Antiparkinsonism Agents

Question 1

Drug class: Dopaminergic Agents
What are the drug names in this class?

Answer 1

-Levodopa
-Carbidopa-levodopa
-Rasagiline
-Amantadine
-Ropinirole

Question 2

Drug class: Dopaminergic Agents
What are the actions?

Answer 2

-promote dopamine synthesis, activate dopamine receptors, prevent dopamine breakdown, or decrease degradation of levodopa (carbidopa)
-helping to restore the balance between the inhibitory and stimulating neurotransmitters

Question 3

Drug class: Anticholinergic Agents for Parkinson’s Disease
What are the drug names in this class?

Answer 3

-Benztropine
-Diphenhydramine

Question 4

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the actions?

Answer 4

-synthetic drugs with greater affinity for colonic receptor size in the CNS than peripheral nervous system

Question 5

Use of antiparkinsonism agents across the lifespan of: CHILDREN

Answer 5

-safety and effectiveness not established
-children developing Parkinson’s is rare, but not impossible
-most of the time children need anti-Parkinson medication because their parkinsonism is induced from other medication’s
-diphenhydramine is the drug of choice (antihistamine with anticholinergic properties)

Question 6

Use of antiparkinsonism agents across the lifespan of: ADULTS

Answer 6

-devastating progression
-inform provider of any herbal/alternate therapies with other conditions, types of medication
-use contraception if childbearing age
-use alternate method to feed infant

Question 7

Use of antiparkinsonism agents across the lifespan of: OLDER ADULTS

Answer 7

-parkinson’s increases with age
-increased adversive effects
-drugs aggravate glaucoma, BPH, constipation, cardiac problems, and COPD
-may need frequent dose adjustments- follow up is important
-may need other drugs to counteract effects of these drugs

Question 8

Use of antiparkinsonism agents across the lifespan of: OLDER ADULTS

Answer 8

-parkinson’s increases with age
-increased adversive effects
-drugs, aggravate, glaucoma, BPH, constipation, cardiac problems, and COPD
-may need frequent dose adjustments- follow up is important
-may need other drugs to counteract effects of these drugs

Question 9

Drug class: Dopaminergic Agents
What are the indications?

Answer 9

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

Question 10

Levodopa

Answer 10

-Main stay of treatment for parkinsonism
-Precursor of dopamine that crosses the blood brain barrier where it is converted to dopamine
-Almost always given in combination with carbidopa as a fixed combination drug
-Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
(The dosage of levodopa can be decreased reducing adverse side effects)

Question 11

Drug class: Dopaminergic Agents
What are the contraindications?

Answer 11

-known allergy
-lactation
-angle closure glaucoma (dopaminergic agents increase eye pressure)

Question 12

Drug class: Dopaminergic Agents
What are the cautions?

Answer 12

-CV disease (these agents can cause changes in EKGs and blood pressure which constrain the cardiovascular system)
-Bronchial asthma (may trigger Bronchos spasm and individuals with asthma)
-H/O peptic ulcer (can increase gastric acid secretion, irritating the stomach lining)
-Urinary tract obstruction (can influence smooth muscle tone, and urinary retention)
-Psychiatric disorders (by stimulating dopamine receptors these drugs may exacerbate psychosis, hallucinations or other psychiatric symptoms)
-Pregnancy

Question 13

Drug class: Dopaminergic Agents
What are the adverse effects?

Answer 13

CNS: anxiety, nervousness, headache, malaise, fatigue, confusion
Peripheral effects: anorexia, nausea, dysphasia, urinary retention
Cardiac: arrhythmias orthostatic hypotension
GI effects: anorexia

Question 14

Drug class: Dopaminergic Agents
What are the drug-drug interactions?

Answer 14

-MAOIs (high risk for hypertensive crisis)
*MAOIs must be stopped 2 weeks before taking a dopaminergic agent
-Vitamin B6
-Carbidopa-levodopa: iron salts
-Rasagiline: tyramine-containing foods (high risk for hypertensive crisis)
-St John’s wort +meperidine = serotonin syndrome
-Acetaminophen + Rasagiline = may increase risk of liver toxicity

Question 15

Nursing considerations for patients receiving dopaminergic agents:
Whats included in the assessment?

Answer 15

-Assess for contraindications or cautions (glaucoma?)
-Perform a physical assessment: skin check
-Assess level of orientation, affect, reflexes, bilateral grip strength, tremors, and spasticity
-Auscultate lungs, monitor pulse, blood pressure and cardiac output
-Auscultate bowel sounds, assess urine output and palpate bladder
Labs: monitor liver and renal function, studies and complete blood count

Question 16

Nursing considerations for patients receiving dopaminergic agents:
What are the nursing diagnoses?

Answer 16

-altered thought process related to CNS effects
-urinary retention related to dopaminergic effects
-constipation risk related to dopaminergic effects
-Injury risk related to CNS effect and incident of orthostatic hypotension
-knowledge deficit therapy

Question 17

Nursing considerations for patients receiving dopaminergic agents:
What are the implementations?

Answer 17

-Arrange to decrease the dose of the drug if therapy has been interrupted for any reason
(a group changes and medication can lead to withdrawal symptoms or rebound effects)
-Evaluate disease, progress and signs and symptoms periodically and record for reference
-Give the drug with meals will reduce GI effects
-Monitor bowel function and institute a program if constipation is severe
-Ensure that the patient avoids before taking the drug if urinary retention is a problem
-Monitor urinary output, palpate, bladder, and check for residual urine
-Establish safety precautions if CNS or vision changes occur
-Monitor hepatic, renal, and hematological tests during therapy
-Provides support services and comfort measures as needed
-Provide thorough patient teaching

Question 18

Nursing considerations for patients receiving dopaminergic agents:
Whats in the evaluation?

Answer 18

-Monitor patient response to the drug (improvement in science and symptoms of Parkinson’s disease: increased motor function and tremor reduction with mild side effects)
-Monitor for adverse effects (CNS changes, urinary retention, G.I. depression, tachycardia, increased, sweating, flushing)
-Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage, name possible adverse effects to watch for and specific measures to prevent them and discuss the importance of continued follow up)
-Monitor the effectiveness of support measures and compliance with the regimen

Question 19

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the indications?

Answer 19

-treatment of parkinsonism
-relief of symptoms of extrapyramidal disorders associated with the use of some drugs

Question 20

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the contraindications?

Answer 20

-Allergy
-Any condition that it’s exacerbated by blocking the peripheral nervous system
-Glaucoma, G.I. obstruction, GU obstruction, myasthenia gravis and prosthetic hypertrophy (enlarged prostate)

Question 21

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the cautions?

Answer 21

-Tachycardia, hypertension (these drugs can increase sympathetic stimulation, and worsen these conditions)
-Hepatic dysfunction
-Pregnancy and lactation
-Individuals at risk for heat exhaustion

Question 22

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the adverse effects?

Answer 22

-CNS effects and peripheral anticholinergic effects: confusion, memory, loss, agitation, delirium, or lightheadedness
-dry mouth, constipation, blurred vision, urinary retention, tachycardia, hypertension.

Question 23

Drug class: Anticholinergic Agents for Parkinson’s Diease
What are the drug-drug interactions?

Answer 23

-other anticholinergics and antipsychotics
-TCAs and phenothiazines

Question 24

Nursing considerations for patients receiving anticholinergic agents for Parkinson’s:
What’s included in the assessment?

Answer 24

-assess for contraindications or cautions
-perform a physical assessment: neuro, GI, abdominal assessment
-assess level of orientation and affect, reflexes, bilateral grip strength, gait, tremors, and spasticity
-Monitor pulse, blood pressure and cardiac output
-Auscultate bowel sounds, assess urine output, and palpate bladder
Labs: Monitor, renal and liver function test

Question 25

Nursing considerations for patients receiving anticholinergic agents for Parkinson’s:
What are the nursing diagnoses?

Answer 25

-dry oral mucus membranes related to anticholinergic effects
-risk for impaired thermoregulation related to anticholinergic effects
-impaired urinary elimination related to genitourinary effects
-altered thought process related to CNS effects
-Injury risk related to CNS effect and incident of orthostatic hypotension
-knowledge deficit therapy

Question 26

Nursing considerations for patients receiving anticholinergic agents for Parkinson’s:
What’s included in the Implementation?

Answer 26

-arrange to decrease dose or discontinue the drug if dry mouth becomes so severe that swallowing becomes difficult
-give drug with caution and arrange for a decrease in dose and hot weather or with exposure to hot environments r/t anticholinergic effects of not being able to sweat effectively
-give drug with meals if G.I. upset is a problem, before meals if dry mouth is a problem, and after meals, if drooling occurs and the drug causes nausea
-monitor function and Institute of bowel program of constipation severe
-ensure that the patient voids before taking the drug, monitor, urinary output and palpate for bladder extension and residual urine
-establish safety precautions if CNS or vision changes occur
-provide through patient teaching

Question 27

Nursing considerations for patients receiving anticholinergic agents for Parkinson’s:
What’s included in the evaluation?

Answer 27

-Monitor patient response to the drug (improvement in science and symptoms of Parkinson’s disease: increased motor function and tremor reduction with mild side effects)
-Monitor for adverse effects (CNS changes, urinary retention, G.I slowing, tachycardia, decreased sweating, flushing)
-Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage, name possible adverse effects to watch for and specific measures to prevent them and discuss the importance of continued follow up)
-Monitor the effectiveness of support measures and compliance with the regimen

Question 28

Adjunctive Agents to treat Parkinson’s
What’s are the names and actions?

Answer 28

-Entacapone: used with carbidopa-levodopa to increase the plasma concentration and duration of action of levodopa (can have adverse effect on fetus, patient should use barrier methods)

-Tolcapone: works in a similar way with carbidopa-levodopa to further increase plasma levels of levodopa (can cause fatal liver damage, don’t give to patients with preexisting liver disease + use barrier methods)

-Safinamide: indicated to work with carbidopa-levodopa in patient with Parkinson’s that are having “off” episodes

-Selegiline: used with carbidopa-levodopa after patients have shown signs of deteriorating response to the treatment (increased risk of MAOI induced hypertension - pt immediately need to report severe headache or other signs of hypertension)