Chapter 15

Question 1

amantadine (symmetrel)

Answer 1

• an antiviral drug that used to be for influenza
• indirect acting
• used early in the disease, only effective for 6-12 months
• can result in dizziness and GI upset

Question 2

bromocriptine

Answer 2

• works by activivating presynaptic dopamine receptors to stimulate the produciton of more dopamine
• only can be used early in the disease
• also inhibits the production of the hormone prolactin

Question 3

carbidopa-levodopa (Sinemet)

Answer 3

carbidopa does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery
-as a result, more levodopa crosses the blood-brain barrier, where is can be converted to dopamine

• as disease progresses, it becomes more difficult to control with levodopa
• given orally

adverse effects: GI distress, hypotension, involuntary effects

• don’t give with open-angle glaucoma
• take it with food

Question 4

benztropine mesylate (Cogentin)

Answer 4

anticholinergic used to manage PD and to control symptoms that patients get after getting antipsychotic drugs
-can dry people up, so in heat need to watch for hyperthermia (heat stroke)

-patient should avoid alchohol because CNS depressant

Question 5

Parkinson’s Disease (PD)

Answer 5

1. Chronic, progressive, degenerative disorder
2. Affects dopamine-producing neurons in the brain
3. Caused by an imbalance of two neurotransmitters
   Dopamine
   Acetylcholine (ACh)

Question 6

Is dopamine inhibitory or excitatory? Is acetycholine inhibitory or excitatory?

Answer 6

dopamine = inhibitory
acetylcholine = excitatory

Question 7

When do symptoms occur?

Answer 7

When 80% of the dopamine stored in the substantia nigra of the basal ganglia is depleted

Question 8

How can symptoms be controlled?

Answer 8

symptoms can be partially controlled as long as there are functioning nerve terminals that can take dopamine

Question 9

TRAP

Answer 9

• tremors
• rigidity
• akinesia
• postural instability

Question 10

Can current drugs slow the progression of parkinsons?

Answer 10

No :(

Question 11

Parkinsons needs a __________ approach

Answer 11

multidisciplinary

Question 12

MAOIs break down ____ in the CNS, primarily in the brain

Answer 12

catecholamines

Question 13

Patient cannot have anything with ______

Answer 13

tyronine (anything aged, wine, meats, cheese)

-can increase blood pressure even more

Question 14

COMT inhibitors (catechol ortho-methyltransferase)

Answer 14

• reduce wearing-off phenomenon

- adverse effects include GI upset, urine discoloration, can worsen dyskinesia that may already be present

Question 15

chorea

Answer 15

-crazy, twisty, uncontrollable movments

Question 16

______ block the effects of ACh

Answer 16

Anticholinergics

Question 17

What is SLUDGE?

Answer 17

Ach is responsible for causing increased salivation, lacrimation (tearing of the eyes), urination, diarrhea, increased GI motility, and possibly emesis (vomiting).

Question 18

Antiparkinson drug nursing implications

Answer 18

Monitor for orthostatic hypotension.
Administer drug with low-protein foods.
Avoid excessive vitamin B6, alcohol, other depressants.
Do not abruptly discontinue.
Assess for suicidal tendencies.
Assess symptom status and “on-off” phenomenon.
Monitor blood cell counts, liver and kidney function.

Question 19

carpidopa-levodopa can make ______ worse

Answer 19

-untreated malignant melanoma