C. Meds for Parkinsonism and AD

Question 1

parkinsonism patho

Answer 1

Pathophysiology

• Chronic neurologic disorder
• Degeneration of

dopaminergic neurons

•Imbalance of the neurotransmitters

•Less dopamine

Question 2

Parkinsonism characteristics

Answer 2

•

Tremors of head and neck

• Rigidity(increased muscle tone)
• Bradykinesia(slow movement)
• Postural changes
• Head and chest thrown forward
• Shuffling walk
• Lack of facial expression
• Pill-rolling motion of hands

Question 3

Parkinsonism treatment

Answer 3

Treatment regimen

• Dopaminergics
• Convert to dopamine

•Dopamine agonists

•Stimulate dopamine receptors

•Anticholinergics

•Block cholinergic receptors

•MAO-B inhibitors

Inhibit MAO-B enzyme that interferes with dopamine

•COMT inhibitors

•Inhibit COMT enzyme that inactivates

dopamine

Question 4

Dopaminergic -

Carbidopa-levodopa (Sinemet)

action

Answer 4

• Action: converted to dopamine
• Short duration of action—must be taken 3 or 4 times per day. Extended release 2 to 4 times/day
• Side effects
• Involuntary choreiform movements
• N & V, Urinary retention
• Fatigue, insomnia, dry mouth, blurred vision
• Orthostatic hypotension, palpitations, dysrhythmias
• Dyskinesia, psychosis, severe depression
• Drug interactions
• Phenytoin, Benzodiazepines,Anticholinergics

Question 5

antiparkinsonism drugs-

nurse interventions

Answer 5

• Nursing interventions
• Do not abruptly discontinue (safety issue)
• Monitor for orthostatic hypotension
• Avoid excess vitamin B6
• Warn of urine/sweat getting harmless brown discoloration
• Assess symptom status and “on-off”phenomenon
• Monitor blood cell counts, liver function &

kidney function (BUN & Creatinine)

•Teaching re: anticholinergic

effects with Benztropine

& Trihexyphenidyl

Question 6

Alzheimer’s Disease AD

Patho

Answer 6

• Progressive, degenerative disease
• Neuritic plaques form
• Neurofibrillary tangles are in neurons
• Cholinergic neurotransmitter abnormality

Question 7

Alzheimer’s Disease AD:

characteristics

Answer 7

• Loss of memory, logical thinking, judgment
• Time disorientation
• Personality changes
• Hyperactivity
• Tendency to wander
• Inability to express oneself

Question 8

Meds to treat AD

Answer 8

• Acetylcholinesterase Inhibitors: donepezil (Aricept), rivastigmine (Exelon), tacrine (Cognex)
• Use
• Mild to moderate Alzheimer’s disease
• Goal
• NOT a cure
• Improve memory
• Slow progression of disease

Question 9

AD med SE

Answer 9

Headache, dizziness, Dehydration, dry

mouth, Blurred vision, Depression, GI

distress, Insomnia, Hypertension,

hypotension, dysrhythmias, Hepatotoxicity

Question 10

AD med-

NI

Answer 10

• Monitor vital signs
• Maintain consistency in care
• Monitor behavioral changes
• •Provide safety*
• when wandering*
• •Arise slowly to avoid dizziness*

•Monitor for GIbleeding