406 E2- Parkinson's Pharm Flashcards
what is the treatment goal of parkinson’s
help individuals maintain their motor function for as long as possible
when is treatment for parkinson’s started
if symptoms affect dominate hand or if symptoms interfere w/ work, ADLs, social or leisure function
dopaminergic drugs can either
increase the amount of dopamine or increase the stimulation of dopamine receptors
what do anticholinergic drugs do
block the effects of ACh
sinemet (combo of levodopa & carbidopa) : MOA
-levodopa: converts to dopamine in the brain and activates dopamine receptors
-carbidopa: blocks destruction of levodopa
what is the most effective drug for PD
sinemet
disadvantages to sinemet
-takes several months to see improvement
-does not work long term
-adverse effects
sinemet: “loss of effect”
-dose wears off so may need shorter dose intervals
-“on off” phenomenon: the abrupt loss of effect that can occur anytime during dosing interval
off periods increase overtime
what can reduce the effect of sinemet
-other drugs
-high protein meals
sinemet: adverse effects
-N/v
-Dyskinesias (abnormal movements)
-postural hypotension
-dysrhythmias
-psychosis (hallucinations, nightmares, paranoia)
-darken sweat & urine
-activate malignant melanoma
sinemet nursing considerations
-give low doses w/ food (not protein rich food)
-monitor cardiac function (esp if dose is being increases)
-tell pts to change positions slowly
-skin assessment before giving
sinemet interactions causing a decreased effect of levodopa
-vit B6 (pyridoxine)
-antipsychotics
-protein
sinemet interactions causes a increased effect of levodopa
-carbidopa
-anticholinergics
-MAO inhibitors (can cause toxicity)
sinemet: route
PO
duopa
carbidopa-levodopa infusion for G or J tube
-gel form suspension
-continuous (up to 16 hrs/d) infusion for continuous blood level
keeps a more consistent amount of the drug in the body
when is duopa used
-when a patient has a tube
-for pts who do not respond well to sinemet
-pts w/ on off phen
duopa teaching
-do not take within 2 weeks of nonselective MAOI
-talk about all medications pt is currently taking
duopa: drug interactions
-anti HTN
-MAOI
-antipsychotic
-metoclopramide
-isoniazid
-iron
-vitamins
duopa: food interactions
high protein
duopa side effects
-falling asleep w/o warning
-orthostatic hypotension
-hallucinations
-unusual urges
-depression
-dyskinesia
side effects also include those related to placement of tube
side effects of tube placement
-infection
-tube dislodgment
-body disturbances
what class is pramipexole
dopamine receptor agonist
pramipexole: MOA
binds w/ D2 receptors
pramipexole: indications
-monotherapy in early PD
-combined w/ sinemet in advanced PD
-restless leg syndrome
pramipexole SE (alone)
-nausea
-sleep attacks
-pathologic gambling & other compulsive behaviors
pramipexole SE (paired w/ levodopa)
-orthostatic hypotension
-dyskinesias
-hallucination risk double
what class is ropinirole
dopamine receptor agonist
ropinirole MOA
stimulates dopamine receptor
exact moa is not known but could increase nerve impulses within the substantia nigra
ropinirole indications
idiopathic PD
ropinirole SE
-similar to other PD drug
-long term use there may be an increased risk of DM and acromegaly
rotigotine
-dopamine receptor agonist
-once daily patch
apomorphine
-dopamine receptor agonist
-short acting subq injection
-for fast relief of symptoms
used in the “off” phase of PD
