Medications Affecting The Nervous System

Transcript of Medications Affecting The Nervous System

1. Medications Affecting the Nervous System Adrenergic blocking Drugs Anticonvulsants Antianxiety Antiparkinson Antipyschotic Antidepressants Narcotic analgesics Non narcotic analgesics Narcotic antagonists 06/03/09 Created by Amanda McBride

2. 06/03/09 Created by Amanda McBride 3. 06/03/09 Created by Amanda McBride 4. 06/03/09 Created by Amanda McBride 5. 06/03/09 Created by Amanda McBride 6. Adrenergic effects 06/03/09 Created by Amanda McBride Type Location Neurotrans mitter Effects ofstimulation Alpha1 Blood vessels Kidney Intestinal smooth muscle Liver Eye Norepinephrine EpinephrineVasoconstriction Decreased renin secreation Relaxation glycogenolysis BlinkingAlpha2Nerve endings Vascular smooth muscle Pancreatic beta cells platelets NorepinephrineEpinephrineInhibit release of norepinephrine Vasoconstriction Inhibit insulin secreation AggregationBeta1HeartEpinephrineIncreased HR, force of contraction, automaticity, rate of AV conduction Beta2Bronchioles Blood vessels GI tract Liver Urinary bladder EpinephrineBronchodilation Vasodilation Decreased motility Glycogenolysis Relaxed muscle 7. Adrenergic Drugs

Epinephrine

- Cardiac arrest

- Anaphylaxis

- Hypotension

- Shock

- Nasal congestion

06/03/09 Created by Amanda McBride 8. Adrenergic blocking Drugs

Alpha adrenergic blocking

- Drugs that block alpha adrenergic receptors

Beta adrenergic blocking

- Drugs that block beta adrenergic receptors

Alpha/beta adrenergic blocking

- Drugs that block both

Antiadrenergic drugs

- Drugs that prevent the release of neurotransmitter norepinephrine

06/03/09 Created by Amanda McBride 9. Action

Stimulation of alpha adrenergic nerves results in vasoconstriction

If stimulation is interrupted or blocked the result is vasodilation

06/03/09 Created by Amanda McBride 10. Use of Alpha adrenergic blocking drugs

Hypertension caused by pheochromocytoma

hypertension

06/03/09 Created by Amanda McBride 11. Adverse effects

Weakness

Orthostatic hypotension

Cardiac arrhythmias

Hypotension

Tachycardia

06/03/09 Created by Amanda McBride 12. Contraindications, precautions, interactions

CAD

Used cautiously in pregnancy, recent MI

06/03/09 Created by Amanda McBride 13. Beta adrenergic Blocking drugs

Decrease the stimulation of sympathetic nervous system on certain tissues

Decreases heart rate

Dilates blood vessels

Decrease cardiac excitability

Decrease cardiac workload and oxygen consumption

Provides membrane stabilizing effects that contribute to the antiarrhythmic activity

06/03/09 Created by Amanda McBride 14. Uses

HTN

HF

Cardiac arrhythmia

Migraine

Angina

Glaucoma

Used to prevent reinfarction in pts with recent MI

06/03/09 Created by Amanda McBride 15. Adverse Reactions

Orthostatic hypotension

Bradycardia

Dizziness, vertigo, headache

GI

Bronchospasm with hx asthma

CHF

Sinus bradycardia

HB

Heart failure

Asthma

Hypotension

Emphysema

06/03/09 Created by Amanda McBride 17. Alpha/Beta adrenergic blocking drugs

Block the stimulation of both receptors, resulting in peripheral vasodilation

Carvedilol

Labetalol

06/03/09 Created by Amanda McBride 18. Use

HTN

CHF, prevents progression of disease

Fatigue

Dizziness

Hypotension

Drowsiness

Insomnia

Weakness

Diarrhea

Chest pain

bradycardia

Bronchial asthma

Decompensated heart failure

Severe bradycardia

Used cautiously in drug controlled CHF, chronic bronchitis, impaired hepatic or cardiac function

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06/03/09 Created by Amanda McBride 21. Beta blocker drugs 06/03/09 Created by Amanda McBride Non-selective beta blockers Cardio-selective beta blockers

Levobunolol

Nadolol

Pindolol

Propanolol

Sotalol

Timolol

Acebutolol

Atenolol

Betaxolol

Bisoprolol

Esmolol

Metoprolol

At high doses this effect is lost.

22. Nursing Process

Assessment

- Vitals

- Baseline assessment

Implementation

- Take same time everyday

- When given for cardiac arrhythmias, these drugs can provoke new or worsen existing ventricular arrhythmias

- Orhtostatic hypotension

Evaluation

- effectiveness

06/03/09 Created by Amanda McBride 23. Cholinergic effects 06/03/09 Created by Amanda McBride Organ Effects HeartDecreased rate Blood vessels vasodilation GI smooth muscle Increased tone and contractility Bronchial smooth muscle Increased tone and contractility Increased resp secreations PupilsConstriction 24. Uses

Urinary bladder atony

Paralytic ileus

Reversal of NMB agents

Alzheimers disease

06/03/09 Created by Amanda McBride 25. Anti-cholinergic drugs

Block the action of acetylcholine on the PNS.

06/03/09 Created by Amanda McBride 26. 06/03/09 Created by Amanda McBride System EffectCNS Stimulation followed by depression CVS Increase in heart rate Respiratory BronchodilationDecrease resp secretions GI Antispasmodic effects d/t decreased muscle tone and motility Miscellaneous effects Decreased salivary secretions and sweat glands, relaxation of urinary bladder 27. Uses

GI disorders

GU disorders

Resp disorders-bronchoconstriction. Atrovent

Cardiac disorders- HB, brady

Parkinsons disease

Pre-op

06/03/09 Created by Amanda McBride 28. Atropine

Belladonna plant

Used in symptomatic bradycardia

06/03/09 Created by Amanda McBride 29. Atrovent

COPD as a bronchodilator

Less thickening of resp secretions

06/03/09 Created by Amanda McBride 30. Scopolamine

Depresses CNS and causes amnesia, drowsiness, euphoria, relaxation and sleep

Used in motion sickness

06/03/09 Created by Amanda McBride 31. Spiriva

Long acting bronchodilator

Daily maintenance tx of bronchospasm assoc with COPD

06/03/09 Created by Amanda McBride 32. Extrapyramidal reactions 06/03/09 Created by Amanda McBride 33. 06/03/09 Created by Amanda McBride 34. Education

Take as prescribed

Hypotension

Do not stop taking abruptly

May cause dizziness or drowsiness

Dont use OTC cold, flu or decongestants without MD advice

Monitor own BP

06/03/09 Created by Amanda McBride 35. Antianxiety Drugs and Sedative-Hypnotic Drugs Benzodiazepines Ativan Valium Nonbenzodiazepines Buspar Sinequan atarax 06/03/09 Created by Amanda McBride 36. 06/03/09 Created by Amanda McBride 37. 06/03/09 Created by Amanda McBride 38. Actions

Block certain neurotransmitter receptor sites, norepinephrine.

High lipid solubility enters CNS easily.

Prevents the neurotransmission of the anxious perception and the bodys physcial reaction to the anxiety

Benzodiazepines exert their tranquillizing effect by potentiating the effects of GABA

Nonbenzodiazepines exert their action in various ways.

Anxiety disorders

Panic attacks

Seizures

Alcohol withdrawa

Acute psychosis

Adjunct for pain

06/03/09 Created by Amanda McBride 40. Adverse Effects

Mild drowsiness-sedation

Lightheadedness, dizziness

Headache

Lethargy

Disorientation

Anger

Restlessness

Nausea

Visual disturbances

06/03/09 Created by Amanda McBride 41. Non benzodiazepines

Buspar

- Not like benzos

Chloral hydrate

- Doesnt suppress REM

- Tolerance after 2 weeks of use.

- Physical dependence.

Antidepressants

- Prozac, Paxil, Effexor, Zoloft.

Imovane

- Transient insomnia

06/03/09 Created by Amanda McBride 42. Dependence

Long term use may result in physical drug dependence and tolerance

With as little as 4-6 weeks of therapy with benzos

06/03/09 Created by Amanda McBride 43. Symptoms of withdrawal

Restlessness

Muscle or bone pain

Insomnia

Diarrhea

Vomiting

Cold flashes

Involuntary leg movements

Seizures

Increased anxiety

Nausea

Sweating

psychoses

06/03/09 Created by Amanda McBride 44. Prevention of withdrawal

Mild symptoms occur after 6-12 weeks of therapeutic doses.

Sever symptoms occur after 4 months of high doses.

Dose should be tapered, reduce 10-25% every 1-2 weeks over 4-16 weeks.

06/03/09 Created by Amanda McBride 45. Antidote

Anexate competes with benzo receptors.

Onset within 2 mins peaks within 6-10 mins.

Half life 60-90 mins.

06/03/09 Created by Amanda McBride 46. Contraindications

Pregnancy

Lactation

06/03/09 Created by Amanda McBride 47. Precautions, Interactions

Used cautiously in elderly pts

Impaired liver and kidney function

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06/03/09 Created by Amanda McBride 48. Nursing Process

Assessment

- Vitals

- Assessment

Implementation

- Observe pt closely for new tx

- Report signs of tolerance

Evaluation

- Therapeutic effect is achieved

06/03/09 Created by Amanda McBride 49. Education

Take as prescribed

Dont discontinue abruptly

Avoid driving

Avoid alcohol

Try to find healthier coping mechanisms.

06/03/09 Created by Amanda McBride 50. Opioids

Rx for pain relief, post-op, cough, acute pulm edema, and diarrhea

Attach to opioid receptors in the brain, spinal cord and GI tract

Cause euphoria by affecting the brain regions that mediate what we perceive as pleasure

06/03/09 Created by Amanda McBrideCreated by Amanda McBride 51. Opioid Analgesics

Uses

- Treatment of mod to severe pain

- Obstetric pain

- Anxiety related dyspnea

- Opiate dependence

- Relieve persistent cough

06/03/09 Created by Amanda McBride 52. How they work

Increase norepinephrine and dopamine

Increases BP, HR, constricts blood vessels, increases blood glucose and opens resp pathways

Increase Dopamine is associated with a sense of euphoria

06/03/09 Created by Amanda McBrideCreated by Amanda McBride Created by Amanda McBride 53. The WHO Pain Ladder 06/03/09 Created by Amanda McBride 06/03/09 Created by Amanda McBride 54. Pain

Subjective

Cultural

Acute

Chronic

Can be affected by mood.

Complex

06/03/09 Created by Amanda McBride 55. Morphine

Half life 2-4 hours.

Accumulates in pts with liver or kidney dysfunction.

Other routes of admin, epidural, intrathecal, inhalation, rectal.

06/03/09 Created by Amanda McBride 56. Fentanyl

Very potent opioid.

Transdermal or IV

High risk of resp depression, given in monitored areas.

06/03/09 Created by Amanda McBride 57. Codeine

Weaker opioid.

Antitussive.

IV or PO

06/03/09 Created by Amanda McBride 58. Hydrocodone

Analgesic, antitussive

Similar to codeine.

06/03/09 Created by Amanda McBride 59. Hydromorphone

Similar to morphine.

Very potent.

06/03/09 Created by Amanda McBride 60. Meperidine

Similar to morphine

Preferred in pts with renal or biliary colic.

Less resp distress in newborns.

Normeperidine

- Metabolite of meperidine

- Accumulates with chronic use, renal failure, Dilantin, rifamipin.

- Produces CNS stimulation, hallucinations, seizures, agitation, tremors.

- Half life 15-30 hours

- Narcan doesnt work.

- Can precipitate serotonin syndrome in people who take MAOI, or amphetamines.

06/03/09 Created by Amanda McBride 61. 06/03/09 Created by Amanda McBride 62. Methadone

Similar to morphine

Longer duration.

Half life 15-30 hours.

06/03/09 Created by Amanda McBride 63. Oxycodone

Similar to codeine.

Crushing and snorting or injecting has led to deaths.

06/03/09 Created by Amanda McBride 64. Drug selection

Morphine, hydromorphone and methadone, non ceiling drugs.

Least potent drug, in smallest dosage for least amount of time.

06/03/09 Created by Amanda McBride 65. Drug dose

Choose according to pain type, severity, quality, pts size, age, health status.

Choose smallest dose 1 st.

Slowrelease for chronic

IV for acute or breakthrough.

06/03/09 Created by Amanda McBride 66. Patient Controlled Analgesic 06/03/09 Created by Amanda McBride 67. Epidural analgesia 06/03/09 Created by Amanda McBride 68. Uses

Decrease anxiety and sedate before surgery

Support anesthesia

Obstetric analgesia

Relieve anxiety in pts with dyspnea

Pain assoc with MI

Opiate dependence

Severe diarrhea

Persistent cough

06/03/09 Created by Amanda McBride 69. Adverse effects

Weakness, lightheadedness

Resp depression

Constipation, nausea

Tachycardia, bradycardia

Urinary retention

Rash

Sweating

06/03/09 Created by Amanda McBride 70. Contraindication, precautions, interactions

Acute bronchial asthma

Increased ICP

Convulsive disorders

Severe renal hepatic impairment

Pregnancy

Use cautiously in elderly

Opiate nave

Undx abdo pain

Hypoxia

SVT

Assessment

- Vital signs

- Assessment including pain

Implementation

- Masking pain symptoms

- Long acting and breakthru

- Constipation prevention and tx

Evaluation

06/03/09 Created by Amanda McBride 72. PQRST Method for Pain Assessment

P =Provokes

- What causes pain?

- What makes it better?

- Worse?

Q =Quality

- What does it feel like?

- Is it sharp?

- Dull?

- Stabbing?

- Burning?

- Crushing? ( Try to let patient describe the pain, sometimes they say what they think you would like to hear. )

R =Radiates

- Where does the pain radiate?

- Is it in one place?

- Does it go anywhere else?

- Did it start elsewhere and now localised to one spot?

S =Severity

- How severe is the pain on a scale of 1 - 10?

( This is a difficult one as the rating will differ from patient to patient. )

T =Time

- Time pain started?

- How long did it last?

No driving

No alcohol

Signs of tolerance

Take as prescribed

GI upset take food

06/03/09 Created by Amanda McBride 74. Opioid toxicity

Resp depression

Low BP

CNS depression

Narcan

06/03/09 Created by Amanda McBride 75. Treatment specific Disorders

Cancer

Post op

Burns

Biliary, renal or uretral colic

06/03/09 Created by Amanda McBride 76. Special populations

Opiate tolerant pts.

Use in children.

Use in older adults.

Renal impairment.

Hepatic impairment.

Home care.

06/03/09 Created by Amanda McBride 77. Opiate Antagonist

Action

- Counteracts effect of narcotic

- Competes for opiate receptors

Narcan

- Short half life, repeated dosing usually needed.

- Few adverse reactions.

06/03/09 Created by Amanda McBride 78. Use

Postop acute resp depression

Opioid reversal

Opioid overdose

Nausea vomiting

Sweating

Tachycardia

Increased BP

tremors

Used cautiously in pregnancy

Opioid dependency

CVS disease

May produce withdrawal in pts who are addicted

Assessment

- Vitals

- Assessment

- Attempt to stimulate postop pt

Implementation

- Balance need for pain control and resps

- Keep suction close by for vomiting

- If pain recurs must treat pain again

06/03/09 Created by Amanda McBride 82. Antidepressant Tricyclic Antidepressants SSRI Misc 06/03/09 Created by Amanda McBride 83. Depressive disorders

Depressive disorders are mental illnesses characterized by deep, long-lasting feelings of sadness or despair. The patient may also lose interest in things that were once pleasurable. Changes in sleep patterns, appetite, and mental processes may also accompany depressive disorders. Depressive disorders are also known simply as depression or as unipolar (one-sided) depression

06/03/09 Created by Amanda McBride 84. Tricyclic Antidepressants

Action

- Increasing and decreasing sensitivity to neurotransmitters

Uses

- Depressive episodes

- Obsessive compulsive disorders

- Chronic neuropathic pain

- Anxiety disorders

- enuresis

Anticholinergic effects

Constipation

Photosensitivy

06/03/09 Created by Amanda McBride 86. Contraindications, Precautions, Interactions

MAOI

Recent MI

Children

Pregnancy

Used cautiously in cardiac disease, hepatic, renal impairment, glaucoma, urinary retention, risk of suicidal behaviour

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06/03/09 Created by Amanda McBride 87. Selective Serotonin Reuptake Inhibitors 06/03/09 Created by Amanda McBride 88. Actions

Increase in serotonin levels is thought to act as a stimulant to reverse depression

Depressive episodes

Obsessive compulsive disorders

Bulimia nervosa

Panic

Premenstrual syndrome

Post traumatic stress disorder

Generalized anxiety

Migraines

Somnolence

Dizziness

Headache

Insomnia

Tremor

Weakness

Constipation, dry mouth, nausea

Pharyngitis

Pregnancy

use cautiously in diabetes, cardiac disease, liver renal impairment, suicidal ideation

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Assessment

- Medical history

- Psych assessment

Implementation

- Response is not rapid

- Orthostatic hypotension

- Dont stop abruptly

- Report any suicidal ideation

Evaluation

- Effect

If dizziness occurs, rise slowly

Keep appts

Report any unusual effects

Take as prescribed

06/03/09 Created by Amanda McBride 94. Symptoms of Psychosis

False personal beliefs that are not part of reality

Truly believes something that doesnt make sense to others

around them, and any reasoning and showing evidence that contradicts

their belief doesnt convince them that their belief is false

Includes the belief that they are being spied on, plotted against,

harmed or tormented; many report receiving messages from the

radio or television

Sensing things that arent actually there

Includes hearing, seeing, smelling, tasting or feeling things

that others dont perceive

The most common hallucinations involve hearing voices usually

saying negative, critical or frightening things to the person,

warning of danger, or even giving orders

Being unable to "think straight"

Organizing thoughts is difficult, making it impossible to

communicate clearly with others

Unable to concentrate on one thought for very long; thoughts may

come and go quickly

Unable to connect thoughts into logical sequences; thoughts are

often blocked and become fragmented

Being emotionally disturbed or excited

Includes appearing disturbed, excited, restless or hyperactive

Trying to seem very important

Believe that they are powerful, wealthy, very intelligent, famous or

have special powers

Being untrusting and guarded

Might think they are being watched, followed, persecuted or

conspired against

Acting unfriendly and showing ill feelings towards

others

Behaving in an abusive, sarcastic and difficult manner

06/03/09 Created by Amanda McBride 95. Antipsychotic Drugs

Act by inhibiting or blocking the release of neurotransmitter dopamine

Acute or chronic pyschosis

Bipolar illness

Agitated behaviours associated with dementia

Sedation, headache, hypotension, dry mouth, urticaria

Behavioural changes, increase in psychotic symptoms

Lethargy, hyperactivity, paranoid reactions, agitation, confusion

06/03/09 Created by Amanda McBride 98. Extrapyramidal Symptoms

Extrapyramidalsymptoms(EPS) are the variousmovement disorderssuch astardive dyskinesiasuffered as a result of takingdopamine antagonists , usuallyantipsychotic(neuroleptic)drugs , which are often used to controlpsychosis , especiallyschizophrenia . Otherantidopaminergicdrugs like theantiemetic metoclopramideor thetricyclic antidepressant amoxapinecan also cause extrapyramidal side effects

06/03/09 Created by Amanda McBride 99. Tardive Dyskinesia

Tardive dyskinesia is characterized by repetitive, involuntary, purposeless movements. Features of the disorder may include grimacing, tongue protrusion, lip smacking, puckering and pursing of the lips, and rapid eye blinking. Rapid movements of the arms, legs, and trunk may also occur. Impaired movements of the fingers may appear as though the patient is playing an invisible guitar or piano. Patients with Parkinson's disease have difficulty moving, while patients with tardive dyskinesia have difficultynotmoving .

06/03/09 Created by Amanda McBride 100. NeurolepticMalignant Syndrome

Rare, fatal complication

Clinical manifestations:

Hyperthermia

Hypertonicityof skeletal muscles

Mental changes

Autonomic instability

Severely depressed

Blood dyscrasias

Liver impariment

Sever hypo/hypertension

Used cautiously in resp disorders, epilepsy, renal impairment, PUD

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Assessment

- Psych assessment

Implementation

- As prescribed

- Safety

Evaluation

- Effect

Keep appts

Report any unusual effects

No alcohol

Avoid sun exposure

06/03/09 Created by Amanda McBride 104.

Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally. In epilepsy, the normal pattern of neuronal activity becomes disturbed, causing strange sensations, emotions, and behavior or sometimes convulsions, muscle spasms, and loss of consciousness. Epilepsy is a disorder with many possible causes. Anything that disturbs the normal pattern of neuron activity - from illness to brain damage to abnormal brain development - can lead to seizures. Epilepsy may develop because of an abnormality in brain wiring, an imbalance of nerve signaling chemicals called neurotransmitters, or some combination of these factors. Having a seizure does not necessarily mean that a person has epilepsy. Only when a person has had two or more seizures is he or she considered to have epilepsy. EEGs and brain scans are common diagnostic test for epilepsy .

06/03/09 Created by Amanda McBride 105. 06/03/09 Created by Amanda McBride 106. 06/03/09 Created by Amanda McBride 107. 06/03/09 Created by Amanda McBride 108. Status Epilepticus

A state of continuous seizures or repetitive, discrete seizures with impaired consciousness in the interictal period

- Duration

- - Traditional criterion: 1530 minutes

- - Practical criterion: duration prompting acute use of anticonvulsant therapy; typically > 5 minutes

- May occur with all type of seizures: grand mal (tonic-clonic) status, myoclonic status, petit mal status, and temporal lobe (complex partial) status

- Associated with major cerebral and systemic physiologic changes

- - Initial stage (first 3060 minutes)

- - - Cerebral metabolism is greatly increased because of seizure activity, but physiologic mechanisms are sufficient to meet the metabolic demands.

- - - Cerebral: increased blood flow, increased metabolism

- - - Autonomic and cardiovascular: hypertension, increased cardiac output, massive catecholamine release, tachycardia, arrhythmias, hyperpyrexia

- - - Metabolic: lactic acidosis, hyperglycemia

- - Decompensated phase

- - - Cerebral metabolic demands cannot be fully met, resulting in hypoxia and altered cerebral and systemic metabolic patterns.

- - - Cerebral: hypoxia, hypoglycemia, increased intracranial pressure

- - - Autonomic and cardiovascular: hypoxia, hypotension, hyperpyrexia

- - - Metabolic: hypoglycemia, hyponatremia, hyperkalemia, metabolic acidosis

- Generalized status is life threatening when accompanied by hyperpyrexia, acidosis (from prolonged muscle activity), and respiratory or cardiovascular compromise.

06/03/09 Created by Amanda McBride 109. 06/03/09 Created by Amanda McBride 110. Anticonvulsants

Action

- Benzodiazepines

- - Inhibit uptake of GABA

- Hydantoins

- - Stabilize the hyperexcitability

Uses

- Seizures

- Neuropathic pain

- Bipolar disorders

- Anxiety disorders

06/03/09 Created by Amanda McBride 111.

Adverse

- Drowsiness, weakness, dizziness

- Headache, somnolence

- Slurred speech, ataxia, nystagmus

- Nausea, vomiting, anorexia

- Rash, urticaria

- Ataxia

Contraindicated

- Dilantin in bradycardia and HB

- Pregnancy

- CNS depression

Precautions

- Liver renal impairment

Interactions

06/03/09 Created by Amanda McBride 112. Dilantin

Not to be given IM

Not stable in D5W

Interacts with many medications.

06/03/09 Created by Amanda McBride 113. Gabapentin

Partial seizures

Treat neuralgia pain.

Chronic pain syndromes

Adjunct therapy in post ortho pt.

06/03/09 Created by Amanda McBride 114. Phenobarbital

Long acting barbiturate.

Half life 50-140 hours

06/03/09 Created by Amanda McBride 115. Drug Selection

Type of seizure

Generalized seizures

- valproic acid

- Dilantin

Partial seizures

- Gabapentin, phenobarb, Dilantin

Adverse effects

- CNS depression

- Cognitive impairment

Vitals

Neuro assessment

History of seizure type/activity

Implementation

- Do not stop abruptly

Evaluation

- Blood levels

- effect

06/03/09 Created by Amanda McBride 117. Monitoring Anti-Epileptic drug therapy

Pt response

Serum drug levels periodically

Monitor for toxicity

Baseline bloodwork.

Changes made gradually over 2-3 months

06/03/09 Created by Amanda McBride 118. Toxicity

Fatalities have been assoc with all AED

SS are extensions of adverse effects

- CNS depression

- Coma

- Resp depression

- CVS problems

- Life threatening.

06/03/09 Created by Amanda McBride 119. Antiparkinsonism Drugs

Action

- Stimulate dopamine receptor sites

Uses

- Parkinsons disease

- RLS

- Viral infections

Dry mouth, anorexia, nausea, vomiting, abdo pain, constipation

Increased hand tremor

Headache

Dizziness

Choreiform movement:ceaseless occurrence of rapid, highly complex jerky movements that appear to be well coordinated but are performed involuntarily

Dystonia is a syndrome of spasms and sustained contractions of the muscles. These muscle movements are not under voluntary control and they result in repetitive abnormal movements of parts of the body or persistently abnormal postures.