C H A P T E R 2 4
Antiparkinsonism agents
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with anticholinergics, a risk for decreased antipsychotic
therapeutic effectiveness may occur, possibly as a result
of a central antagonism of the two agents.
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Anticholinergic agents are used to suppress the
stimulatory effects of acetylcholine in the substantia
nigra, bringing balance into the control of
movement.
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The adverse effects associated with the
anticholinergic drugs are related to blocking of
the acetylcholine in the parasympathetic nervous
system—dry mouth, constipation, urinary retention,
increased heart rate, decreased sweating.
KEY POINTS
Care considerations for
people receiving anticholinergic agents
Assessment: History and examination
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Assess for contraindications or cautions:
any known allergies to these drugs
to avoid
hypersensitivity reactions
; GI depression or
obstruction, urinary hesitancy or obstruction,
benign prostatic hypertrophy or glaucoma,
which may be exacerbated by the peripheral
anticholinergic effect of the drug
; cardiac
arrhythmias, hypertension or hypotension,
which may be increased due to the dominance
of sympathetic stimulatory activity due to
blockage of parasympathetic activity
; myasthenia
gravis,
which may be exacerbated by blockage
of acetylcholine receptors
; current status related
to pregnancy or breastfeeding
due to risk of fetal
or infant adverse effects
; hepatic dysfunction,
which could interfere with drug metabolism and
increase risk for toxicity
; and exposure to a hot
environment,
which may block the individual’s
reflex sweating.
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Perform a physical assessment
to determine
baseline data for determining the effectiveness
of the drug and the occurrence of adverse effects
associated with drug therapy.
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Assess level of orientation and neurological status,
including affect, reflexes, bilateral grip strength,
gait, tremors and spasticity,
to evaluate any CNS
effects.
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Monitor pulse, blood pressure and cardiac output
to evaluate for possible adverse effects related to
blocking of suppressive action on the heart.
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Auscultate bowel sounds
to evaluate GI motility
and detect possible indications of paralytic ileus.
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Assess urine output and palpate bladder
to
determine adequate renal and bladder function.
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Monitor the results of laboratory tests such as renal
and liver function tests
to determine the need for
possible dose adjustment and identify potential
toxic effects.
Implementation with rationale
■
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Arrange to decrease dose or discontinue the drug
if dry mouth becomes so severe that swallowing
becomes difficult.
Provide sugarless lozenges to
suck and frequent mouth care to help with this
problem.
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Give drug with caution and arrange for a decrease
in dose in hot weather or with exposure to hot
environments
because people are at increased risk
for heat prostration because of decreased ability to
sweat.
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Give drug with meals if GI upset is a problem,
before meals if dry mouth is a problem and after
meals if drooling occurs and the drug causes
nausea
to facilitate compliance with drug therapy.
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Monitor bowel function and institute a bowel
program
if constipation is severe.
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Ensure that the person voids before taking the
drug; monitor urinary output and palpate for
bladder distension and residual urine
if urinary
retention is a problem.
■
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Establish safety precautions if CNS or vision
changes occur
to prevent injury.
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Provide thorough teaching about topics such as
the drug name and prescribed dose, measures
to help avoid adverse effects, warning signs
that may indicate problems and the need for
periodic monitoring and evaluation
to enhance
knowledge about drug therapy and to promote
compliance.
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Offer support and encouragement
to help the
person cope with the progressive nature of the
disease and long-term drug regimen.
Evaluation
■
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Monitor response to the drug (improvement in
signs and symptoms of Parkinson’s disease or
parkinsonism).
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Monitor for adverse effects (CNS changes, urinary
retention, GI slowing, tachycardia, decreased
sweating, flushing).
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Evaluate the effectiveness of the teaching plan
(person can give the drug name and dosage,
name possible adverse effects to watch for and
specific measures to prevent them and discuss the
importance of continued follow-up).
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Monitor the effectiveness of support measures and
compliance with the regimen.
