Antiparkinson Agents. 👍🏼 Flashcards
Explain Anticholinergic
Drugs that decrease the amount or effect of acetylcholine in the body.
What is Basal ganglia ?
Group of structures located deep within the brain and are involved in the regulation of movement, coordination and various cognitive functions.
Explain Bradykinesia
When people are having a hard time performing movements, and those movements may be extremely slow. Bradykinesia is a common characteristics of Parkinson’s Disease.
Explain Dopaminergic
A drug that increases the effect of dopamine.
What is Parkinson disease
Disease that is defined by a progression of loss of motor control, coordination and function. It is caused by lack of dopamine from cells in the substantia nigra.
What is Parkinsonism ?
Clinical syndrome that can be caused by multiple situations. These situations can be medication that blocks dopamine, damage caused by cerebrovascular disease, brain tumors or traumatic brain injuries.
What is Substantia nigra ?
Part of the basal ganglia and has a large amount of dopamine producing neurons. When these nerve cells atrophy this leads to Parkinson’s disease.
Explain the progression of Parkinson’s Disease.
â—ŹLack of coordination
â—ŹRhythmic tremors
â—ŹRigidity/weakness
â—ŹTrouble maintaining position or posture
â—ŹBradykinesia
â—ŹDifficulty walking
â—ŹDrooling and affected speech
â—ŹMask-like expressions
â—ŹDifficulty swallowing
Explain the difference between Parkinsonism and Parkinson’s disease?
Parkinsonism : Broad terms used to describe a group of neurological symptoms that include tremors, rigidity, bradykinesia and postural instability. This can results from various conditions incl. Parkinson’s disease.
Parkinson’s disease : Specific neurodegenerative disorder characterized by the progressive loss of dopamine producing neurons in the substantia nigra. It is the most common cause of Parkinsonism.
When is Parkinson’s disease normally diagnosed?
Can be diagnosed at any age, but is diagnosed most often in middle age and when people reach 60 yrs.
What is the reason for Parkinson’s most often being diagnosed in the older population?
As people age, the risk of neurodegenerative changes increases and the ability of the brain to maintain and repair its neurons declines.
What does treatment of Parkinson’s disease focus on?
Treating symptoms because there currently is no known cure.
True/False
Parkinson’s is progressive disorder.
True.
Once the basal ganglia start to deteriorate, they will continue to deteriorate until the patient dies.
What causes the signs and symptoms of Parkinson’s disease?
damaged neurons in basal ganglia
When we say that people with Parkinson’s often have a mask like expression, what do we mean?
they will often have a reduced or fixed facial expression caused by muscle stiffness and bradykinesia, which makes expressions and facial movement difficult.
What are some theories regarding the reason for degeneration of the basal ganglia?
â—‹Viral infection
â—‹Blows to the head
â—‹Brain infection
â—‹Atherosclerosis
â—‹Exposure to drugs/environmental factor
We believe the most common cause is genetics or environmental exposure.
Why are patients with Parkinson’s at a higher risk of aspiration pneumonia?
Due to difficulties with swallowing and chewing.
True/False
Patients with Parkinson’s also experience a decrease in their level of alternes and cognition.
False.
The disease does not affect alertness or cognition even while their body is slowly deteriorating, however 20% of Parkinson’s patients may have severe cognitive dementia as well.
What is the most common cause of death in Parkinson’s patients?
Pneumonia aspiration or falling.
When treating Parkinson’s with medications, what are we aiming to restore?
The balance between dopamine and cholinergic neurons.
What should we encourage patients to do as part of their treatment?
â—‹Be as active as possible
â—‹Perform exercises
This helps maintain strength and balance which may alleviate bradykinesia and rigidity.
â—‹Maintain independency with ADLs as long as possible.
This promotes patient self esteem and prevent sense of helplessness.
â—‹Follow drug protocols
When we are attempting to treat Parkinson’s we can tackle this two different ways, what are those two ways?
1) Increase the amount of dopamine available.
2) Decrease the effects of acetylcholine to attain the balance.
We are trying to get bac to an equal balance between the excitatory and inhibitory chemicals.
Addressing the excitatory chemical involves blocking the ___________________
Acetylcholine.
how do we increase dopamine in the brain?
- Increase the amount of dopamine produced.
- Stimulate the receptors to be more active
- Prevent dopamine breakdown which allows it to act for longer.
True/False
Dopamine can cross the blood brain barrier.
False.
Dopamine cannot cross the blood brain barrier because it is too large and charged to pass through the regulated blood vessels in the brain.
Why do we give patients Levodopa instead of Dopamine?
Because Dopamine cannot pass through the blood brain barrier, however Levodopa can as it is a precursor to dopamine which crosses the blood brain barrier and is converted into dopamine in the brain.
What lifespan considerations should we keep in mind when prescribing Antiparkinsonism Agents to children?
Incidences are rare but does happen.
Usually needed to treat Parkinsonism induced from other medications.
Diphenhydramine (antihistamine and an anticholinergic)blocks Ach is the drug of choice in children.
What lifespan considerations should we keep in mind when prescribing Antiparkinsonism Agents to adults?
Struggle with becoming dependent on other people.
If patients are using herbal supplements this need sot be reported due to the many DDI’s with antiparkinsonism drugs.
May interfere with Pregnancy and Lactation. Barrier contraceptive and alternative feeding measures should be used.
What lifespan considerations should we keep in mind when prescribing Antiparkinsonism Agents to older adults?
Most patients fall within this category. Most will be male.
Increased risk of adverse reactions to medication.
Many conditions may be exacerbated by the drugs such as glaucoma, enlarged prostate, constipation, heart problems and COPD.
Frequent follow up checks needed.
What are the 5 dopaminergic agents that we use for Parkinson’s ?
â—ŹAmantadine
●Carbidopa–levodopa
â—ŹLevodopa
â—ŹRasagiline
â—ŹRopinirole
How does Dopaminergic Agents work?
They either increase the amount of dopamine made, increase the sensitivity of the receptors or increase the time that dopamine remain in the synaptic cleft or make the precursor Levodopa act longer.
This medications aim to restore balance by increasing the amount of inhibitory chemicals or dopamine.
Why would we give Dopaminergic Agents to a patient?
To reduce the symptoms of Parkinson’s or Parkinsonism.
Which is the most common drug that we use to treat Parkinson’s disease?
Levodopa.
What happens when we give Levodopa with Carbidopa?
Less Levodopa is metabolized in the GI tact and can be used in the brain. Giving them together enables us to give a lower dose and reduce the risks of adverse reactions.
What would contraindicate the use of Dopaminergic Agents for a patient?
â—‹Known allergy - Hypersensitivity
â—‹Lactation - drug can pass through human milk.
â—‹Angle closure glaucoma - due to dopaminergic agents increasing ocular pressure.
What patient factor should prompt increased caution when combined with Dopaminergic agents?
â—‹CV disease - Meds can cause changes in EKG and BP
â—‹Bronchial asthma - May trigger bronchospasms
â—‹H/O peptic ulcer - May increase gastric acid secretion
â—‹Urinary tract obstruction - due to effect on smooth muscle tone
â—‹Psychiatric disorders - may be exacerbated due to stimulation of dopamine receptors.
â—‹Pregnancy - Benefit outweigh risk.
What adverse reactions may we see in patients who are takin Dopaminergic Agents?
â—‹CNS effects- anxiety, nervousness
â—‹Peripheral effects- anorexia, nausea, dysphagia, urinary retention
â—‹Cardiac- arrhythmias, orthostatic hypotension
* Headache, malaise, fatigue ataxia (lack of muscle coordination) and confusion.
Are there any DDI’s with Dopaminergic Agents, and if so, what are they?
â—‹MAOIs - heightened risk of hypertensive crisis.
â—‹Vitamin B6 - can interfere with effect of dopaminergic agents.
â—‹Carbidopa-levodopa and iron salts - increase dopaminergic effect
○Rasagiline: tyramine-containing foods (Hypertensive crisis) , St. John’s wort, meperidine and
acetaminophen
How far in advance should a patient stop taking MAOI’s before starting Dopaminergic agents?
2 weeks.
What can happen if St. Johns Wort is taken with Meperidine
Serotonin Syndrome
What can happen is Rasagiline is taken with Acetaminophen?
Increased risk of liver toxicity over time.
Prior to giving patients Dopaminergic Agents, what should we be assessing for?
â—‹Assess for contraindications or cautions incl Glaucoma and mental health. Assess coordination and muscle strength to determine dose.
Look at liver function in lab to ensure that the medications is not making these worse.
- Inspect skin
- Auscultate lungs, monitor pulse, blood pressure, and cardiac output - catch adverse reactions early on.
- Auscultate bowel sounds, assess urine output and palpate bladder
Prior to giving patients Dopaminergic Agents, what nursing diagnosis should we predict?
â—‹Altered thought processes r/t CNS effects
â—‹Urinary retention r/t dopaminergic effects
â—‹Constipation risk r/t dopaminergic effects
â—‹Injury risk r/t CNS effects and incidence of orthostatic hypotension
â—‹Knowledge deficit regarding drug therapy
A nurse is assessing a patient with Parkinson’s disease who has been prescribed dopaminergic agents. The nurse notes that the patient has a history of asthma. What is the most appropriate nursing action?
Monitor for signs of bronchospasms.
When/after administering Dopaminergic drugs, what implementations should we be prepared to do for our patients ? (long answer)
â—‹Arrange to decrease the dose of the drug if therapy has been interrupted for any reason
â—‹Evaluate disease progress and signs and symptoms periodically and record for reference
â—‹Give the drug with meals - reduce GI effect.
â—‹Monitor bowel function and institute a bowel program if constipation is severe
â—‹Ensure that the patient voids before taking the drug if urinary retention is a problem
â—‹Monitor urinary output, palpate bladder, and check for residual urine
â—‹Establish safety precautions if CNS or vision changes occur
â—‹Monitor hepatic, renal, and hematological tests periodically during therapy
â—‹Provide support services and comfort measures as needed
â—‹Provide thorough patient teaching
What can happen if a patient abruptly stops taking their medication?
It can lead to withdrawal symptoms and rebound effect such as worsening of motor symptoms like rigidity, tremors and bradykinesia. Medication should be tapered off.
What adverse reactions should patients taking dopaminergic agents be educated to report?
Worsening of uncontrolled movements, urinary retention, severe constipation, abdominal pain, severe dizziness, severe nausea, vomiting, loss of appetite, and CNS changes such as hallucinations, confusion, depression or agitation.
What types of food should patients takin Dopaminergic agents avoid?
Tyramine containing food such as aged cheese and meats. Red wine and fermented food.
Anticholinergic agents balance the __________________ chemicals.
Excitatory.
Where does the anticholinergic agents work for people with Parkinson’s disease?
Designed to work primarily in the CNS. Adverse reactions comes form the fact that they still have a mild effect of the parasympathetic nervous system.
What are the names of the Anticholinergic agents that we use to treat Parkinsonism?
Benztropine
Diphenhydramine
What would indicate the use of Anticholinergic agents?
Reduce the symptoms of Parkinson’s or other movement disorders caused by disruption in the extrapyramidal system.
What other conditions may be exacerbated by the anticholinergic effects and would therefore be contraindicated?
Glaucoma
Gi Obstruction
Gu obstruction
Myasthenia Gravis
Prostatic Hypertrophy
What patient factors should prompt for increased caution when administering anticholinergic medications for Parkinson’s disease?
â—‹Tachycardia, hypertension
â—‹Pregnancy and lactation
â—‹Individuals at risk for heat exhaustion
How come patients who might be working outside in the sun should be cautious when taking anticholinergic agents?
Because they reduce sweating, so there is a greater risk of heat exhaustion.
What are some adverse reactions that patients taking anticholinergic agents may experience?
Can’t spit
Can’t see
Can’t pee
Can’t poop.
Tachycardia
Hypotension
These agents may also cause more confusion, memory loss, agitation, delirium and lightheadedness.
Are there any DDI’s to anticholinergic agents, and if so, what are they?
Other anticholinergic agents and antipsychotics : TCAs, phenothiazines - may cause a fatal paralytic ilia’s. and increased risk of toxic psychosis which is drug induced psychosis.
Prior to administering anticholinergic agents, what should we be assessing for?
â—‹Assess for contraindications or cautions
â—‹Perform a physical assessment : Neuro, GI, Abdominal, strength, vitals and renal and liver labs for a baseline.
Prior to administering anticholinergic agents, what nursing diagnosis should be expected?
â—‹Dry oral mucous membranes r/t anticholinergic effects
â—‹Risk for impaired thermoregulation r/t anticholinergic effects
â—‹Impaired urinary elimination r/t genitourinary effects
â—‹Constipation risk r/t GI effects
â—‹Altered thought processes r/t CNS effects
â—‹Injury risk r/t CNS effects
â—‹Knowledge deficit regarding drug therapy
When/ after administering anticholinergic agents for Parkinson’s disease, what implementations should we be expected to do and be prepared for? (long answer)
â—‹Arrange to decrease dose or discontinue the drug if dry mouth
becomes so severe that swallowing becomes difficult
â—‹Give drug with caution and arrange for a decrease in dose in hot
weather or with exposure to hot environments
â—‹Give drug with meals if GI upset is a problem, before meals if dry
mouth is a problem, and after meals if drooling occurs and the drug
causes nausea
â—‹Monitor bowel function and institute a bowel program if constipation is severe
â—‹Ensure that the patient voids before taking the drug; monitor urinary
output and palpate for bladder distention and residual urine
â—‹Establish safety precautions if CNS or vision changes occur
â—‹Provide thorough patient teaching
What are the 4 adjunctive agents that we should know for the exam?
Entacapone
Tolcapone
Safinamide
Selegiline
What is the purpose of Entacapone?
Used with Carbidopa-Levodopa to increase the plasma concentration and duration of action of levodopa.
Adverse effects on fetus so barrier methods should be used.
What is the purpose of Tolcapone?
Increase plasma levels of levodopa
Can cause fatal liver damage- do not use with patients with liver disease.
What is the purpose of Safinamide?
Indicated to work with carbidopa-levodopa in patients with Parkinson that are having “off” episodes.
Block breakdown of dopamine.
What is the purpose of Selegiline ?
Used with Carbidopa- Levodopa after patients have shown signs of deteriorating response to this treatment.
Irreversibly inhibit NHO and prevent it from breaking down dopamine. Increased adverse effects with MOA.
