Parkinsons/Alzheimers Flashcards
Dopaminergic Agents
carbidopa-levodopa (Sinemet)
converted to dopamine; prevents levodopa breakdown
Dopaminergic Agent SE
dizziness
sleep-dysfunction
DROWSINESS
fatigue
n/v
constipation
OH
dystonia
dyskinesia (involuntary movements)
psychosis/severe depression
discolored urine, sweat, tears, etc.
“on-off phenomenon”
Dopaminergic Agent Nursing Interventions
NO HIGH PROTEIN MEAL (give with carbs)
take at same time everyday and don’t discontinue abruptly
caution in pts with psychiatric disorders (dopamine can worsen hallucinations)
fall precautions
monitor for dyskinesia, BP changes, mental status
no MAOIs (HTN crisis)
CI in glaucoma
Dopamine Agonists
amantadine (Symmetrel)
stimulate dopamine receptors
Dopamine Agonists SE
dizziness
HA
insomnia
confusion
anxiety
irritability
blurred vision
nausea
OH
peripheral edema
Anticholinergic Agents
benztropine mesylate (Cogentin)
inhibit release of acetylcholine to reduce overactivity and reduce tremors and muscle rigidity
Anticholinergic Agents SE
dry mouth
blurred vision
photophobia (sunglasses!)
urinary retention
constipation
tachycardia
glaucoma (CI)
confusion, hallucinations, memory issues
Anticholinergic Agents Nursing Interventions
increase fluids, fiber and exercise
eye exams/sunglasses for photophobia
VS
observe for involuntary movements
avoid alcohol, cigs, caffeine and aspirin to lower GI acidity
ice chips/sugarless candy for dry mouth
monitor mental status, VS, HR and I+O
take at bedtime to reduce drowsiness
don’t discontinue abruptly!
Monoamine Oxidase B Inhibitors (MAOI)
selegiline
inhibit MAO-B enzyme that interferes with dopamine
MAOI SE
dizziness
HA
confusion
hallucinations
depression
insomnia
ataxia
nausea
constipation
OH
MAOI Nursing Interventions
avoid foods high in tyramine
Catechol-o-Methyl Transferase (COMT) Inhibitors
entacapone (Comtan), tolcapone (Tasmar)
inhibit COMT enzymes that inactive dopamine
COMT Inhibitors SE
dizziness
drowsiness
HA
insomnia
confusion
hallucinations
OH
GI upset
constipation
dyskinesia
dystonic reactions
muscle cramps
Parkinson’s Meds Overall Nursing Interventions
baseline VS (and every 4-8 hours)
daily weights
mental status assessments
baseline dyskinesia, tremors, gait, swallowing, rigidity
no CNS depressants
monitor for side effects especially in older adults
take meds as prescribed; don’t crush extended release drugs
don’t stop meds abruptly
assess suicidal thoughts, “on-off” phenomenon
labs (CBC, liver, kidneys)
“On-Off” Phenomenon
shift in mobility in response to medication
Acetylcholinesterase/Cholinesterase Inhibitors
rivastigmine (Exelon)
allow more acetylcholine in neuron receptors; increases cognitive function and slows disease progress
Acetylcholinesterase/Cholinesterase Inhibitors SE
dizziness/HA
confusion
GI upset (n/v/d) or bleed
dehydration
weight loss/anorexia
peripheral edema
OH
depression
insomnia
increased urination
Acetylcholinesterase/Cholinesterase Inhibitors Nursing Interventions
use cautiously with asthma and COPD (increased cholinergic activity)
monitor weight loss (weigh regularly) and dehydration; cognitive function, HR, GI SE, VS
don’t stop abruptly
take with food to reduce nausea
report severe vomiting, weight loss, dizziness
anticholinergic drugs can worsen dementia!
N-Methyl-D-Aspartate Antagonist
memantine (Namenda)
reduces abnormally high levels of glutamate
N-Methyl-D-Aspartate Antagonist SE
dizziness
HA
sedation
weight gain
diarrhea
ADE are rare
N-Methyl-D-Aspartate Antagonist Nursing Interventions
may take months for symptoms to improve
Alzheimer’s Meds Overall Nursing Interventions
baseline VS, weight, GI status, urinary status, cognitive function
swallowing ability
requires DOT? (med supervision)
monitor VS, daily weights, heart status and I+O
assess cognitive function often
monitor for dizziness, insomnia, anorexia
watch for seizures and other SE; overdose
take as prescribed, don’t crush extended release meds
take with food or milk to avoid GI upset
use cautiously with GI bleeding, liver, kidney, heart disease
older, frail women shouldn’t take >5 mg/day of dorepezil (Aricept)
S/S of Med Overdose
severe n/v
sweating
salivation
hypotension
bradycardia
convulsions
increased muscle weakness (including respiratory)
