Antiparkinson agents Flashcards
antiparkinson agents across the lifespan
- children only experience parkinsonian symptoms from other drugs - diphenhydramine is the drug of choice
- child bearing should use contraceptives while on meds
- parkinsons worsens and occurs in old age and may need dose adjustments
what are the dopaminergics?
amantadine levodopa carbidopa-levodopa rasagiline ropinirol
what are the actions of dopaminergics?
- helps to restore the balance between the inhibitory and stimulating neurons
- increases the levels of dopamine and directly stimulates receptors
what are the indications of dopaminergics?
relief of S/S idiopathic parkinsons
what are the contra-cautions of dopaminergics?
- allergy
- angle closure glaucoma
- GI obstruction, pregnancy and lactation
- CV disease
- bronchial asthma
- H/O peptic ulcer
- urinary tract obstruction
- psychiatric disorders
ALL will be worsened with dopaminergics
what are the adverse effects of dopaminergics?
- anxiety
- nervousness
- HA
- blurred vision
- arrhythmias
what are the drug-drug for dopaminergics?
- MAOIs: increases risk of hypertensive crisis
- Vitamin B6, Tyramine-containing foods, St. Johns wort, Meperidine and other analgesics: decrease in dopaminergics effects
why choose levodopa?
almost always combined with carbidopa because the dosage of levodopa can be decreased, reducing S/E’s
crosses blood-brain barrier to convert to dopamine
assesment for dopaminergics
- HX and physical exam for ADL’s and current signs and symptoms to monitor progression
- any contraindications?
- HX of melanoma?
- watch urinary output due to possible retention
- labs: kidney and liver
nursing diagnosis for dopaminergics
- disturbed though process
- risk for urinary retention R/T dopaminergic effects
- constipation R/T dopaminergics effects
- risk for injury R/T CNS effects and orthostatic hypertension
implementaion for dopaminergics
- decrease dose if therapy was interrupted
- evaluate disease progress and S/S
- take with meals
- monitor bowel function and institute program
- monitor urinary output, palpate bladder, check for residual
- establish safety
- monitory hepatic/renal and hematological tests
evaluation for dopaminergics
- improvement in S/S of disease
- watching for adverse effects
- effectiveness of support measures
what are our anticholinergic agents?
benztropine
diphenhydramine
anticholinergic actions
synthetic drugs with greater affinity for receptor sites in CNS
anticholinergic contra/cautions
- allergy
- narrow angle glaucoma
- GU obstruction
- prostatic hypertrophy
- myasthenia gravis
- tachycardia / dysrhythmias
- hyper/hypotension
- hepatic dysfunction
- pregnancy and lact
- hot environments
adverse effects of anticholinergic
CNS effects and peripheral anticholinergic effects: dry mouth, urinary retention, blurred vision
CANT spit, see, poop, pee
drug-drug for anticholinergic
other anticholinergics: increase anticholinergic effects
antipsychotics: decrease in psych effects
assessment for anticholinergic
- HX and physical with progress of disease, reflexes, gait
- contraindications or cautions?
- monitor bowel sounds and urine output
- labs: kidney and liver
anticholinergic nursing diagnosis
- impaired oral mucous membranes r/t anticholinergic effects
- risk for impaired thermoregulation r/t anticholinergic
- impaired urinary elimination r/t GU effects
- constipation r/t GI effects
- disturbed thought process r/t CNS effects
anticholinergic implementation
- arrange to decrease dose or d/c drug if dry mouth impedes swallowing
- give with caution and decrease dose in hot weather
- give drug with meals if GI upset occurs before meals if have dry mouth or after if drooling occurs or nausea
- monitor bowel and urine for protocols
- urinate prior to admin
- establish safety if CNS or vision changes
evaluation of anticholinergics
- improvement in S/S of disease
- monitor for CNS changes, urine retention, GI slow, tachy, decreased sweat/flushing
what are the adjunct agents?
Entacapone
Tolcapone
Safinamide
Selegiline
how does entacapone work?
used with carbidopa-levodopa to increase plasma concentration and duration of levodopa to increase effectivness
how does tolcapone work?
used with carbidopa-levodopa to increase plasma levels of levodopa - increased levels of dopamine
how does safinamide work
indicated to work with carbidopa-levodopa for parkinson patients with “off” episodes
how does selegiline work?
used with carbidopa-levodopa after signs of deterioration in response to their treatment
