Pariskon And Alzheimers

Question 1

Parkinsonism
Patho

Characteristics

Treatment

Answer 1

Pathophysiology
Chronic neurologic disorder
Imbalance of the neurotransmitters dopamine
(DA) and acetylcholine (ACh) Marked by degeneration of neurons of the
extrapyramidal motor tract Reason for the degeneration of neurons is
unknown.

Characteristics mainly first 3 
●	Tremors of head and neck
●	Rigidity (increased muscle tone)
●	 Bradykinesia (slow movement)
●	Postural changes (Head and chest thrown forward)
●	Shuffling walk
●	 Lack of facial expression
●	Pill-rolling motion of hands

Treatment
● Anticholinergics ( Block cholinergic receptors )
● Dopaminergics ( Convert to dopamine)
● Dopamine agonists ( Stimulate dopamine receptors)
● MAO-B inhibitors ( Inhibit MAO-B enzyme that interferes with dopamine )
● COMT inhibitors ( Inhibit COMT enzyme that inactivates dopamine)

Question 2

Cogentin

Answer 2

Parasympatholytics- Inhibit release of acetylcholine
● Benztropine (Cogentin)- inhibit release of acetylcholine, Reduce the rigidity and some of the tremors, Minimal effect on bradykinesia
○ Nursing Implications: Monitor vital signs, monitor urine output for early detection of urinary retention, increase fluid intake, fiber, and exercise to avoid constipation,observe for involuntary movements
,
○ Patient teaching: Suggest use of sunglasses for photophobia, encourage patient to relieve dry mouth with ice chips, hard candy, or sugarless chewing gum, advise patients to avoid alcohol, cigarettes, caffeine, and aspirin to decrease gastric acidity, have routine eye examinations

○ Mechanism of action: Inhibits release of acetylcholine, treats drug induced parkinsonism or pseudoparkinsonism

• *Valerian and Kava Kava potentiates sedation effect of this drug, so don’t combine!**
• *Someone with narrow angle glaucoma can NEVER take anticholinergic**

Question 3

Carbidopa-levodopa (Sinemet)
Action
Teaching
Intervention

Answer 3

Mechanism of action: converts itself to dopamine | Increases mobility

Nursing Interventions • Monitor vital signs and electrocardiogram. Orthostatic hypotension may occur during early use
of carbidopa-levodopa and bromocriptine. Instruct patients to rise slowly to avoid faintness. • Observe for weakness, dizziness, or syncope, which are symptoms of orthostatic hypotension. • Administer carbidopa-levodopa with low-protein foods. High-protein diets interfere with drug
transport to the central nervous system (CNS). • Observe for symptoms of Parkinson’s disease.

Patient Teaching General • Urge patients not to abruptly discontinue the medication. Rebound Parkinson’s disease
(increased symptoms of Parkinson’s disease) can occur. • Inform patients that urine may be discolored and will darken with exposure to air. Perspiration
may also be dark. Explain that both are harmless, but clothes may be stained. • Advise patients to avoid chewing or crushing extended-release tablets. Side Effects • Encourage patients to report side effects and symptoms of dyskinesia. Explain that it may take
weeks or months before symptoms are controlled. Diet • Suggest to patients that taking carbidopa-levodopa with food may decrease GI upset, but food
will slow the rate of drug absorption. • Urge patients who take high doses of selegiline to avoid foods high in tyramine such as aged
cheese, red wine, cream, yogurt, chocolate, bananas, and raisins to prevent hypertensive crisis.

Question 4

● Amantadine (Symmetrel)-

Action use intervention

Answer 4

Also antiviral drug for influenza A
○ Mechanism of Action: Stimulates dopamine receptors
○ Use: Early treatment of parkinsonism as drug tolerance develops, improvement of symptoms- given as adjunctive therapy, it is not sustaining
○ Nursing Implications: Monitor for orthostatic hypotension
, **Administer drug with low-protein foods,
avoid vitamin B6 (B6 inhibits conversion of levodopa to dopamine), (B6 foods-kidney beans, Lima, Cereals , patient still needs b6 for nerve function, if not they will have muscle weakness, avoid alcohol, other depressants,
do not abruptly discontinue,
warn of harmless brown discoloration of urine and sweat,
assess for suicidal tendencies,
assess symptom status and “on-off” phenomenon,
Monitor blood cell counts, liver and kidney function*
taken alone or in combination with levodopa or anticholinergic