Chapter 15 Antiparkinson Drugs

Question 1

Parkinson’s Disease (PD)

Answer 1

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

Question 2

When do Symptoms occur in Parkinson’s Disease?

Answer 2

• Symptoms occur when about 80% of the dopamine stored in the substantia nigra of the basal ganglia is depleted.
• Symptoms can be partially controlled as long as there are functioning nerve terminals that can take up dopamine.

Question 3

Parkinson’s Disease Classic Symptoms Include:

Answer 3

Akinesia 
Bradykinesia
Rigidity
Tremor
Postural instability
Staggering gait
Drooling
`

Question 4

Akinesia

Answer 4

absense of psychomotor activity resulting in masklike facial expression

Question 5

Bradykinesia

Answer 5

Slowness of movement

Question 6

Rigidity

Answer 6

“Cogwheel” rigidity, resistance to passive movement

Question 7

Tremor

Answer 7

Pill rolling: tremor of the thumb against the forefinger seen mostly at rest and less severe during voluntary activity; usually starts on one side then progresses to the other; is the presenting sign in 70% of cases; also seen as tremor of the hand and extremities

Question 8

Postural Instibility

Answer 8

Unsteadiness that leads to danger of falling; leaning to one side, even when sitting

Question 9

The “off–on phenomenon” that some patients with PD experience is best explained as the

Answer 9

variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms

Question 10

Dyskinesia

Answer 10

Difficulty in performing voluntary movements

Question 11

Two Common types of Dyskinesia

Answer 11

Chorea and Dystonia

Question 12

Chorea

Answer 12

irregular, spasmodic, involuntary movements of the limbs or facial muscles

Question 13

Dystonia

Answer 13

abnormal muscle tone leading to impaired or abnormal movements

Question 14

Rasagiline (Azilect) and Selegiline (Eldepryl)

Answer 14

-Used as monotherapy or used as adjuncts with levodopa
-Contraindications
Known drug allergy
Concurrent use with meperidine

Question 15

Levodopa Therapy

Answer 15

• Levodopa is a precursor of dopamine.

- Blood–brain barrier does not allow exogenously supplied dopamine to enter but does allow levodopa to enter.

Question 16

Bromocriptine (Parlodel)

Answer 16

• Works by activating presynaptic dopamine receptors to stimulate the production of more dopamine
• Caution when used for patients with peripheral vascular disease
• Adverse reactions: GI upset, dyskinesias, sleep disturbances
• Drug interactions: erythromycin and adrenergic drugs

Question 17

Ropinirole (Requip) and Rotigotine (Neupro)

Answer 17

Also used to treat a disorder known as restless legs syndrome, a nocturnal movement of the legs that disrupts sleep

Question 18

Anticholinergic Therapy

Answer 18

• Anticholinergics block the effects of ACh
• Used to treat muscle tremors and muscle rigidity associated with PD
• These two symptoms are caused by excessive cholinergic activity.
• Does not relieve bradykinesia (extremely slow movements)

Question 19

SLUDGE

Answer 19

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

Question 20

Benztropine (Cogentin)

Answer 20

• Anticholinergic drug used for PD and extrapyramidal symptoms from antipsychotic drugs
• Caution during hot weather or exercise because it may cause hyperthermia
• Adverse effects: tachycardia, confusion, disorientation, toxic psychosis, urinary retention, dry throat, constipation, nausea, and vomiting
• Anticholinergic syndrome
• Avoid alcohol

Question 21

Nursing Implications for AntiParkinsons Drugs

Answer 21

• When starting dopaminergic drugs, assist patient with walking because dizziness may occur
• Administer oral doses with food to minimize GI upset
• Encourage patient to force fluids to at least 3000 mL/day (unless contraindicated)
• Taking levodopa with MAOIs may result in hypertensive crisis