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P A R T 1
Introduction to nursing pharmacology
Interventions
Monitor the person’s perceptual losses or changes.
Provide protective measures to prevent falling or injury.
Consult with the prescriber to decrease the dose or dis
continue the drug. Provide supportive measures to cope
with drug effects.
Neurological effects (neurotoxicity)
Many drugs can affect the functioning of the nerves
in the periphery and the central nervous system.
Nerves function by using a constant source of energy
to maintain the resting membrane potential and allow
excitation. This requires glucose, oxygen and mainte
nance of electrolyte balance.
General central nervous system effects
Although the brain is fairly well protected from many
drug effects by the blood–brain barrier, some drugs
do affect neurological function, either directly or by
altering electrolyte or glucose levels. Beta-blockers,
which are used to treat hypertension, angina and many
other conditions, can cause feelings of anxiety, insomnia
and nightmares.
Assessment
Symptoms may include confusion, delirium, insomnia,
drowsiness, hyperreflexia or hyporeflexia, bizarre
dreams, hallucinations, numbness, tingling and
paraesthesias.
Interventions
Provide safety measures to prevent injury. Caution the
person to avoid dangerous situations such as driving
a car or operating dangerous machinery. Orient the
person and provide support. Consult with the prescriber
to decrease drug dose or discontinue the drug.
Atropine-like (anticholinergic) effects
Some drugs block the effects of the parasympathetic
nervous system by directly or indirectly blocking cho
linergic receptors. Atropine, a drug used preoperatively
to dry up secretions and any other indications, is the
prototype anticholinergic drug. Many cold remedies and
antihistamines also cause anticholinergic effects.
Assessment
Dry mouth, altered taste perception, dysphagia, heart
burn, constipation, bloating, paralytic ileus, urinary
hesitancy and retention, impotence, blurred vision,
cycloplegia, photophobia, headache, mental confusion,
nasal congestion, palpitations, decreased sweating and
dry skin may be noted.
Interventions
Provide sugarless lozenges and mouth care to help relieve
dryness of the mouth. Arrange for a bowel program as
appropriate. Have the person void before taking the
drug, to aid voiding. Provide safety measures if vision
changes occur. Arrange for medication for headache and
nasal congestion as appropriate. Advise the person to
avoid hot environments and to take protective measures
to prevent falling and also dehydration, which may
be caused by exposure to heat, owing to decreased
sweating.
Parkinson-like syndrome (parkinsonism)
Drugs that directly or indirectly affect dopamine levels
in the brain can cause a syndrome that resembles Parkin
son’s disease. Many of the antipsychotic and neuroleptic
drugs can cause this effect. In most cases, the effects go
away when the drug is withdrawn.
Assessment
Lack of activity, akinesia, muscular tremors, drooling,
changes in gait, rigidity, extreme restlessness or “jitters”
(akathisia), or spasms (dyskinesia) may be observed.
Interventions
Discontinue the drug, if necessary. Know that treatment
with anticholinergics or antiparkinson drugs may be
recommended if the benefit of the drug outweighs the
discomfort of its adverse effects. Provide small, frequent
meals if swallowing becomes difficult. Provide safety
measures if ambulation becomes a problem.
Neuroleptic malignant syndrome
General anaesthetics and other drugs that have direct
central nervous system effects can cause neuroleptic
malignant syndrome, a generalised syndrome that
includes high fever.
Assessment
Extrapyramidal symptoms, including slowed reflexes,
rigidity, involuntary movements; hyperthermia; and
autonomic disturbances, such as hypertension, fast
heart rate and fever, may be noted.
Interventions
Discontinue the drug if necessary. Know that treatment
with anticholinergics or antiparkinson drugs may be
required. Provide supportive care to lower the body tem
perature. Institute safety precautions as needed.
Teratogenicity
Many drugs that reach the developing fetus or embryo
can cause death or congenital defects, which can include
skeletal and limb abnormalities, central nervous system
alterations, heart defects and the like. The exact effects
of a drug on the fetus may not be known. In some cases,
a predictable syndrome occurs when a drug is given to a
pregnant woman. In any situation, inform any pregnant
woman who requires drug therapy about the possible
effects on the baby. Before a drug is administered to a
pregnant woman, the actual benefits should be weighed
