Cebu Normal University College of Nursing Osmea Boulevard, Cebu City DRUG STUDY

DRUG DATA Generic Name Biperiden hydrochloride Trade Name Akineton Patients Dose N/A Minimum Dose 2 mg t.i.d. or q.i.d PO Maximum Dose 16 mg TID PO Contents Biperiden hydrochloride Availability Tablets, solution for injection Routes of Administration PO, IM , IV

CLASSIFICATION Therapeutic Anticholinergic, antidyskinetic Pharmacologic Tertiary amine Pregnancy Category C

MECHANISM OF ACTION Pharmacokinetics Onset IM-15 minutes IV-10-30 minutes

INDICATIONS

CONTRAINDICATIONS Contraindications Achalasia, bladder neck obstruction, hypersensitivity to biperiden, myasthenia gravis, narrow-angle glaucoma, prostatic hypertrophy, pyloric or duodenal obstruction, stenosing peptic ulcer, toxic megacolon Precautions Geriatric/debilitated patients; diabetes, respiratory insufficiency , prostatic hyperplasia, CNU tumors, intestinal obstruction, Lactation: discontinue or bottle feed ; Pedi: children with acute illnesses , infections, gastroenteritis, dehydration Drug Interactions Drug-Drug
amantadine: Possibly

ADVERSE REACTIONS
CNS: Agitation, confusion, delirium, delusions, depression, disorientation, dizziness, drowsiness, euphoria, excitement, fever, hallucinations, headache, lightheadedness, listlessness, memory loss, nervousness, paranoia, psychosis, weakness CV: Hypotension, mild bradycardia, orthostatic hypotension, palpitations, tachycardia EENT: Blurred vision, diplopia, dry mouth, increased intraocular pressure, mydriasis, narrow-angle glaucoma, suppurative parotitis GI: Constipation, duodenal ulcer, epigastric distress, ileus, nausea, vomiting GU: Dysuria, urinary hesitancy, urine retention MS: Muscle spasms, muscle weakness SKIN: Decreased sweating, dermatosis,

General As adjunct to treat all forms of Parkinsons disease Peak To control IM- unknown extrapyramidal IV- unknown symptoms (except tardive Duration dyskinesia) IM-1-8 hours caused by IV-unknown phenothiazines and other Half-life: 30 hours neuroleptic Action: Blocks drugs acetylcholines action at cholinergic receptor sites. Patients Actual This action restores the Indication brains normal dopamine N/A and acetylcholine balance, which relaxes muscle movement and decreases rigidity and tremors. Biperiden also may inhibit dopamine reuptake and storage, which prolongs dopamines action. Therapeutic Effects Diminished signs and symptoms of parkinsonian syndrome, decreased

NURSING RESPONSIBILITIES Before 1. Monitor patients blood pressure . 2. Assess mental status (mood, behavior, orientation). 3. Assess muscle rigidity and tremor as baseline. 4. Assess fluid intake and bowel function 5. Prepare drug aseptically and verify the right dose. Render health teaching as appropriate. During 1. Verify patients identity using the chart and other patient and nurses confirmation. 2. Administer oral doses with food, milk, or a full glass of water. 3. Expect to give I.V. or I.M. biperiden when patient needs more rapid response than oral drug can provide. 4. When giving biperiden to patient with druginduced extrapyramidal

sweating or salivation

increased adverse anticholinergic effects digoxin: Possibly increased serum digoxin level haloperidol: Possibly increased schizophrenic symptoms, decreased serum haloperidol level, and development of tardive dyskinesia levodopa: Possibly decreased levodopa effectiveness phenothiazines: Possibly reduced phenothiazine effects and increased psychiatric symptoms

flushing, rash, urticaria

reactions, be alert for worsening of psychiatric symptoms. 5. Observe patient carefully when administering medication to ensure that medication is taken not hoarded or cheeked. After 1. Document medication given. 2. Dont let patient sit or stand up until blood pressure and heart rate have returned to baseline. 3. Caution patient to avoid driving and other activities that require alertness until biperidens CNS effects are known. 4. Instruct to frequently do good oral hygiene. 5. Be alert for and immediately report signs of neuroleptic malignant syndrome. 5. Because biperiden decreases sweating, urge patient to avoid extremely hot and humid conditions to reduce risk of heatstroke and severe hyperthermia. This is especially

important for elderly patients and those who abuse alcohol or have chronic illness or CNS disease. 7. Emphasize the need for periodic eye exams. SOURCE: Deglin, J.H., Vallerand, A.H. (2009). Daviss Drug Guide for Nurses. Ed.11. Philadelphia: F.A. Davis Company pp. 223-226 Lippincotts Nurses Drug Handbook , ed. 10. 2011, pp. 142-143