week 7 pharm Flashcards
what is the MOA of levodopa
it enters the brain and converts to dopamine, restoring the balance btween acetylcholine and dopamine with Parkinsons
why do you need to give levodopa in combo with decarboxylase
because only a small amount of levodopa actually crosses the BBB, so they usually add a dopamine enzyme antagonist so that the dopamine stays
what is sinemet
levodopa/carbidopa combo. this is basically levodopa combined with a decarboxylase inhibitor to make levodopa more available
what is decarboxylase
an enzyme that breaks down dopamine (including fake levodopa dopamine). when inhibited it increases amount of available levodopa in the brain
which Parkinson’s drug can cause dark urine and sweat
levodopa
what are 4 nursing considerations for levodopa
- patients should avoid high protein meals
- assess PD symptoms
- monitor BP
- Advise pt not to stand abruptly
what are some adverse effects of levodopa
n/v
dyskinesias (involuntary movements in the face, leg, or trunk)
postural hypotension
psychosis
CNS effects (impulse issues, difficulty regulating mood, etc.)
dark sweat and urine
whats the main differences between the on/off phenomenon and the wearing off effect
which drug does this occur with
on/off: abrupt, not dose dependent.
wearing off: gradual return of PD symptoms, dose dependent, usually seen at end of dose interval
these may occur with long term use of levodopa
what are two ways to minimise the on/off phenomenon
- adding a dopamine agonist/MAOB inhibitor
- avoiding high protein meals
what are ways to minimise the wearing off phenomenon with levodopa `
-increasing frequency of dose
- adding MAOB to prolong half life
- adding dopamine agonist
which drug is the dopamine agonist
pramipexole (mirapex)
what is pramipexole (mirapex) MOA
directly activates dopamine receptors by mimicking dopamine
what is a unique adverse effect with mirapex
can cause sleep attacks!
what are 4 nursing considerations with pramipexole
- don’t take with sedating meds or alcohol
- don’t drive
- discontinue if sleep attacks occur
- monitor BP regularly, advise patients to change positions slowly
what kind of drug is Selegiline (deprenyl)
MAO-B inhibitor
what is MAO-B
an enzyme that breaks down and inactivates dopamine in the brain
whats the difference between decarboxylase and MAO-B
decarboxylase is an enzyme that converts levodopa into dopamine, but does it outside the BBB so the dopamine goes to other parts of the body leaving little to actually cross the BBB. inhibiting it will allow more levodopa to actually get to the Brian.
MAO-B is an enzyme that breaks down and inactivates dopamine.
which drug can help slow disease progression in newly diagnosed parkinsons patients?
selegiline/ deprenyl
what are some adverse effects for selegiline
insomnia, hypertensive crisis in high doses, down give with SSRIs (serotonin syndrome), can worsen adverse effects for levodopa
risk for falls
how long do benefits of selegiline usually last
only about 12-24 months
which if the big 3 Parkinsons symptoms do anticholinergics NOT improve
bradykinesia
what are the anticholinergic side effects
mad, hot, dry, cant see, cant shit, cant piss
why d0 anticholinergics help with Parkinson’s
blocks acetylcholine, corrects nt imbalance by focusing on acetylcholine.
what is methylprednisone (soiu-medrol)
IV form of prednisone
what are some monitoring paremeters for a patient on methylprednisone
mainly monitor for acute infection because its a pretty intense immunosuppressant
- fever
- UTI
- increased WBC
- cough
- pain/swelling
what do interferon beta drugs (Betaseron) do and how do they help with MS
its an immunomodulator (very soft immunosuppressant )
MS is autoimmune which means the immune system is being dramatic, so this drug weakens the immune system a bit so that the patient gets relief of symptoms
which meds should you not take with betaseron
hepatotoxic meds and other immunosuppressants
which MS treating drug is similar to chemotherapy and originally made for cancer treatment
mitoxantrone (novantrone)
what is the MOA of novantrone
it stops DNA replication of all rapidly dividing cells, especially immune cells
its good for MS because it basically destroys rapidly dividing immune cells
what are 4 big adverse effects with mitoxantrone
- myelosupression (toxic to bone marrow cells because they are rapidly dividing and making blood cells)
- cardiotoxicity: monitor HR and BP (could lower ejection fraction)
- teratogenic so no preggo
- hair loss, N/V, cold sores
what kind of drugs (class) is baclofen/Lioresel
it is a GABA agonist
what is the MOA of baclofen/lioresel
it is a GABA agonist. GABA is inhibitory so it stops unnecessary excitation of the skeletal muscles. i
what would adverse effects look like with baclofen/lioresel
- basically could be a little too inhibitory
if you take with CNS depressants it could cause respiratory depression
if dose is too high it could also cause CNS depression
what is Gabapentin (neurotin) and what does it usually treat
It is a GABA analog. it enhances the release of GABA and changes the way nerves send signals to the brain. its great for neuropathic pain
