20. Parkinson's and Alzheimer's Meds Flashcards
chronic neurological disorder w/ degeneration of dopaminergic neurons leading to a lack of dopamine and imbalance of NTs dopamine and ACh (more excitatory ACh than inhibitory dopamine)
Parkinson’s disease
frequently occurs as an adverse reaction to various drugs, carbon monoxide, manganese, or disorders (encephalitis, stroke, or trauma)
Pseudoparkinsonism
symptoms of Parkinson’s disease
- involuntary tremors of limbs (triad)
- rigidity of muscles (triad)
- bradykinesia (triad)
- postural changes (head and chest forward)
- shuffling walk
- lack of facial expression
- pill-rolling motions of hands
5 treatment regimens for Parkinson’s disease
- anticholinergics (block cholinergic receptors)
- dopamine replacements (stimulate dopamine receptors)
- dopamine agonists (stimulate dopamine receptors)
- MAO-B inhibitors (inhibits MAO-B enzyme that interferes w/ dopamine)
- COMT inhibitors (inhibits COMT enzyme that inactivates dopamine)
what type of drug is Benztropine Mesylate
anticholinergic (antiparkinson)
MOA of bneztropine
- blocks cholinergic (muscarinic) receptors
- decreases ACh to reduce excess cholinergic activity
- blocks dopamine reuptake
uses of benztropine
- helps decrease muscle stiffness, sweating, and production of saliva
- improves walking ability in people w/ Parkinson’s disease
administration of benztropine
PO
side effects/adverse effects of benztropine
- drowsiness
- dizziness
- constipation/illeus
- flushing
- nausea
- nervousness
- blurred vision
- dry mouth
- urinary retention
contraindications for benztropine
- glaucoma
- myasthenia gravis
- tardive dysinesia
pt teaching for benztropine
- don’t drive car or operate machinery until you know how the drug affects you
- avoid long term sun exposure (drug can cause skin sensitivity to sunlight)
- avoid alcohol
- hard candy (sour) can help w/ dry mouth
what type of drug is carbidopa-levodopa
dopaminergic
MOA of carbidopa-levodopa
- transmission of levodopa to brain cells for conversion to dopamine
- carbidopa blocks conversion of levodopa to dopamine in intestine and peripheral tissues
uses of carbidopa-levodopa
- treat Parkinson’s disease
- Parkinsonism
- relieves tremors and rigidity
side effects of carbidopa-levodopa
- anorexia
- N/V
- dysphagia
- dyskinesia
- erythema
- fatigue
- dizziness
- HA
- dry mouth
- constipation
- bitter taste
- twitching
adverse effects of carbidopa-levodopa
- blood dyscrasia
- cardia dysrhythmias
- abrupt discontinuation can cause neuroleptic malignant syndrome
administration of carbidopa-levodopa
take w/ food to decrease GI upset (can slow absorption rate)
pt teaching
- don’t discontinue abruptly
- urine may be discolored or appear dark/stain clothes (harmless)
- don’t chew or crush ER tablets
what type of drug is tolcapone (Tasmar)
catechol-o-methyltransferase inhibitor
MOA of tolcapone
inhibits metabolism of levodopa in the bloodstream -> increases duration of drug in body
use of tolcapone
idiopathic PD
administration of tolcapone
only in conjunction w/ levodopa/carbidopa
Adverse effects of tolcapone
- fulminant liver failure
- disorientation
- confusion
- hallucinations
- psychosis
what to monitor for w/ tolcapone
- acute fulminant liver failure -> LFTs initially and Q 2 weeks
contraindications for tolcapone
- liver disease
- non traumatic rhabodomylosis
- hyperpyrexia (high fever)
- confusion
pathophysiology of Alzheimer’s disease
- cholinergic neuron degeneration and acetylcholine deficiency
- neuritic plaques form
- neurofibrillary tangles are in neurons
what is the goal of Alzheimer’s therapy
slow memory and cognition loss
what type of drug is Rivastigmine
acetylcholinesterase (AChE) inhibitor
MOA of rivastigmine
elevates ACh concentration
use of rivastigmine
improves milk to moderate memory loss in Alzheimer’s disease
side effects of rivastigmine
- ABD pain
- anorexia
- N/V/D
- dehydration
- weight loss
- weakness
- dizziness
- drowsiness
- depression
- peripheral edema
- dry mouth
- nystagmus
- shakiness (tremor)
- HA
adverse effects of rivastigmine
- seizures
- bradycardia
- orthostatic hypotension
- cataracts
- MI
- heart failure
- hepatotoxicity
- suicidal ideation
- SJS
administration of rivastigmine
- oral: BID w/ food (peak onset 1 hour)
- transdermal patch: applied daily to clean skin same time each day with rotating sites (peak 8-16 hours)
contraindications of rivastigmine
- liver and renal diseases
- urinary tract obstruction
- orthostatic hypotension
- bradycardia
- active GI bleed
- asthma/COPD
- peptic ulcer disease
- surgery
- smoking
pt teaching for rivastigmine
- increases effects of general anesthetics
- NSAIDs increase GI effects
- tobacco increases clearance
- TCAs decrease effects
- don’t double dose or stop abruptly
