What happens in patients with parkinson's? - ANS • A decrease in normal dopamine levels; the nerve cells that produce dopamine break down
• Progressively gets worse over time
s&s of Parkinson's - ANS Mask-like
blank expression
stooped posture
tremors
shuffling gait
Wh...
What happens in patients with parkinson's? - ANS • A decrease in normal dopamine levels;
the nerve cells that produce dopamine break down
• Progressively gets worse over time
s&s of Parkinson's - ANS Mask-like
blank expression
stooped posture
tremors
shuffling gait
What is the mechanism of action of parkinson's medications? - ANS increase levels of
dopamine or antagonize effects of Ach
What are indirect acting meds for parkinson? - ANS Indirect acting dopaminergic drugs
Dopamine Modulators
COMT Inhibitor
Direct Acting meds for parkinson? - ANS Direct acting dopamine receptor agonist
indirect acting dopaminergic- Selegiline (Zelapar) - ANS indirect acting dopamine receptor
agonists (MAO-B inhibitor)
inhibits the action of the enzyme monoamine oxidase primary role of MAO is the breakdown of
catecholamines (the catecholamines are pi, norepi and dopamine)
prevents breakdown of lepadopa
Selegiline (Zelapar) interactions - ANS can be used with carbidopa-levodopa
cannot be used with meperidine
interaction with tyramine foods;(cheese; wine, beer , yogurt) produces severe hypertension
when is Selegiline (Zelapar) used? - ANS early stage;adjunct drug for parkinsons
dopamine modulator- amantadine (Symmetrel) - ANS anti viral used in the early stage
nerve fibers release dopamine in the basal ganglia & blocks the reuptake of dopamine reduces
tremor and rigidity
also used for influenza; effective for 6-8 months.
is a dopamine modulator
improves muscle control and reduces stiffness
,adverse effects of amantadine (Symmetrel) - ANS dizziness, insomnia and nausea; this
med has anticholinergic effects, if used with other anticholinergic meds will have additive effects
What are two types of COMT inhibitor? - ANS talcapone (Tasmar)
entacapone (Comtan)
COMT inhibitor-talcapone (Tasmar) - ANS adjunct drug to carbidopa-levodopa
treats symptoms
levodopa dose-sparing effect.
Works both centrally and peripherally
COMT inhibitor-entacapone (Comtan) - ANS adjunct; Works only peripherally, can not
cross BBB
Adverse effects of talcapone or entacapone - ANS GI upset
urine discoloration associated with severe liver failure
What is the treatment for serotonin syndrome? - ANS discontinuation of all serotonin
reuptake inhibitors and supporting the patient to maintain homeostasis.
How long until you experience benefits from SSRIs? - ANS 4-6 weeks until benefits show
up from this medication
SSRIs should be taken in the _________ to prevent any sleep disturbances. - ANS SSRIs
should be taken in the morning to prevent any sleep disturbances.
In caring for a patient experiencing ALCOHOL withdrawal, the nurse expects to administer
which medication or medication class as treatment for this condition? - ANS
benzodiazepines
which are first line drugs for parkinson? - ANS bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)
they stimulate pre/post synaptic dopamine receptors in the brain to stimulate production of
dopamine
bromocriptine (Parlodel)- Adverse effects - ANS ataxia, dizziness, headache, depression,
Caution: can produce vasoconstriction in peripheral tissues; can worsen PVD
Pramipexole (Mirapex)-Adverse Effects - ANS edema, fatigue, syncope, dizziness,
drowsiness
Ropinirole (Requip)-Adverse effects - ANS drowsiness
othohypotension
, Dopamine replacement drugs: carbidopa-levodopa (Sinemet) - ANS Levodopa changes
into dopamine in the brain, helping to control movement. Carbidopa prevents the breakdown of
levodopa in the bloodstream so more levodopa can enter the brain. Carbidopa can also reduce
some of levodopa's side effects such as nausea and vomiting.
What do large doses of levodopa cause? - ANS involuntary movements, GI distress,
hypotension and cardiac arrhythmias
what are carbidopa-levodopa (Sinemet) adverse effects? - ANS palpitations, hypotension,
urinary retention, depression, dyskinesia
which are Parkinson's Medications
Adjunct meds? - ANS anticholinergic and antihistamines
anti-cholinergic drug-Cogentin (benztropine): - ANS secondary drug for tremor/muscle
rigidity;
action is to block acetylcholine;
does not help bradykinesia; meds can cross the Blood brain barrier
anti cholinergic for parkinsons
anti-histamine-Benadryl (diphenhydramine): - ANS secondary drug for tremor/muscle
rigidity; decreases dyskinesia; anticholinergic properties
adverse effects of adjunct meds for parkinson? - ANS urinary retention, confusion, visual
blurring, palpitations, and increased intraocular pressure
what drug is most often prescribed for parkinson? - ANS levodopa (used with carbidopa to
suppress nausea)
body metabolizes levodopa to produce dopamine bc injections of dopamine would just be
blocked by the body's defense
Bromocriptine - ANS 1st line drug for parkinson
improves ability to move, decreases shakiness, stiffness and slowed movement
A-L-B-M - ANS Amantadine
levodopa
bromocriptine
MAO-inhibtors
Parkinson's medication- even __________ late can result in a decrease in function or being "off"
for hours - ANS 30 minutes
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