Antiparkinson agents

Question 1

antiparkinson agents across the lifespan

Answer 1

• 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

Question 2

what are the dopaminergics?

Answer 2

amantadine 
levodopa
carbidopa-levodopa
rasagiline
ropinirol

Question 3

what are the actions of dopaminergics?

Answer 3

• helps to restore the balance between the inhibitory and stimulating neurons
• increases the levels of dopamine and directly stimulates receptors

Question 4

what are the indications of dopaminergics?

Answer 4

relief of S/S idiopathic parkinsons

Question 5

what are the contra-cautions of dopaminergics?

Answer 5

• 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

Question 6

what are the adverse effects of dopaminergics?

Answer 6

• anxiety
• nervousness
• HA
• blurred vision
• arrhythmias

Question 7

what are the drug-drug for dopaminergics?

Answer 7

• MAOIs: increases risk of hypertensive crisis
• Vitamin B6, Tyramine-containing foods, St. Johns wort, Meperidine and other analgesics: decrease in dopaminergics effects

Question 8

why choose levodopa?

Answer 8

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

Question 9

assesment for dopaminergics

Answer 9

• 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

Question 10

nursing diagnosis for dopaminergics

Answer 10

• 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

Question 11

implementaion for dopaminergics

Answer 11

• 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

Question 12

evaluation for dopaminergics

Answer 12

• improvement in S/S of disease
• watching for adverse effects
• effectiveness of support measures

Question 13

what are our anticholinergic agents?

Answer 13

benztropine

diphenhydramine

Question 14

anticholinergic actions

Answer 14

synthetic drugs with greater affinity for receptor sites in CNS

Question 15

anticholinergic contra/cautions

Answer 15

• allergy
• narrow angle glaucoma
• GU obstruction
• prostatic hypertrophy
• myasthenia gravis
• tachycardia / dysrhythmias
• hyper/hypotension
• hepatic dysfunction
• pregnancy and lact
• hot environments

Question 16

adverse effects of anticholinergic

Answer 16

CNS effects and peripheral anticholinergic effects: dry mouth, urinary retention, blurred vision

CANT spit, see, poop, pee

Question 17

drug-drug for anticholinergic

Answer 17

other anticholinergics: increase anticholinergic effects

antipsychotics: decrease in psych effects

Question 18

assessment for anticholinergic

Answer 18

• HX and physical with progress of disease, reflexes, gait
• contraindications or cautions?
• monitor bowel sounds and urine output
• labs: kidney and liver

Question 19

anticholinergic nursing diagnosis

Answer 19

• 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

Question 20

anticholinergic implementation

Answer 20

• 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

Question 21

evaluation of anticholinergics

Answer 21

• improvement in S/S of disease

- monitor for CNS changes, urine retention, GI slow, tachy, decreased sweat/flushing

Question 22

what are the adjunct agents?

Answer 22

Entacapone
Tolcapone
Safinamide
Selegiline

Question 23

how does entacapone work?

Answer 23

used with carbidopa-levodopa to increase plasma concentration and duration of levodopa to increase effectivness

Question 24

how does tolcapone work?

Answer 24

used with carbidopa-levodopa to increase plasma levels of levodopa - increased levels of dopamine

Question 25

how does safinamide work

Answer 25

indicated to work with carbidopa-levodopa for parkinson patients with “off” episodes

Question 26

how does selegiline work?

Answer 26

used with carbidopa-levodopa after signs of deterioration in response to their treatment