Parkinsons

Question 1

First symptoms

Answer 1

Tremor that begins in one hand or one side of the body. Other symptoms include bradykinesia, akinesia, rigid limbs, shuffling gait, stooped posture, drooling, reduced facial expression and soft spoken voice.

Question 2

Cause

Answer 2

Depletion of dopamine

Question 3

EPS

Answer 3

Akinesia, akathisia, dystonic reactions, pakinsonism and rabbit mouth

Question 4

General Characteristics of Anti-Parkinson Drugs

Answer 4

• increase levels of dopamine in the brain
  Or
• inhibit actions of acetylcholine in the brain. Balance the neutotransmitters

Question 5

Drugs classes for tx PD

Answer 5

-Dopaminergic
-Anticholinergic
- Antihistamine
-Monoamine Oxidase Inhibitors
- COMT

Question 6

Levodopa-carbidopa (Sinemet)

Answer 6

Side effects- nausea, drowsiness, hypotension, delusions, hallucinations
-referred by two numbers (large number is the levodopa)

Question 7

Levodopa

Answer 7

Relieves all major symptoms, does not alter underlying disease process but does improve quality of life, acts to replace dopamine in basal ganglia of the brain, readily penetrates CNS and is converted to dopamine.
- contraindicated in pts with narrow-angle glaucoma, hemolytic anemia, angina pectoris, transient ischemic attacks, or hx of melanoma and in clients taking MAO inhibitors drugs.

Question 8

Carbidopa

Answer 8

Does not penetrate the blood-brain barrier, allows more levodopa to reach brain and much smaller doses of levodopa.

Question 9

Amantadine

Answer 9

-an antiviral agents used to prevent the spread of influenza A virus.
- increases release and inhibits reuptake of dopamine in the brain.
- relieves symptoms rapidly, within 1 to 5 days but loses efficacy in 6 to 8 wks

Question 10

Bromocriptine (Parlodel)

Answer 10

-directly stimulate dopamine receptors in brain
-used in tax of idiopathic PD with levodopa/carbidopa
-used to treat muscle rigidity

Question 11

Anticholinergic Drugs

Answer 11

• decrease salivation, spasticity and tremors.
  -used to relieve symptoms of parkinsonism that can occur with use of antipsychtic drugs
  -treats tremor associated with PD
  -many side effects: dry mouth, blurred vision, constipation, delirium, anxiety, agitation, hallucinations.

Question 12

Benztropine (Cogentin)

Answer 12

-synthetic anticholinergic agent
- used as adjuncts in tx of all forms of PD
- useful in treatment of EPs reactions from antipsychotic pharmacotherapy
- Side effects: dry mouth, sedation, constipation, and tachycardia

Question 13

Atropine

Answer 13

-eye drops given orally to dry up secretions
- used for excessive drooling
- can cause urinary hesitancy/retention, tachycardia and blurred vision

Question 14

Antihistamine

Answer 14

-treats tremor and rigidity associated with PD
- Side effect: sedation
- ex/ diphenhydramine (benadryl)

Question 15

Monoamine Oxidase Inhibitor (MAO)

Answer 15

-treats bradykinesia, rigidity, and tremors
- levels of dopamine increase
- Side effects similar to dopaminergic drugs

Question 16

Selegiline (apo- selegiline)

Answer 16

• inhibits metabolism of dopamine by MAO
• aids symptom control and allows decreased dosage of levodopa/carbidopa

Question 17

Transferase (COMT) Inhibitor

Answer 17

The drug slows down the breakdown of levodopa, works only when used in combination with Sinemet. Helps to manage symptoms caused by wearing off of sinemet before next dose is due.

Question 18

COMT

Answer 18

-Entacapone (Comtan)
- inhibits enzymes that break down neurotransmitters
- effects of levodopa last longer
- Side effects: paradoxical dyskinesia, gi upset, urine discoloration.

Question 19

Common Drugs specific to EPS

Answer 19

• benztropine (cogentin)
• Diphenhydramine (Benadryl)
• Clonazepam
• Lorazepam
• Diazepam