Parkinsons & Dementia (week 11) Flashcards
A slowly progressive neurodegenerative disorder that affects more than 1 million Americans with symptoms of tremors, rigidity, postural instability, and slowed movement.
Parkinson’s Disease
With Parkinson’s, you have too little ____ and too much ____.
Dopamine
Acetylcholine
What does Parkinson’s medication provide?
Symptomatic relief, does not delay progression
What are the two types of drugs to treat Parkinsons?
Dopaminergic agents
Anticholinergic agents
What are the 5 Dopaminergic agents for Parkinsons?
Levodopa/Carbidopa Pramipexole Entacapone Selegiline Amantadine
What is the MOA of Levodopa?
Can cross the BBB
Converted into Dopamine after it closes the BBB
What are the two Motor fluctuations with Levodopa?
Long term use leads to dyskinesias
‘Off-times’ lead to loss of symptom relief
What is the MOA or Carbidopa?
Prevents conversion of levodopa in the intestines
Strictly a carrier drug
Name two Dopamine replacements
Levodopa/Carbidopa
What are some side effects of Levodopa/Carbidopa?
Psychosis Dyskinesia N/V Postural Hypotension Dysrhythmias
What is an alternate name for Levodopa/Carbidopa?
Sinamet
What do you want to know in the MAR before administering Levodopa/Carbidopa?
MAOI
Anticholinergic drugs
What kind of meals should be avoided with Levodopa/Carbidopa?
High-protein meals
What harmless effect can levodopa/carbidopa cause?
Some people experience darkened urine and sweat
Name a Dopamine Receptor Agonist
Pramipexole (Mirapex)
What is a first line drug used for PD that is used in conjunction with Levodopa/Carbidopa to allow for lower doses?
Pramipexale )Mirapex)
What is the MOA of Pramipexole (Mirapex)?
Direct activation of dopamine receptors in the striatum
What are the adverse effects of Pramipexole? (Mirapex)?
Nausea/Dyskinesia/Postural hypotension
Hallucinations
Sleep Attacks
Impulse control disorders
What are some nursing implications you should know with Pramipexole (Mirapex)?
Cautious use in older adults
May be taken with food to reduce nausea and vomiting
What are the three other Anti-parkinsons Medications?
Entacapone
Amantadine
Selegiline
Name a COMT Inhibitor
Entacapone
What is the MOA of Entacapone?
Inhibiting COMT prevents early breakdown of Levodopa
What is the MOA of Amantadine?
Promotes release of DA from remaining DA Neurons
What drug is the only drug recommended for dyskinesias?
Amantadine
Name an MAO-B inhibitor
Selegiline
What is the MOA of Selegiline?
Prevents dopamine breakdown
What drug is the 1st line of defense to decrease ‘off-times’ effect?
Selegiline
What disease does not have enough acetylcholine?
Dementia
Alzheimer’s
Treatment of _______ with these drugs can yield improvement that is statistically significant but clinically marginal
Alzheimer’s
What are the four drugs approved for Alzheimers?
Memantine (Nemanda)
Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)
Name a Cholinesterase Inhibitor
Donepezil (aricept)
What is the MOA of Donepezil (Aricept)?
Prevents the breakdown of Acetylcholine by (AChE) and increases the availability if acetylcholine
What are some side effects of Donepezil (Aricept)?
Nausea and diarrhea
weight loss
Prolonged QT Interval
BRADYCARDIA
What are some nursing implications you want to know with Donepezil (Aricept)?
Cautious use in patients with asthma or COPD
Urinary retention or obstruction
May be taken with food
Symptoms typically get better over time
Name an NMDA Receptor
Memantine (Namenda)
What is the MOA of Memantine (Namenda)?
Creates blockade of further calcium entry
