Module 14B Anti Parkinson agents Flashcards
Parkinson’s Disease
Progressive chronic neurological disorder
May develop in people of any age
Usually effects those who are past middle age and entering their 60s
No cure for the disease
Therapy is aimed at management of signs and symptoms
Progression of Parkinson’s
Disease
Lack of coordination Rhythmic tremors Rigidity/weakness Trouble maintaining position or posture Bradykinesia Difficulty walking Drooling and affected speech Mask-like expressions
Theories About the Cause of
Parkinson’s Disease
Viral infection Blows to the head Brain infection Atherosclerosis Exposure to certain drugs Environmental factors
Management of Care for Patients
with Parkinson’s Disease
Encourage Patients To:
◦ Be as active as possible ◦ Perform exercises ◦ Maintain independency with ADLs as long as possible ◦ Follow drug protocols Caregivers Should: ◦ Monitor adverse effects ◦ Provide encouragement and support
Use of Antiparkinsonism Agents
Across the Lifespan
Children
◦ Safety and effectiveness not established
◦ Incidence in children is very small
◦ Do experience parkinsonian symptoms from
drug effects
◦ Diphenhydramine is drug of choice
Adults
◦ Devastating progression
◦ Inform provider of any herbal/alternate
therapies
◦ Use contraception in childbearing age
◦ Use alternate method to feed infant
Older Adults
◦ Parkinson’s increases with age
◦ Increased adverse effects
◦ Aggravate glaucoma, BPH, constipation, cardiac
problems, and COPD.
◦ May need frequent dose adjustments – follow
up important
◦ May need other drugs to counteract effects of
these drugs
Dopaminergics
Amantadine Levodopa Carbidopa–levodopa Rasagiline Ropinirole
Dopaminergics action and indications
Actions
◦ Increasing the levels of dopamine in the substantia nigra
◦ Directly stimulating the dopamine receptors in that area
◦ Helping to restore the balance between the inhibitory and stimulating neurons
Indications
◦ Relief of the signs and symptoms of idiopathic Parkinson’s disease
Dopaminergics
Contraindications
Contraindications
◦ Known allergy ◦ Angle closure glaucoma ◦ GI obstruction, pregnancy and lactation Cautions ◦ CV disease ◦ Bronchial asthma ◦ H/O peptic ulcer ◦ Urinary tract obstruction ◦ Psychiatric disorders
Dopaminergics
Adverse Effects
Drug -drug interactions
Dopaminergics Adverse Effects ◦ Anxiety ◦ Nervousness ◦ Headache ◦ Blurred vision ◦ Arrhythmias Drug-Drug Interactions ◦ MAOIs ◦ Vitamin B6 ◦ Tyramine-containing foods ◦ St. John’s wort ◦ Meperidine and other analgesics
Levodopa
Mainstay of treatment for parkinsonism
Precursor of dopamine that crosses the blood–brain barrier, where it is converted to dopamine
Almost always given in combination with carbidopa as a fixed-combination drug
Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
◦ The dosage of levodopa can be decreased, reducing adverse side effects
Nursing Considerations for
Patients Receiving Dopaminergic
Agents assessment and diagnosis
Assessment
◦ History and physical exam
◦ Allergies; GI depression or obstruction, urinary hesitancy or obstruction, BPH, or glaucoma; cardiac
arrhythmias, hypertension, or respiratory disease; pregnancy or lactation; renal and hepatic dysfunction
◦ Assess skin for lesions or history of melanoma; level of orientation, affect, reflexes, gait, tremors and
spasticity; LS; VS; BS; urine output
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Disturbed thought processes related to CNS effects
◦ Risk for urinary retention related to dopaminergic effects
◦ Constipation related to dopaminergic effects
◦ Risk for injury related to CNS effects and incidence of orthostatic hypertension
◦ Deficient knowledge regarding drug therapy
Nursing Considerations for
Patients Receiving Dopaminergic
Agents implementation
Implementation
◦ Arrange to decrease the dose of the drug if therapy has been interrupted for any reason
◦ Evaluate disease progress and signs and symptoms periodically and record for reference
◦ Give the drug with meals
◦ Monitor bowel function and institute a bowel program if constipation is severe
◦ Ensure that the patient voids before taking the drug if urinary retention is a problem
◦ Monitor urinary output, palpate bladder, and check for residual urine
◦ Establish safety precautions if CNS or vision changes occur
◦ Monitor hepatic, renal, and hematological tests periodically during therapy
◦ Provide support services and comfort measures as needed
◦ Provide thorough patient teaching
Anticholinergic Agents
Benztropine
Diphenhydramine
Anticholinergic Agents
Actions/Indications
Contraindications/Cautions
◦ Synthetic drugs with greater affinity for receptor sites in CNS than peripheral nervous system
Contraindications/Cautions
◦ Allergy, narrow-angle glaucoma, GU obstruction, prostatic hypertrophy, myasthenia gravis
◦ Tachycardia, dysrhythmias, hyper- or hypotension, hepatic dysfunction, pregnancy/lactation, hot
environments
Anticholinergic Agents
Adverse Effects
Drug-Drug Interactions
Adverse Effects
◦ CNS effects and peripheral anticholinergic effects
Drug-Drug Interactions
◦ Other anticholinergics, antipsychotics
Can’t Spit Can’t See
Can’t Poop Can’t Pee
Nursing Considerations for
Patients Receiving
Anticholinergic Agents
Assessment & diagnosis
Assessment
◦ History and physical exam
◦ Allergies; GI depression or obstruction, urinary hesitancy or obstruction, BPH, or glaucoma; arrhythmias, hypertension, or
hypotension; MG; pregnancy or lactation; hepatic dysfunction; exposure to a hot environment
◦ Assess level of orientation, affect, reflexes, bilateral grip strength, gait, tremors, and spasticity; monitor pulse, blood pressure,
and cardiac output; auscultate bowel sounds; assess urine output and palpate bladder
◦ Monitor appropriate labs
Nursing Diagnoses
◦ Impaired oral mucous membranes related to anticholinergic effects
◦ Risk for impaired thermoregulation related to anticholinergic effects
◦ Impaired urinary elimination related to genitourinary effects
◦ Constipation related to GI effects
◦ Disturbed thought processes related to CNS effects
◦ Risk for injury related to CNS effects
◦ Deficient knowledge regarding drug therapy
Nursing Considerations for
Patients Receiving
Anticholinergic Agents
Implementation
◦ Arrange to decrease dose or discontinue the drug if dry mouth becomes so severe that swallowing
becomes difficult
◦ Give drug with caution and arrange for a decrease in dose in hot weather or with exposure to hot
environments
◦ Give drug with meals if GI upset is a problem, before meals if dry mouth is a problem, and after meals if
drooling occurs and the drug causes nausea
◦ Monitor bowel function and institute a bowel program if constipation is severe
◦ Ensure that the patient voids before taking the drug; monitor urinary output and palpate for bladder
distention and residual urine
◦ Establish safety precautions if CNS or vision changes occur
◦ Provide thorough patient teaching
Adjunctive Agents
Used to improve patient response to traditional therapy
◦ Entacapone
◦ Safinamide
◦ Tolcapone
◦ Selegiline
Adjunctive Agents
Entacapone is used with carbidopa–levodopa to increase the plasma concentration and duration
of action of levodopa
Tolcapone works in a similar way with carbidopa–levodopa to further increase plasma levels of
levodopa
Safinamide is indicated to work with carbidopa–levodopa in patients with Parkinson that are
having “off” episodes.
Selegiline is used with carbidopa–levodopa after patients have shown signs of deteriorating
response to this treatment.
