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Pharm 1 > drug therapy for Parkinson's, urinary spasticity, and disorders requiring anticholinergic drug therapy > Flashcards

drug therapy for Parkinson's, urinary spasticity, and disorders requiring anticholinergic drug therapy Flashcards

1
Q

define parkinson’s disease

what is it and what is it characterized by?

A

-chronic, progressive, degenerative disorder of the CNS
-characterized by resting tremor, bradykinesia, rigidity, and postural instability

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2
Q

describe the etiology of parkinsons disease

A

cause of the nerve cell damage is unknown

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3
Q

describe the pathophysiology of parkinson’s disease

where and what neurotransitters are involved?

A

-progressive destruction of or degerative changes in dopamine producing nerve cells in the substantia nigra in the basal ganglia
-decrease in dopamine and increase in acetylcholine

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4
Q

describe the clinical manifestations of parkinsons disease

A

-pill rolling movements
-bradykinesia (slow movement)
-akinesia (no movement)
-shuffling gait/stooped posture
-masklike facial expressions/rigidity
-soft voice

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5
Q

what drug therapy is used for patients with parkinson’s disease

A

dopamine receptor agonsists and COMT inhibitors

-goal is to balance dopamine and acetylcholine

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6
Q

describe levodopa-carbidopa

two meds in one - why?

A

-most common used for parkinsons
-levodopa changes to dopamine in the brain, carbidopa prevents the breakdown of levodopa in the blood
-this helps correct the neurotransmitter imbalance in the brain

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7
Q

describe the pharmacokinetics of levodopa-carbidopa

A

-well absorbed in small intestine after oral administration
-primarily excreted in the urine

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8
Q

describe the action of levodopa-carbidopa

A

-increases the amount of dopamine in the brain
-levodopa is the metabolic precursor of dopamine

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9
Q

describe the use of levodopa-carbidopa

A

-dopamine receptor agonists
-symptomatic treatment of idiopathic parkinsons, often akinetic symptoms
-tx of serious restless leg syndrome

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10
Q

describe some adverse effects of levodopa-carbidopa

A

-CNS -> headache, anxiety, drowsiness, hallucinations
-cardiovascular -> orthostatic hypotension, increase or decrease in HR, decrease in BP
-GI -> anorexia, N+V, teeth grinding
-others

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11
Q

what are some contraindications of levodopa-carbidopa

A

-hypersensitivity, narrow angle glaucoma, melanoma, peptic ulcer disease, HTN
-severe cardiovascular, pulmonary, renal, hepatic, endocrine disorders

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12
Q

what are some nursing implications with levodopa-carbidopa

A

-preventing interactions
-administering medication
-assessing for therapeutic and adverse effects (know baseline HR and BP and check periodically)
-patient teaching

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13
Q

what are some parts of patient teaching that should be mentioned with levodopa-carbidopa

A

-do not stop abruptly, must be tapered off
-stop all MAOIs -> cause risk for hypertensive crisis
-do not crush, must be swallowed whole
-can be given with food
-no iron vitamins or increased protein in diet

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14
Q

what are some other drugs in the same class as levodopa-carbidopa

and what consideration should be made?

A

-amantadine, pramipexole, ropinirole, selegeline
-must be given in conjunction with levodopa-carbidopa

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15
Q

what is the black box warning for levodopa-carbidopa

and what should be checked?

A

-risk for fulminant fatal acute renal failure
-check BUN, GFR, creatinine, as well as urine output characteristics

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16
Q

why should you check BUN, creatinine, and GFR of a person taking levodopa-carbidopa

A

all indicators of renal function/failure

black box warning on med is acute renal failure

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17
Q

describe ropinirole

drug class? action? concentration? half life?

A

-stimulates dopamine receptors in the brain
-same class as levodopa-carbidopa
-steady state concentration on approx 2 days
-40% protein bound
-1/2 life elimination = 6 hours

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18
Q

can ropinirole be taken with levodopa-carbidopa

A

-yes
-especially when levopa becomes less effective, have to decrease levodopa dose when adding this medication

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19
Q

describe the pharmacokinetics of ropinirole

A

-well absorbed orally (peak level 1-2 hours)
-metabolized by cytochrome P450 (liver) (pts with hepatic impairment - increase adverse effects)
-renal excretion (alter dose in patients with renal impairment/failure)

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20
Q

describe COMT

what does it play a role in?

A

plays a role in the metabolism of dopamine and the breakdown of 10% of lepodopa in the body

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21
Q

should tolcapone be given by itself?

like with no other drugs?

A

nope. tolcapone has to be given with levodopa-carbidopa as an adjunct or add-on therapy

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22
Q

what if tolcapone doesnt work for a patient after three weeks?

A

discontinued due to the undesirable side effects, but not stopped abruptly bc it has to be tapered off over 2 weeks

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23
Q

describe the pharmacokinetics of tolcapone

A

-absorbed rapidly and is highly protein bound
-metabolized in the liver
-crosses the placenta
-excreted in the feces and urine

also has 2-3 hour half life

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24
Q

describe the action of tolcapone

A

inhibits the metabolism of levodopa in the bloodstream, may also inhibit COMT in the brain and prolong the activity of dopamine at the synapse

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25
Q

what is tolcapone used for?

A

treatment of the signs and symptoms of idiopathic parkinsons disease

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26
Q

what are the adverse effects associated with tolapone

A

-CNS = disorientation, confusion, hallucination, and psychosis
-cardiovascular = othrostatic hypotension
-GI very sudden severe liver failure
-respiratory
-generalized

look at ALT/AST lab results bc they indicate liver function

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27
Q

name some contraindications of tolcapone

A

-hypersensitivity
-liver disease
-nontraumatic rhabdomyolysis
-hyperpyrexia
-confusion

28
Q

what are some nursing implications for tolcapone

A

-preventing interactions
-administering the medication
-assessing for theraputic and adverse effects
-patient teaching

29
Q

describe patient teaching for tolcapone

A

-no MAOIs -> risk for hypertensive crisis
-must taper off, no abruptly stopping
-do not breats feed on this med
-have liver function tests as scheduled
-use caution when operating machinery and avoid alcohol or other CNS depressants

30
Q

name another drug in the class of tolcapone

A

entacapone

said to be newer and safer with less side effects

31
Q

what kind of drug is the combination drug: levodopa carbidopa and entacapone

A

catechol-o-methyltransferase (COMT) inhibitor and decarboxylase inhibitor/dopamine precursor

32
Q

what is entacapone

A

selective inhibitor of COMT, allows for increased levodopa in serum levels

33
Q

describe the pharmacokinetics of combination drug: levodopa carbidopa and entacapone

A

-well absorbed in small intestine after oral administration
-primarily excreted in urine

34
Q

describe the action of combination drug: levodopa carbidopa and entacapone

A

-levodopa is metabolic precursor for dopamine
-carbidopa inhibits the breakdown of levodopa
-entacapone is a selective inhibitor of COMT that alters levodopa to increase serum concentration

35
Q

name some adverse effects of combination drug: levodopa carbidopa and entacapone

A

-GI= diarrhea, N+V, drug indiced colitis
-solmnolence (non interactive behavior)
-dyskinesia (difficulty moving)
-bruxism (teeth grinding)
-suidical ideations

36
Q

what are some contraindications of combination drug: levodopa carbidopa and entacapone

A

-hypersensitivity, concurrent use with MAOI
-melanoma, firbrotic complications

37
Q

what are some nursing implications of combination drug: levodopa carbidopa and entacapone

A

-preventing interactions
-administering med
-assessing therapeutic and adverse effets
-pt teaching

38
Q

what is the MOA of anticholinergics

what do they do/block

A

inhibit the action of acetylcholine in the brain and affects the PNS, often will interact with the muscarinic and nicotinic receptors

39
Q

describe drug therapy with anticholinergics

A

-act by occupying receptor sites on target organs innervated by PNS resulting in fewer sites free to respond to Ach
-decreases or eliminates parasympathetic response

-response is dependent on number of receptor sites blocked

40
Q

what are the symptoms of anticholinergic overdose

A

-hyperthermia
-mydriasis
-delirium
-tachycardia
-myoclonic movements
-seizures
-coma
-respiratory arrest
-cycloplegia (paralysis of ciliary muscles of the eyes)

41
Q

name some antocholinergic effects on different locations in the body

A

-CNS stimulation followed by depression
-increased HR
-bronchodilation and decreased respiratory tract secretions
-decreased GI spasms
-decreased salivary and sweat gland secretions
-ureter and urinary bladder relaxation
-smooth muscle relaxation in gallbladder and bile ducts

42
Q

define atropine sulfate

A

-extracted from the belladonna plant or prepared synthetically, is a salt that is very soluble in water
-also classified as a muscarinic antagonist

43
Q

describe the pharmacokinetics of atropine sulfate

A

-well absorbed in all forms of administration (IV takes 2-4 mins to work and lasts 4 hrs)
-metabolized in liver
-excreted in urine

44
Q

what are some uses of atropine sulfate

A

-tx of bradycardia
-preoperatively (decreases respiratory secretions)
-eye drops (dilates pupils and relieves swelling pain)
-used as an antidote
-used in emergency situations

45
Q

describe the action of atropine sulfate

A

blocks the effects of acetylcholine at muscarinic cholinergic receptors that mediate the effects of parasympathetic postganglionic impulses

46
Q

describe the adverse effects of atropine sulfate

A

-cardiovascular = tachycardia
-CNS = mydriasis, blurred vision, photophobia, increased IOP
-GI = dry mouth, constipation, paralytic ileus
-GU = urinary retention

paralytic ileus = slowing of the bowel

47
Q

name some contraindications of atropine sulfate

A

hypersensitivity, glaucoma, stenosing peptic ulcer, pyloroduodenal obstruction, bronchial asthma, bladder neck obstruction, hepatic or renal disease

48
Q

what are some nursing implications for atropine sulfate

A

-preventing interactions
-administering med
-assessing for therapeutic and adverse effects

49
Q

what patient teaching is important with atropine sulfate

A

-avoid excessive high temperatures, drink water frequently
-rinse mouth frequently and maintain good dental hygiene
-void before taking the medication
-visit ophthalmologist regularly
-notify provider if… fluid intake is greater or less than output, develop a fever, weakness becomes severe

50
Q

what are some other drugs in the class with atropine sulfate

A

ipratropium (dilates constricted bronchioles), scopolamine (motion sickness patch), tiotropium bromide

51
Q

define benztropine mesylate

A

newer synthetic drug that is more selective for muscarinic receptors in the CNS

52
Q

what is benztropine mesylate used for?

A

adjunctive therapy of all forms of parkinsons

53
Q

describe the pharmacokinetics of benztropine mesylate

A

-can be administered orally of parenterally (IV)
-absorbed in GI tract
-metabolized in the liver
-excretion is unknown (watch kidney function no matter what)

54
Q

describe the action of benztropine mesylate

A

-helps to normalize the imbalance of cholinergic and dopaminergic neurotransmission in the basal ganglia

55
Q

describe the adverse effects of benztropine mesylate

A

-CNS = confusion, hallucinations, memory loss, agitation, and heaviness of the limbs
-cardiovascular = tachycardia, orthostatic hypotension
-general =muscle movement issues, dry mouth and decreased sweating, elevated temperature

56
Q

what are some contraindications of benztropine mesylate

A

glaucoma, GI issues, myasthenia gravis, cardiovascular issues

57
Q

what are some nursing implications associated with benztropine mesylate?

A

-preventing interactions
-administering medication
-assessing for therapeutic and adverse effects (monitor I+O, bowel sounds, and BM occurrence)

58
Q

describe important points with patient teaching related to benztropine mesylate

A

-avoid alcohol, sedatives, and OTC medications including cough or cold remedies
-void before taking medication
-notify provider if… fluid intake is greater or less than output, weakness becomes severe, develop a fever
-drink water frequently and maintain good dental hygiene
-avoid excessively high temperatures

59
Q

what is oxybutynin used for?

A

bladder instability in patients with uninhibited and reflex neurogenic bladder, overactive bladder, incontinence, urgency, and frequency

60
Q

describe the pharmacokinetics of oxybutynin

A

-can be administered in oral and transdermal forms
-metabolized in the liver and excreted in urine

61
Q

describe the action of oxybutynin

A

acts directly on the smooth muscle and inhibits the effects of acetylcholine at muscarinic receptors (antispasmodic/antimuscarinic)

62
Q

describe th adverse effects of oxybutynin

A

CNS = drowsiness, dizziness, blurred vision
-dry mouth, nausea, urinary hesitancy, and decreased sweating

same as any other anticholinergic

63
Q

what are some contraindications of oxybutynin

A

hypersensitivity, GI issues, glaucoma, myasthenia gravis, cardiovascular instability, urinary retention

64
Q

what ae some nursing implications of oxybutynin

A

-preventing interactions
-administering the medication (look at dosage, do not crush)
-assessing for therapeutic and adverse effects (check renal function and track urination frequency before and after medication)

65
Q

describe patient teaching with oxybutynin

A

-have periodic bladder examinations
-drink water frequently and avoid excessive high temperature
-notify provider if… fluid intake is greater or less than output or if fever is developed
-do not cut, crush, or chew medication
-if using patch, apply to dry intact skin and remove old on before applying new

Pharm 1 (29 decks)

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