Sedatives
(Propofol)
Adrenergic
Phenylephrine)
Calcium Channel
Blocker
(Diltiazem)
Mechanism of
Action
CNS depression by
activating GABA
receptor
Vasoconstriction,
inotropic effects
(^ CO)
• Dilates coronary/
peripheral arteries
• Slow SA/AV node
conduction
Therapeutic effect
Sedation
Increase BP
Decrease BP, slow
HR
Side effects
Bradycardia,
hypotension,
Apnea
Tachycardia,
decrease
peripheral
perfusion
Hypotension,
bradycardia, heart
block
Special
considerations
Onset:15-30min
Half life: 1-8 min
• Will alter neuro
assessment
• IV
Onset: minutes
IV
*Must be given
through central line
1
Mechanism of
Action
1Anti-Coagulants
• Heparin
• Warfarin
• Rivaroxaban
• Dabigatran
etexilate
Anti-platelets
• Clopidogrel
• Aspirin
Glucocorticosteroid
• Dexamethasone
• Methylpredisone
Calcium Channel
Blockers
•
Nimodipine
H: Prevents conversion of
Platelet aggregate
Decreases
inflammation/
normal immune
response
Relaxing narrowed
blood vessels in
the brain
fibrin-> fibrinogen/
Prothrombin-> thrombin
W: Depresses hepatic
synthesis of vitamin K.
Therapeutic effect
for these patients
Blood thinner,
allows the blood to
easily get through
narrowed arteries
Prevents further
stenosis of diseased
vessels.
Decreases cerebral
edema
Preventing
cerebral
vasospasm post
CVA
Side effects/
Adverse Reaction
BLEEDING
BLEEDING
Hypertension,
hyperglycemia, weight
gain, decreased
immune response
Hypotension,
bradycardia
Thrombocytopenia
Special
considerations
Reversal agents
• Heparin-protamine
• Warfarin- vitamin K
• Rivaroxaban &
Dabigatran etexilate:
NONE
Need to be tapered
down, abrupt
withdrawn causes
acute adrenal
insufficiency.
• Monitor INR for
Warfarin.
• Monitor aPTT for
heparin.
2
Anti-Parkinson agent
(Levodopa/Carbidopa)
Pharmacokinetics
Side effects/
Adverse effects
-Converted to dopamine in the brain.
-Carbidopa added to protect the
premature metabolism of levodopa
before it can reach the brain.
Stimulate dopamine receptors in the
brain.
•
•
-N/V
•
•
•
Teaching/
Special considerations
Dopamine Agonist
(pramipexole, ropinirole)
N/V
Cardiovascular effects
(tachycardia, palpitations)
Orthostatic hypotension
Discoloration of sweat/urine
Dyskinesia
*“On/off effect”: sudden return of
symptoms, treated with a drug holiday or
manipulating doses.
-Psychiatric effects (impulse disorders)
-Psychosis
-Sedation
-Orthostatic hypotension
-Not as effective, worse side effects.
-Therapeutic effect: 2mos
-Change position slowly
“Wearing off”: therapeutic effects of
medications may wear off right before the next
dose is due. Schedule is important.
3
Anticholinergic
(benztropine mesylate)
Pharmacokinetics
Side effects/
Adverse reactions
COMT Inhibitors
(entacapone & tolcapone)
MAO-B Inhibitor
(Selegiline &
Rasagiline)
Blocks acetylcholine
receptors. Diminishes
excess cholinergic effect
from acetylcholine.
Stimulate dopamine
receptors in the brain.
Increase the duration of action
of levodopa within the brain.
Increase “on” time, decrease
“off” time.
-Inhibits breakdown of
dopamine.
-Urinary retention, dry
mouth, constipation.
-N/V
-Psychiatric effects
(impulse disorders)
-Psychosis
-Sedation
-Orthostatic hypotension
-Orthostatic hypotension
-GI symptoms
-Discoloration urine/sweat
•
Hypertensive crisis
-Not as effective, worse side
effects.
-Therapeutic effect: 2mos
-Change position slowly
-Change position slowly
-Dark urine is common.
•
Avoid foods high in
tyramine (aged
cheese, cured
meat, beer, soy)
-N/V
-Sedation
Teaching/
Special
considerations
Dopamine Agonist
(pramipexol,ropinirole)
-Controls tremors & rigidity but
does not help bradykinesia.
-Change position slowly
->Hypertensive crisis
4