As a nurse, it’s important to know how to use these medications safely and effectively. This includes knowing which side effects may occur with each medication. It is also essential to focus on nursing responsibilities related to each medication.

Anticonvulsant Drugs

Anticonvulsant drugs are used to treat convulsions and seizures, which are sudden abnormal electrical discharges from nerve cells in the brain. The drugs in this class are known for their ability to prevent the spread of electrical activity in the brain that causes seizures.

These drugs work by altering or blocking the excitatory signals that cause seizures. However, they do not affect the normal functioning of nerves and muscles or cause sedation.

Examples of Anticonvulsant Drugs

While there are many different types of anticonvulsants, they all work to prevent seizures by blocking the activity of specific neurotransmitters in the brain.

Levetiracetam

Levetiracetam (an anticonvulsant) is given to prevent and treat seizures for those at high risk, such as clients with a brain tumor, following brain surgery or any trauma on the brain which can increase intracranial pressure. This medication is often preferred over phenytoin due to the minimal drug-to-drug interactions.

Indication:

• Anticonvulsant:
  • Prevent & treat seizures
  • Often preferred over phenytoin

Common Side Effects:

• Drowsiness & fatigue

Phenytoin

Phenytoin, (think phenytoxic) is like most toxic drugs – the max range is twenty. The therapeutic range is ten to twenty. Given for long-term protection against seizures for patients with epilepsy and other long-term chronic seizure disorders.

Nurses need to check the therapeutic range of the drug as well to monitor liver function, which is the primary site for drug metabolism. A toxic range can cause also cause liver damage.

Indication:

• Epilepsy (long-term protection against seizures)

Cholinergic vs Anticholinergic Drugs

Cholinergic drugs and Anticholinergic Drugs are both medications that affect the nervous system, but they do so in different ways.

The difference between these two drugs is that cholinergic drugs work to increase the amount of acetylcholine in a client’s body, while anticholinergic drugs work to decrease the amount of acetylcholine in the body.

Cholinergic Drugs

Cholinergic drugs are acetylcholine agonists, meaning they can increase the amount of acetylcholine in the body. They may be used to treat muscle spasms or certain types of pain, such as trigeminal neuralgia.

Neostigmine belongs to a class of drugs called cholinesterase inhibitor, while pyridostigmine is an acetylcholinesterase inhibitor. These drugs work by increasing the amount of acetylcholine in your body. Acetylcholine is a neurotransmitter involved in many processes, including muscle contraction and memory formation.

Neostigmine and pyridostigmine are both used to reverse the effects of anticholinesterase poisoning in people who have consumed nerve agents like sarin gas or VX nerve agent.

Your body makes acetylcholine in your brain and nervous system, but it can also come from food or supplements that increase levels in the body.

Without enough acetylcholine, you might experience symptoms such as confusion, trouble walking and/or speaking, muscle spasms or twitching, diarrhea, sweating, and rapid heartbeat.

A cholinergic crisis can develop as a result of overstimulation of nicotinic and muscarinic receptors at the neuromuscular junctions. This is usually secondary to the inactivation or inhibition of acetylcholinesterase,(an enzyme that causes rapid hydrolysis of acetylcholine). Its action serves to stop the excitation of a nerve after the transmission of an impulse.

You can usually treat a cholinergic crisis with medications that block the effects of acetylcholine on your body’s receptors (similar to how antihistamines work against histamines).

Examples of Cholinergic Drugs

Cholinergic medications can be divided into two categories: direct-acting and indirect-acting. The muscarinic receptors are directly bound to and activated by the direct-acting cholinergic agonists.

Examples of direct-acting cholinergic agents include:

• Choline esters (acetylcholine, methacholine, carbachol, bethanechol)
• Alkaloids (muscarine, pilocarpine, cevimeline)

Acetylcholine is more readily available at cholinergic receptors when cholinergic drugs with indirect action are used.

These include reversible agents (physostigmine, neostigmine, pyridostigmine, edrophonium, rivastigmine, donepezil, galantamine) and irreversible agents (echothiophate, parathion, malathion, diazinon, sarin, woman).

Anticholinergic Drugs

Anticholinergic drugs are antagonists of acetylcholine receptors, meaning they block the action of acetylcholine at those receptors. They’re often used to treat symptoms related to Alzheimer’s disease or dementia, including confusion and agitation.

Another response to keep in mind is anticholinergic toxicity. Anticholinergic toxicity is a condition that occurs when you take too much of a medication that blocks the body’s ability to produce acetylcholine, a neurotransmitter.

It can be dangerous if not treated quickly, so you need to know what to do and how to recognize symptoms of anticholinergic toxicity.

Symptoms of anticholinergic toxicity include:

• Slowed heart rate
• Drooling
• Difficulty swallowing
• Blurred or double vision
• Dry mouth and eyes

Examples of Anticholinergic Drugs

Despite not being the cause of their therapeutic effects, drugs like antipsychotics, tricyclic antidepressants, and diphenhydramine (when used to treat allergies) have anticholinergic characteristics. Others include:

• Benztropine and trihexyphenidyl: Counters reduced dopamine levels and relieves symptoms of Parkinson disease.
• Oxybutynin and tolterodine: Helps treat incontinence and detrusor hyperactivity.
• Oxybutynin: Helps treat hyperhidrosis.
• Atropine: Dilates pupils during retina visualization and helps treat cholinergic toxicity.
• Glycopyrrolate: Decreases salivary and tracheal secretions in anesthesia.

Neuromuscular Blocking Agents

Neuromuscular blocking agents are drugs that block the transmission of nerve impulses to muscle cells, which can cause paralysis. They work by blocking the transmission of nerve impulses, which prevents muscles from contracting.

Examples of Blocking Agents

Acetylcholine is a neurotransmitter that is responsible for sending signals between nerve cells – and it can also be used as a way to block those signals. When administering acetylcholine, it will block the client’s nerves from sending signals to each other – stopping the client from feeling pain.

Cisatracurium also blocks the transmission of messages between nerve cells. It works by binding to receptors on the muscle cell membrane, preventing acetylcholine from binding to its receptor and causing muscle contraction. It’s an effective general anesthesia because it doesn’t cross the blood-brain barrier.

Pancuronium works by blocking the transmission of nerve impulses, which causes muscle relaxation. It is also used to treat spasms and seizures in patients who have been given other medications that do not work on their own.

Conclusion of Neurological Drugs

Neurological drugs are used to treat and manage brain disorders, such as epilepsy, Parkinson’s disease, and Alzheimer’s disease. These medications can also be used to treat mental illnesses like depression or anxiety.

Convulsions and seizures (sudden aberrant electrical discharges from brain nerve cells), are treated with anticonvulsant medications. This class of medications is well-known for hindering seizure-inducing electrical activity in the brain.

Drugs that impact the nervous system also include cholinergic and anticholinergic drugs, which have different action modes. Cholinergic medications work by raising the body’s acetylcholine levels, while anticholinergic medications aim to lower acetylcholine levels.

Neuromuscular blocking medicines prevent nerve impulses from reaching muscle cells, resulting in paralysis. They function by obstructing the passage of nerve impulses, which hinders the contraction of muscles.

Sources

https://www.ncbi.nlm.nih.gov/books/NBK538163/
https://www.ncbi.nlm.nih.gov/books/NBK555893/