Drugs for Parkinson Disease and Alzheimer Disease Flashcards by Kevin Park

What is Parkinson Disease?

Chronic neurologic disorder

Imbalance of neurotransmitters; Dopamine and acetylcholine.

Progressive degeneration of dopamine-producing neurons leading to DECREASE IN INHIBITORY DOPAMINE HORMONES and INCREASE IN EXCITATORY ACETYLCHOLINE HORMONES

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What is pseudoparkinsonism?

Symptoms similar to Parkinson disease.

Frequently occurs as an adverse reaction to various drugs, carbon monoxide, manganese, or other disorders (encephalitis, stroke, trauma)

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What are the clinical manifestations of Parkinson Disease?

Involuntary tremors of limbs

Rigidity of muscles

Bradykinesia (slow movement)

Postural changes
(Head and chest thrown
forward)

Shuffling walk

Lack of facial expression

Pill-rolling motion of hands

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What are some non pharm interventions for Parkinson Disease?

Exercise

Group Support

Proper nutrition to prevent weight loss

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What do Anticholinergics do ?

Blocks cholinergic receptors

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What do Dopamine replacements do?

Stimulate dopamine receptors

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What do COMT inhibitors do?

Inhibit COMT enzyme that inactivates dopamine

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What class drug is Benztropine Mesylate?

Anticholinergic

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What is the MOA of Benztropine Mesylate?

Blocks acetylcholine

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What is Benztropine Mesylate used for?

Decrease muscle stiffness, sweating, and production of saliva

Improves walking ability for Parkinson’s disease patients.

Reduces rigidity and tremors.

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How is Benztropine Mesylate administered?

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True or false? Benztropine Mesylate cannot help with what?

Bradykinesia

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What are the SE/ASE of Benztropine Mesylate?

Drowsiness

Dizziness

Constipation

Flushing

Nausea

Nervousness

Blurred vision

Dry mouth

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True or false? We can recommend Benztropine Mesylate to patients with dementia or memory loss.

FALSE

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What should be taught to a patient prescribed to Benztropine Mesylate?

Avoid alcohol

Avoid long term sun exposure.

Avoid driving a car or operate machinery until you know how this drug affects you

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What drug class is Carbidopa-Levodopa?

Anticholinergic/Antiparkinson

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What is the MOA of Carbidopa-Levodopa?

Transmission of levodopa to brain cells for conversion to dopamine

Carbidopa blocks the conversion of levodopa to dopamine in the intestine and peripheral tissues

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What is Carbidopa-Levodopa used?

To treat Parkinson’s Disease, Parkinsonism and to relieve tremors and rigidity.

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What are the Side effects of Carbidopa-Levodopa?

Anorexia

N/V

Dysphagia

Dyskinesia

Erythema

Fatigue

Dizziness

Headache

Dry mouth

Constipation

Bitter taste

Twitching

What are the Adverse SE of Carbidopa-Levodopa?

Blood dyscracias

Cardiac dysrhythmias

Agranulocytosis

Abrupt discontinuation of Carbidopa-Levodopa may cause?

Neuroleptic Malignant syndrome

How should Carbidopa-Levodopa be taken?

With good to decrease GI upset

What should be taught to a patient on Carbidopa-Levodopa?

Do not discontinue abruptly

Urine may be discolored or appear dark

Avoid chewing or crushing the ER tablets

Take med with food

Why is Carbidopa-Levodopa taken as a combo therapy instead of using only Levodopa?

When levodopa is used alone, only 1% reaches the brain because 99% converts to dopamine while in the peripheral nervous system. B

By combining carbidopa with levodopa, carbidopa can inhibit the enzyme decarboxylase in the periphery, thereby allowing more levodopa to reach the brain

What drug is considered as a Catechol-o-methyltransferase inhibitor?

Tolcapone (Tasmar)

What is the MOA of Tolcapone?

Inhibits metabolism of levodopa in the bloodstream Increases duration of drug in the body.

What is Tolcapone used for?

Idiopathic Parkingson's Disease

How is Tolcapone administered?

Only in conjunction with levodopa/carbidopa

What are the ASE of Tolcapone?

Cardiovascular, Dermatologic, GI, respiratory Effects Fulminant Liver Failure Disorientation Confusion Hallucinations Psychosis

What should be done if a patient on tolcapone develops acute fulminant liver failure?

Liver Function Tests done immediately and then Q2 weeks

What are the contraindications for Tolcapone?

Liver disease Nontraumatic rhabdomyolysis Hyperpyrexia Confusion

What should a nurse know about Alzheimer disease?

Incurable, dementia illness Chronic, progressive neurodegenerative disorder Cognitive dysfunction Onset usually between ages 45-65

What is the cause of Alzheimer Disease?

Unknown

What is the pathophysiology of Alzheimer disease?

Cholinergic neuron degeneration and acetylcholine deficiency Neuritic Plaques form Neurofibrillary tangles are in neurons

What are the clinical manifestations of Alzheimer Disease?

Memory loss, Confusion Inability to communicate Aggressive behavior, depression, psychoses

Later progression in Alzheimer Disease can show what Symptoms?

Loss of memory, logical thinking, and judgment Time disorientation Personality changes Hyperactivity; tendency to wander Inability to express oneself Later hostility, paranoia Inability to recognize family members Inability to swallow properly.

What is the goal of therapy for Alzheimer's Disease?

Early detection of AD Slow memory and cognition loss

What drug is considered as an Acetylcholinesterase Inhibitor?

Rivastigmine

What is the MOA of Rivastigmine?

Elevate acetylcholine concentration

What is Rivastigmine used for?

Improves mild to moderate memory loss in Alzheimer Dementia.

What are the side effects of Rivastigmine?

Abdominal pain anorexia N/V/D dehydration weight loss weakness dizziness drowsiness depression peripheral edema dry mouth nystagmus shakiness (tremor), & headache

What adverse effects is associated with Rivastigmine?

Seizures Bradycardia Orthostatic Hypotension Cataracts MI HF

What are Life threatening effects possible from Rivastigmine?

Hepatotoxicity Dysrhythmias Suicidal ideation Stevens Johnson Syndrome

How is Rivastigmine administered?

Oral = Take twice daily with food. Peak onset is 1 hour Transdermal patch = applied daily to clean skin, apply patch at same time each day, rotate sites daily, & peak 8-16hrs

What are the contraindications of Rivastigmine?

Liver and renal disease Urinary tract obstruction Orthostatic hypotension Asthma/COPD Peptic Ulcer disease Surgery Smoking Bradycardia Hypersensitivity Active GI bleed

What should be taught to the patient on Rivastigmine?

Rivastigmine Increases the effects of: theophylline, general anesthetics, cimetidine Avoid NSAIDS b/c it can increase GI effects and bleeds Avoid Tobacco b/c it can increase clearance of rivastigmine TCAs decrease effects Do not double the dose if you forget to take it. DO NOT ABRUPTLY WITHDRAW!!