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Collab Therapies 2 > Parkinson Disease And Its Meds > Flashcards

Parkinson Disease And Its Meds Flashcards

1
Q

What two hormones play a role in Parkinson’s disease?
What is the goal of drug therapy?

A

Dopamine (which is too low) and acetylcholine (which is too high)

Drug treatment: aims at increasing the levels of dopamine in the brain and decreasing the levels of acetylcholine to restore the balance and reduce the symptoms

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2
Q

Which Parkinson medication is considered to be a dopamine replacement therapy?

A

Levodopa/carbidopa
Also called sinemet

  • Increases dopamine levels in the brain and decrease its breakdown and increasing its presence

They need to be given together so it can cross the CNS

Levodopa (replacement of dopamine which increases its levels) and carbidopa will decrease the breakdown of levodopa allowing for larger doses to enter the CNS

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3
Q

What are some contraindications to the use of levodopa/carbidopa (sinemet)?

A
  • closed angle glaucome (bc it increases intra ocular pressure)
  • melanoma (can activate malignant melanoma)
  • undiagnosed skin conditions (due to possible melanoma activation)

And caution use with open angle glaucoma

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4
Q

What are some AE of sinemet? (Levodopa/Carbidopa)

A

common:
- nausea
- vomiting
- constipation
-dyskinesia
- GI upset

Other/life threatening:
- cardiac dysthymias
- hypotension
- palpitations
- hemorrhage
- melanoma
- muscle cramps
- GI perforation

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5
Q

What are some signs of sinemet toxicity? (Too much dopamine)

A

Too much movement, tardive dyskinesia is a sign
Blinking too much
Grimacing
Can’t control the movements

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6
Q

How should levodopa/Carbidopa be taken?

A
  • best taken on an empty stomach but can be taken with food to decrease GI upset
  • take with a low protein snack or meal
  • don’t take with a high protein meal (should take protein about 30min before)
  • don’t take with too much vitamin B6
  • should increase hydration
  • increase fiber in diet as it often causes constipation
  • take at same time everyday
  • don’t disrupt abruptly or can cause Parkinson crisis or rebiund
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7
Q

What are some drug interactions with levodopa/carbidopa?
And some other interactions?

A
  • with MAOIs: increase toxicity (hypertensive crisis)
  • with benzodiazepines or psychotics: decrease levodopa effect
  • vitamin B6 (pyridoxine) : decrease drug effect
  • with a high protein meal: decrease drug effectiveness
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8
Q

What medication is also often prescribed with levodopa/carbidopa (sinemet)? And what is it’s class?

A

Selegiline

MAOI
Monoamine oxidase inhibitor
An indirect acting dopamine egos drug

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9
Q

Why is selegiline (a MAOI) often prescribed with sinemet?

A

Bc it improves the therapeutic effect of levodopa by preventing its breakdown

Can also allow for a lower dose of sinemet to be given

They also help by increasing the levels of dopaminergic stimulation in the CNS

Good for adjunct use for Parkinson disease

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10
Q

What are some contraindications to the use of selegiline?

A
  • KDA
  • concurrent use of the opioid meperidine hydrochloride
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11
Q

What are some AE associated with selegiline (the MAOI)?

A
  • drowsiness
  • dizziness
  • nausea
  • red/brown urine

Life threatening:
Serotonin syndrome

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12
Q

What are some foods that contain thyramine? What drug requires you to not take foods with thyramine?

A
  • salami, aged cheese, vermouth, draft beer, wine, dry sausages, smoked or pickled fish, soy products, alcohol

Should be avoided with the MAOIs (selegiline)

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13
Q

How should selegiline be taken?

A
  • should be taken with food
  • should be taken with a low protein snack or meal
  • avoid thyramine containing foods
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14
Q

What are some interactions with selegiline?

A
  • opioids analgesics, antidepressants, other MAOIs : increase CNS stimulation which increases the risk for serotonin syndrome
  • oral contraceptives, carbamazepine: decrease selegiline effects
  • opioid meperidine: associated with delirium, muscle rigidity, hyper irritability
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15
Q

Which medication is considered a dopamine modulator?
What is it’s class?
What is it’s actions?

A

Amantadine hydrochloride
Is an antiviral, indicated for PD treatment as it acts as a dopamine modulator

Helps controls symptoms of tremor, including motor rigidity, it also has anticholinergic effects which can helps with dyskinesia

Usually indicated for early stages of PD while there are still some intact neurons in the nuclea.

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16
Q

What are some known AE with amantadine hydrochloride ?

A
  • dizziness
  • insomnia
  • nausea
  • dry mouth
  • orthostatic hypotension
17
Q

What is the drug interaction with amantadine?

A

Has an increased anticholinergic effect with other anticholinergic drugs (increase anticholinergic AE)

18
Q

How should amantadine be taken ?

A
  • should be taken with a light, bland snack to decrease GI upset
  • generally taken at night due to sedating properties
  • for dry mouth: frequent mouth care, suck sugarless hard candies, sugarless gum, increase fluid intake
19
Q

What are some patient education to be done for PD medications?

A
  • change position slowly to prevent orthostatic hypotension
  • report any AE : twitching, eye spasms, (may indicate overdose)
  • never discontinue abruptly or can cause Parkinsonian crisis
  • do not take with foods high in protein
  • avoid alcohol, OTC drugs unless accepted by HCP, avoid driving
  • avoid thyramine containing foods (with selegiline)
  • avoid too much vitamin b6 with levodopa
  • may change urine Color (selegiline)
  • ## round the clock dosing
20
Q

What are some nursing considerations with PD?

A
  • assess BP and respiration (due to orthostatic hypotension)
  • assess mental status
  • monitor for involuntary movements (sign of toxicity)
  • evaluate therapeutic response
21
Q

What are some therapeutic responses to antiparkinsonian meds?

A
  • improved sense of well being
  • improved mental status
  • increased appetite
  • ability to perform ADLs
  • improved concentration
  • increased fluidity in movement, decreased rigidity and tremors
22
Q

Which condition will alert the nurse to a potential caution or contraindication in regard to the use of dopaminergic drug for treatment of mild PD?

A) diarrhea
B) tremors
C) angle closure glaucoma
D) unstable gait

A

C

23
Q

A pt is taking entacapone (selegiline) as part of the therapy for PF. Which intevertion by the nurse is appropriate at this time?

A) notify the pt that this drug causes discoloration of urine
B) limit the pt’s intake of thyramine containing foods
C) monitor results from kidney studies bc this drug can serious affect kidney function
D) force fluids to prevent dehydration

A

A

B is not good bc it’s not limit we don’t want them to take any at all

24
Q

During pt teaching for antiparkinsonian drugs, the nurse will include which statement?

A) “the drug will be stopped when tremors and weaknesses are relieved”
B) “if a dose is missed take two doses to avoid significant decreases in blood levels “
C) “be sure to notify your physician if your urine turns brownish- orange”
D)”take care to change positions slowly to prevent falling due to a drop in blood pressure”

A

D

25
Q

A pt with PD will start taking entacapone (selegiline) along with the levodopa- carbidopa he has been taken for a few years. The nurse recognizes that the advantage of taking entacapone is that

A) the entacapone can reduce on off effects
B) the levodopa may be stopped in a few days
C) there is less GI upset with entacapone
D) it does not cause the cheese effect

A

A

26
Q

The nurse is assessing a pt who’s has bgun therapy with amantadine for PD. The nurse will look for which possible AE? Select all that apply

A) nausea
B) palpitations
C) dizziness
D) insomnia
E) edema

A

A, C, E

27
Q

A pt was prescribed amantadine hydrochloride and asked why her cousin is taking levodopa/carbidopa. The nurse replies…

A) levodopa/carbidopa is associated with involuntary spasms
B)amantadine hydrochloride is used when your nerve cells are still working
C) amantadine hydrochloride has less AE
D) amantadine hydrochloride procuces more dopamine in nerve cells than levodopa/carbidopa

A

B

28
Q

Which instructions should you include in the plan of care for a pt newly prescribed carbidopa/levodopa for the tx of PD? Select all that apply

A) if you don’t notice improvement in your symptoms within 1 week, notify your neurologist
B) when going from a sitting to a standing position, be sure to change position slowly
C) it is a good idea to remove extra clutter in your home that could cause you to trip and fall
D) go to the ER if you notice that your urine changes to a slightly reddish color
E) avoid eating meals that contain a large amount of proteins while taking the medication

A

B, C, E

Collab Therapies 2 (28 decks)

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