Anti-Parkinsons Chapter 24

Question 1

What is Parkinsons disease?

Answer 1

Chronic, progressive neurological disorder
Decline of dopamine producing cells in the substantia nigra

Question 2

What are hallmarks of parkinsons disease?

Answer 2

Tremor: pill-rolling**
Rigidity: cog-wheeling**
Akinesia/ Bradykinesia: shuffled gait**
Loss of Postural Stability

Question 3

What happens with neurotransmitter with a person with parkinson’s disease?

Answer 3

Dopamine will be low and cause acetylcholine to be high

Question 4

What are medication classes used for parkinsons disease?

Answer 4

-Dopaminergic agents
-Anticholinergic agents

Question 5

What do dopaminergic agents do?

Answer 5

Increase effects of dopamine at receptors
used for parkinsons more effective than anti-cholinergic agents

Question 6

What do anti-cholinergic agents do?

Answer 6

Oppose effects of ACh at receptor sites. So ach isnt attaching and stimulating

Combo meds are often given to reduce dosage and achieve better control of symptoms

Question 7

What is ** levodopa/carbidopa (Sinemet)?

Answer 7

Dopaminergic agent

Question 8

What is therapeutic actions of Levodopa?

Answer 8

Dopaminergic agent
Dopamine doesnt cross the blood barrier brain so
-Levodopa crosses blood brain barrier, is metabolized into dopamine, short duration
Less levodopa is used, adverse effects reduced*
Dopamine is already low in the brain so if dopamine is given as a drug it will not be useful for parkinsons because it doesn’t cross the blood brain barrier.

Question 9

What is therapeutic actions Carbidopa?

Answer 9

Dopaminergic agent

Carbidopa prevents breakdown of levodopa in GI and periphery-allows more to get to brain
Carbidopa does nothing on its own so it is given with levodopa so it is not broken down before reaching the blood brain barrier. DO not need to give higher dose of levodopa if given with carbidopa

Question 10

What are pharmacokinetics of levodopa/carbidopa (Sinemet)?

Answer 10

Dopaminergic Agents
Oral
Short duration –>dosed 2-3 times a day

Question 11

What are adverse effects of levodopa/carbidopa (Sinemet)?

Answer 11

On-Off Syndrome: wears off, ‘freezing’
**Extended release helps reduce this
( happens when the common treatment levodopa wears off and motor symptoms return, before it’s time for your next dose.)

GI upset (up to 6 months) N/V/ anorexia
CNS effects –»> confusion, anxiety, fatigue, confusion, blurred visions
Dyskinesia (involuntary movements)
Hypotension
Urinary retention
Do not take with protien because protein inhibit absorbtion

Question 12

What is amantadine (Symmetral)?

Answer 12

Dopaminergic Agents

Question 13

What is the therapeutic action of amantadine (Symmetral)?

Answer 13

Dopaminergic Agents
Increase release and inhibits re-uptake of dopamine in the brain —> increasing dopamine levels

Question 14

What are the indications of amantadine (Symmetral)?

Answer 14

Dopaminergic Agents
Initially an antiviral
Parkinson’s –> may be given early onset of dz
Relieves symptoms 1-5 day
Often given with levodopa –> can reduce dyskinesia seen with levodopa

Question 15

What are adverse effects of amantadine (Symmetral)?

Answer 15

Dopaminergic Agents
On-Off Syndrome: wears off, ‘freezing’
**Extended release helps reduce this
( happens when the common treatment levodopa wears off and motor symptoms return, before it’s time for your next dose.)

GI upset (up to 6 months)
CNS effects –»> confusion, anxiety, fatigue, confusion, blurred visions
Dyskinesia (involuntary movements)
Hypotension
Urinary retention

Question 16

What are contras of dopaminergic agents?

Answer 16

-Angle closure glaucoma
-Suspicious skin lesions –> melanoma risk (levodopa)

Question 17

What are cautions of dopaminergic agents?

Answer 17

-CAD, HTN, asthma, urinary obstruction
-Renal and hepatic disease

Question 18

What are drug to drug interactions with dopaminergic agents?

Answer 18

MAOIs –> stop 14 days prior to allow wash-out. Could increase dopamine levela and cause hypertension crisis
Avoid vitamin B-6: promotes breakdown of levodpa making it less effective (Ex; Milk, chickpeas, fish)
levodopa –> less effective

Question 19

What is benztropine (Cogentin)?

Answer 19

Used as anticholinergic therapy

Question 20

What is the therapeutic actions of benztropine (Cogentin)?

Answer 20

-Help to restore chemical balance
-Block effects of acetylcholine at receptor sites reducing tremors, rigidity

Question 21

What is the indications of benztropine (Cogentin)?

Answer 21

Useful as adjunctive therapy
Useful when levodopa no longer effective
patient may no longer respond to levodopa

Question 22

What is the adverse effects of benztropine (Cogentin)?

Answer 22

r/t block PSNS

dry mouth, disorientation, confusion, memory loss, nervousness, tachycardia, urinary retention

Question 23

What is the contras of benztropine (Cogentin)?

Answer 23

-Narrow angle glaucoma
-GI & GU obstruction
-Myasthenia gravis

Question 24

What is the cautions of benztropine (Cogentin)?

Answer 24

Hx of tachy, arrhythmias, HTN. Could be made worse because blockage of PSNS
Hepatic dysfunction
Hot environments –> reduces sweat response

Question 25

What is assessment for parkinsons medications?

Answer 25

Allergies
Co-morbidities
VS, Neuro assessment
Physical assessment
Labs (renal, hepatic)
Medications

Question 26

What is Nursing diagnosis for parkinsons medications?

Answer 26

Risk for injury (falls) r/t CNS effects
Impaired urinary eliminations r/t GU effects
Constipation r/t GI effects (anti-cholinergic)

Question 27

What is implementation for parkinsons medications?

Answer 27

Monitor for adverse effects
Educate patient on adverse effects
Establish safety precautions
Monitor GI and GU function
Monitor labs (renal, hepatic)
Oral care (anti-cholinergic)

Question 28

What is Evaluation for parkinsons disease?

Answer 28

Continuous assessment of patient response to medication regimen