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Pharm Exam 3 Materials > Drugs for Parkinson Disease and Alzheimer Disease > Flashcards

Drugs for Parkinson Disease and Alzheimer Disease Flashcards

1
Q

What is Parkinson Disease?

A

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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2
Q

What is pseudoparkinsonism?

A

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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3
Q

What are the clinical manifestations of Parkinson Disease?

A

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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4
Q

What are some non pharm interventions for Parkinson Disease?

A

Exercise

Group Support

Proper nutrition to prevent weight loss

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5
Q

What do Anticholinergics do ?

A

Blocks cholinergic receptors

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6
Q

What do Dopamine replacements do?

A

Stimulate dopamine receptors

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7
Q

What do COMT inhibitors do?

A

Inhibit COMT enzyme that inactivates dopamine

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8
Q

What class drug is Benztropine Mesylate?

A

Anticholinergic

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9
Q

What is the MOA of Benztropine Mesylate?

A

Blocks acetylcholine

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10
Q

What is Benztropine Mesylate used for?

A

Decrease muscle stiffness, sweating, and production of saliva

Improves walking ability for Parkinson’s disease patients.

Reduces rigidity and tremors.

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11
Q

How is Benztropine Mesylate administered?

A

PO

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12
Q

True or false? Benztropine Mesylate cannot help with what?

A

Bradykinesia

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13
Q

What are the SE/ASE of Benztropine Mesylate?

A

Drowsiness

Dizziness

Constipation

Flushing

Nausea

Nervousness

Blurred vision

Dry mouth

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14
Q

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

A

FALSE

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15
Q

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

A

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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16
Q

What drug class is Carbidopa-Levodopa?

A

Anticholinergic/Antiparkinson

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17
Q

What is the MOA of Carbidopa-Levodopa?

A

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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18
Q

What is Carbidopa-Levodopa used?

A

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

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19
Q

What are the Side effects of Carbidopa-Levodopa?

A

Anorexia

N/V

Dysphagia

Dyskinesia

Erythema

Fatigue

Dizziness

Headache

Dry mouth

Constipation

Bitter taste

Twitching

20
Q

What are the Adverse SE of Carbidopa-Levodopa?

A

Blood dyscracias

Cardiac dysrhythmias

Agranulocytosis

21
Q

Abrupt discontinuation of Carbidopa-Levodopa may cause?

A

Neuroleptic Malignant syndrome

22
Q

How should Carbidopa-Levodopa be taken?

A

With good to decrease GI upset

23
Q

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

A

Do not discontinue abruptly

Urine may be discolored or appear dark

Avoid chewing or crushing the ER tablets

Take med with food

24
Q

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

A

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

25
Q

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

A

Tolcapone (Tasmar)

26
Q

What is the MOA of Tolcapone?

A

Inhibits metabolism of levodopa in the bloodstream

Increases duration of drug in the body.

27
Q

What is Tolcapone used for?

A

Idiopathic Parkingson’s Disease

28
Q

How is Tolcapone administered?

A

Only in conjunction with levodopa/carbidopa

29
Q

What are the ASE of Tolcapone?

A

Cardiovascular, Dermatologic, GI, respiratory Effects

Fulminant Liver Failure

Disorientation

Confusion

Hallucinations

Psychosis

30
Q

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

A

Liver Function Tests done immediately and then Q2 weeks

31
Q

What are the contraindications for Tolcapone?

A

Liver disease

Nontraumatic rhabdomyolysis

Hyperpyrexia

Confusion

32
Q

What should a nurse know about Alzheimer disease?

A

Incurable, dementia illness

Chronic, progressive neurodegenerative disorder

Cognitive dysfunction

Onset usually between ages 45-65

33
Q

What is the cause of Alzheimer Disease?

A

Unknown

34
Q

What is the pathophysiology of Alzheimer disease?

A

Cholinergic neuron degeneration and acetylcholine deficiency

Neuritic Plaques form

Neurofibrillary tangles are in neurons

35
Q

What are the clinical manifestations of Alzheimer Disease?

A

Memory loss, Confusion

Inability to communicate

Aggressive behavior, depression, psychoses

36
Q

Later progression in Alzheimer Disease can show what Symptoms?

A

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.

37
Q

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

A

Early detection of AD

Slow memory and cognition loss

38
Q

What drug is considered as an Acetylcholinesterase Inhibitor?

A

Rivastigmine

39
Q

What is the MOA of Rivastigmine?

A

Elevate acetylcholine concentration

40
Q

What is Rivastigmine used for?

A

Improves mild to moderate memory loss in Alzheimer Dementia.

41
Q

What are the side effects of Rivastigmine?

A

Abdominal pain

anorexia

N/V/D

dehydration

weight loss

weakness

dizziness

drowsiness

depression

peripheral edema

dry mouth

nystagmus

shakiness (tremor), & headache

42
Q

What adverse effects is associated with Rivastigmine?

A

Seizures

Bradycardia

Orthostatic Hypotension

Cataracts

MI

HF

43
Q

What are Life threatening effects possible from Rivastigmine?

A

Hepatotoxicity

Dysrhythmias

Suicidal ideation

Stevens Johnson Syndrome

44
Q

How is Rivastigmine administered?

A

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

45
Q

What are the contraindications of Rivastigmine?

A

Liver and renal disease

Urinary tract obstruction

Orthostatic hypotension

Asthma/COPD

Peptic Ulcer disease

Surgery

Smoking

Bradycardia

Hypersensitivity

Active GI bleed

46
Q

What should be taught to the patient on Rivastigmine?

A

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.

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Pharm Exam 3 Materials (5 decks)

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