing interventions