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Pharmacology Exam #3 > Antiparkinsonism Agents > Flashcards

Antiparkinsonism Agents Flashcards

1
Q

What is parkinsonism?

A
  • General syndrome of muscle tremors, bradykinesia, altered gait, etc. regardless of cause
  • Could be related to medications
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2
Q

What is Parkinson’s Disease?

A
  • Progressive chronic neurological disorder
  • Related to damaged neurons in basal ganglia cells
  • May develop in people of any age
  • Usually affects those past midlife - entering their 60s
  • Cause is unknown - thought to be a combo of genetic and environmental factors
  • No cure
  • Therapy manages signs and symptoms
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3
Q

What is the management of care of patients with Parkinson’s Disease?

A
  • Drug therapy is aimed at restoring balance between dopamine and cholinergic neurons
  • Encourage patients to:
    Be as active as possible
    Perform exercises
    Maintain independence with ADLs as long as possible
    Follow drug protocols
  • Patient and family need education on drug therapy and psychological support
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4
Q

Lifespan Considerations for Antiparkinsonism Agents
In Children

A
  • Safety and effectiveness not established
  • Incidence in children is very small
  • They DO experience parkinsonism symptoms from drug effects
  • Diphenydramine is the drug of choice
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5
Q

Lifespan Considerations for Antiparkinsonism Agents
In Adults

A
  • Devastating progression
  • Inform provider of ANY herbal/alternate therapies
  • Use contraception in childbearing age
  • Use alternate method to feed infant
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6
Q

Lifespan Considerations for Antiparkinsonism Agents
In Older Adults

A
  • Increases with age
  • Increased adverse effects
  • Drugs aggravate glaucoma, BPH, constipation, cardiac problems, and COPD that often are seen in this population
  • May need frequent dose adjustments
  • May need other drugs to counteract effects of these drugs
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7
Q

Dopaminergic Agents
Drug Names

A

🔴 Amantadine
🟠 Carbidopa-levodopa
🟡 Levodopa
🟢 Rasagiline
🔵 Ropinirole

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8
Q

Dopaminergic Agents
Mechanism of Action

A
  • Promote dopamine synthesis
  • Activate dopamine receptors
  • Prevent dopamine breakdown
  • Decrease degradation of levodopa (carbidopa)
  • Help to restore balance between inhibitory (dopamine) and stimulating (acetylcholine) neurotransmitters
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9
Q

Dopaminergic Agents
Indications

A

Relief of the signs and symptoms of idiopathic Parkinson’s disease

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10
Q

Levodopa

A
  • Naturally created by the body
  • Precursor to dopamine
  • Mainstay of treatment for parkinsonism
  • Crosses the blood brain barrier where it is converted to dopamine
  • Almost always given as combo drug with carbidopa
  • Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
  • The dosage of levodopa can be decreased with the added carbidopa, reducing adverse effects
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11
Q

Dopaminergic Agents
Contraindications

A

Absolute:
* Allergy
* Lactation
* Angle closure glaucoma (inc. in eye pressure - exacerbates this)

Cautions:
* CV disease: orthostatic hypotension, arrhythmias
* Bronchial asthma: could trigger bronchospasm
* History of Peptic Ulcer
* Urinary Tract Obstruction
* Psychiatric disorders
* Pregnancy

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12
Q

Dopaminergic Agents
Adverse Effects

A
  • CNS: anxiety, nervousness
  • Peripheral effects: anorexia, nausea, dysphagia, urinary retention
  • Cardiac: arrhythmias, orthostatic hypotension
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13
Q

Dopaminergic Agents
Drug Interactions

A
  • MAOIs: STOP 2 WEEKS before taking dopaminergics - ⬆️risk of hypertensive crisis
  • Vitamin B6

Carbidopa-Levodopa: Iron Salts
Rasagiline: tyramine containing foods (inc. risk of hypertensive crisis); St. John’s Wort (inc. risk of serotonin syndrome); Meperidine; Acetaminophen (inc. risk of liver toxicity)

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14
Q

Dopaminergic Agents
Assessment

A

History:
* Check for all contraindications and cautions

Physical:
* Skin
* CNS: Level of orientation, affect, reflexes, bilateral grip strength, gait, tremors, spasticity
* Lung sounds
* Vitals
* Bowel sounds
* Urine output
* Palpate bladder

Labs:
* Liver and Renal function tests
* CBC

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15
Q

Dopaminergic Agents
Nursing Diagnoses/Conclusions

A
  • Altered thought processes (r/t CNS effects)
  • Urinary retention (r/t dopaminergic effects)
  • Constipation risk (r/t dopaminergic effects)
  • Injury risk (r/t CNS effects and orthostatic hypotension)
  • Knowledge Deficit
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16
Q

Dopaminergic Agents
Implementation/Patient Teaching

A
  • Arrange to decrease dose of the drug if therapy has been interrupted for any reason
  • Evaluate disease progression, record for reference
  • Give the drug with meals to reduce GI effects
  • Bowel program if constipation is severe
  • Void before administration if urinary retention is an issue
  • Safety precautions for CNS or vision issues
  • Involve support system
  • Report: worsening symptoms, severe constipation or N/V, urinary retention, abdominal pain, severe dizziness, hallucinations, confusion, depression, agitation
  • Avoid tyramine containing foods
  • Do not miss doses or stop abruptly
  • Encourage follow up appointments
  • Avoid driving until CNS effects are known
17
Q

Anticholinergic Agents
Drug Names
To treat parkinsonism

A

Bentropine
Diphenhydramine

18
Q

Anticholinergic Agents
Mechanism of Action

A

Synthetic drugs with greater affinity for cholinergic receptor sites in the CNS rather than the peripheral nervous system

19
Q

Anticholinergic Agents
Indications

A
  • Treatment of parkinsonism
  • Relief of symptoms of extrapyramidal disorders associated with use of some drugs
20
Q

Anticholinergic Agents
Contraindications

A

Absolute:
* Allergy
* Any condition exacerbated by blocking the PNS: Glaucoma, GI obstruction, GU obstruction, myasthenia gravis, and prostatic hypertrophy

Cautions:
* Tachycardia, hypertension
* Pregnancy and lactation
* Individuals at risk for heat exhaustion

21
Q

Anticholinergic Agents
Adverse Effects

A
  • CNS effects and periperal anticholinergic effects
  • Works mostly in the CNS: dizziness, confusion, etc.
22
Q

Anticholinergic Agents
Drug Interactions

A
  • Other anticholinergics
  • Antipsychotics: TCAs, phenothiazines
23
Q

Anticholinergic Agents
Assessment

A

History:
* Check for all cautions and contraindications

Physical:
* Level of orientation and affect, reflexes, bilateral grip strength, gait, tremors, and spasticity
* Monitor pulse, blood pressure, and cardiac output
* Auscultate bowel sounds
* Urinary output, palpate bladder

Labs:
* Renal and Liver function tests

24
Q

Anticholinergic Agents
Nursing Diagnoses/Conclusions

A
  • Dry oral mucous membranes (r/t anticholinergic effects)
  • Risk for impaired thermoregulation (r/t anticholinergic effects)
  • Impaired urinary elimination (r/t genitourinary effects)
  • Constipation risk (r/t GI effects)
  • Altered thought processes (r/t CNS effects)
  • Injury risk (r/t CNS effects)
  • Knowledge Deficits
25
Q

Anticholinergic Agents
Implementation

A
  • Arrange to decrease or discontinue if dry mouth becomes so severe that swallowing becomes difficult
  • Give drug with caution and arrange for decrease in dose in hot weather or exposure to hot environments
  • Give drug with meals if GI upset is an issue, before meals if dry mouth is a problem, and after meals if drooling occurs and causes nausea
  • Bowel program if constipation is severe
  • Void before taking drug
  • Safety precautions for CNS effects
  • Stay hydrated
  • Avoid other CNS depressants
  • Encourage follow up appointments
26
Q

Adjunctive Agents
Drug names

A

Entacapone: used with carbidopa-levodopa to increase plasma concentration and duration of action of levodopa; use barrier contraceptives
Safinamide (MAOI): with with carbidopa-levodopa in patients with Parkinson’s having “off” episodes
Selegiline (MAOI): used with carbidopa-levodopa after patient has shown signs of deteriorating response to treatment:
Tolcapone: works with carbidopa-levodopa to increase plasma levels of levodopa: use barrier contraceptives, avoid in hepatic dysfunction

Pharmacology Exam #3 (14 decks)

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