Module 14B Anti Parkinson agents

Question 1

Parkinson’s Disease

Answer 1

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

Question 2

Progression of Parkinson’s

Disease

Answer 2

Lack of coordination
Rhythmic tremors
Rigidity/weakness
Trouble maintaining position or posture
Bradykinesia
Difficulty walking
Drooling and affected speech
Mask-like expressions

Question 3

Theories About the Cause of

Parkinson’s Disease

Answer 3

Viral infection
Blows to the head
Brain infection
Atherosclerosis
Exposure to certain drugs
Environmental factors

Question 4

Management of Care for Patients
with Parkinson’s Disease
Encourage Patients To:

Answer 4

◦ 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

Question 5

Use of Antiparkinsonism Agents

Across the Lifespan

Answer 5

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

Question 6

Dopaminergics

Answer 6

Amantadine
Levodopa
Carbidopa–levodopa
Rasagiline
Ropinirole

Question 7

Dopaminergics action and indications

Answer 7

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

Question 8

Dopaminergics

Contraindications

Answer 8

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

Question 9

Dopaminergics
Adverse Effects
Drug -drug interactions

Answer 9

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

Question 10

Levodopa

Answer 10

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

Question 11

Nursing Considerations for
Patients Receiving Dopaminergic
Agents assessment and diagnosis

Answer 11

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

Question 12

Nursing Considerations for
Patients Receiving Dopaminergic
Agents implementation

Answer 12

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

Question 13

Anticholinergic Agents

Answer 13

Benztropine

Diphenhydramine

Question 14

Anticholinergic Agents
Actions/Indications

Contraindications/Cautions

Answer 14

◦ 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

Question 15

Anticholinergic Agents

Adverse Effects

Drug-Drug Interactions

Answer 15

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

Question 16

Nursing Considerations for
Patients Receiving
Anticholinergic Agents
Assessment & diagnosis

Answer 16

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

Question 17

Nursing Considerations for
Patients Receiving
Anticholinergic Agents

Implementation

Answer 17

◦ 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

Question 18

Adjunctive Agents

Used to improve patient response to traditional therapy

Answer 18

◦ Entacapone
◦ Safinamide
◦ Tolcapone
◦ Selegiline

Question 19

Adjunctive Agents

Answer 19

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.