C H A P T E R 2 4
Antiparkinsonism agents
379
ANTICHOLINERGIC AGENTS
Anticholinergics
(Table 24.2) are drugs that oppose the
effects of acetylcholine at receptor sites in the substantia
nigra and the corpus striatum, thus helping to restore
chemical balance in the area. Anticholinergics used to
treat Parkinson’s disease include benztropine (
Benztrop
,
Cogentin
), biperiden (
Akineton
) (not available in New
Zealand) and benzhexol (
Artane
) (not available in
New Zealand)
.
Therapeutic actions and indications
The anticholinergics used to treat parkinsonism are syn-
thetic drugs that have been developed to have a greater
give drug with food; administer with carbidopa; have
person void before each dose.
Provide support and reassurance to deal with disease and
drug effects.
Instruct the person regarding drug dose, effects and
adverse symptoms to report.
Evaluation
Evaluate drug effects: relief of signs and symptoms of
Parkinson’s disease.
Monitor for adverse effects: CNS effects; renal changes,
urinary retention; GI effects (constipation); increased
sweating or flushing.
Monitor for drug–drug interactions: hypertensive crisis with
MAO inhibitors, decreased effects with vitamin B
6
or
phenytoin.
Evaluate the effectiveness of the teaching program.
Evaluate the effectiveness of comfort and safety
measures.
TEACHING FOR S.S.
• The drug that has been prescribed is called levodopa.
It increases the levels of dopamine in the central areas of
the brain and helps to reduce the signs and symptoms of
Parkinson’s disease.
• Often, this drug is combined with another drug, which
allows the correct levels of levodopa to reach the brain.
• People who take this drug must have their individual dose
needs adjusted over time. Common effects of this drug
include:
•
Fatigue, weakness and drowsiness
: Try to space activities
evenly through the day; allow rest periods to avoid
these side effects. Take safety precautions and avoid
driving or operating dangerous machinery if these
conditions occur.
•
Dizziness, fainting
: Change position slowly to avoid dizzy
spells.
•
Increased sweating, darkened urine
: This is a normal
reaction. Avoid very hot environments.
•
Headaches, difficulty sleeping
: These usually pass as
the body adjusts to the drug. If they become too
uncomfortable and persist, consult with your healthcare
provider.
• Report any of the following to your healthcare
provider:
uncontrolled movements of any body part,
chest pain or palpitations, depression or mood changes,
difficulty in voiding, or severe or persistent nausea and
vomiting.
• Be aware that vitamin B
6
interferes with the effects of
levodopa. If you feel that you need a vitamin product,
consult with your healthcare provider about using an
agent that does not contain vitamin B
6
.
• Avoid eating large quantities of health foods that contain
vitamin B
6
, such as grains and brans. If you are taking a
carbidopa–levodopa combination, these precautions are
not as important.
• Tell any doctor, nurse or other healthcare provider
involved in your care that you are taking this drug.
• Keep this drug and all medications out of the reach of
children.
• Do not overexert yourself when you begin to feel better.
Pace yourself.
• Take this drug exactly as directed, and schedule regular
medical checkups to evaluate its effects.
TABLE 24.2
DRUGS IN FOCUS Anticholinergic agents
Drug name
Dosage/route
Usual indications
benzhexol (Artane)
1–10 mg PO daily in 3–4 divided doses
Adjunctive treatment of parkinsonism and
drug-induced extrapyramidal reactions
benztropine (Cogentin)
0.5–6 mg/day PO may be needed; 1–2 mg IM
or IV; reduce dose in older people
Adjunctive treatment of parkinsonism, and
drug-induced parkinsonism resulting from
drug effects
biperiden (Akineton)
1–4 mg PO t.d.s. or q.i.d
Adjunctive treatment of parkinsonism, and
drug-induced parkinsonism resulting from
drug effects
