NUR 3145 PHARMACOLOGY EXAM 3 | QUESTIONS | WITH COMPLETE
SOLUTIONS | RATED A+
Parkinson's Disease Medications - Mechanism of action: increase levels of dopamine
and/or antagonize effects of Ach
Indirect acting dopaminergic drugs - selegiline (Zelapar) -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; prevents breakdown
of lepadopa
used in early stage ; adjunct drug.
Adverse effect: interaction with tyramine foods;(cheese; wine, beer , yogurt) produces
severe hypertension
MAO (monoamine oxidase) causes - the breakdown of catecholamines in the body; the
catecholamines are epi; norepi; and dopamine.
MAO inhibitors ; selegiline and rasagiline causes an increase in the levels of
dopaminergic stimulation in the CNS; both are approved for use in combo with
carbidopa-levodopa; do not use concurrently with meperidine
Dopamine Modulator: - amantadine (Symmetrel) - 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.
Adverse effects: dizziness, insomnia and nausea; this med has anticholinergic effects, if
used with other anticholinergic meds will have additive effects
COMT Inhibitor: both drugs block COMT - talcapone (Tasmar)- adjunct drug to
carbidopa-levodopa; treats symptoms; levodopa dose-sparing effect. Works both
centrally and peripherally
entacapone (Comtan) - adjunct; Works only peripherally, can not cross BBB
Adverse effect: GI upset, urine discoloration; associated with severe liver failure.
Direct acting dopamine receptor agonist
first line agents; stimulate pre/post synaptic dopamine receptors in the brain stimulate
production of more dopamine; all dopamine agonists -
direct acting dopamine receptor agonists (drugs) - bromocriptine (Parlodel)..Adverse
effects: ataxia, dizziness, headache, depression, Caution: can produce vasoconstriction
in peripheral tissues; can worsen PVD
Dopamine replacement drugs: - carbidopa-levodopa (Sinemet) - drug of choice for
elderly patients; used when patient functionally impaired. Carbidopa prevents
breakdown in periphery and thus prevents s/s of too much levodopa and also requires
lesser dose of levodopa
Large doses of levodopa:
involuntary movements, GI distress, hypotension and cardiac arrhythmias
parkinsons adjunct meds Anti-cholinergic Drugs - Cogentin (benztropine): secondary
drug for tremor/muscle rigidity; action is to block acetylcholine; does not help
bradykinesia; meds can cross the BBB
parkinson adjunct meds: Antihistamines:
Benadryl (diphenhydramine): secondary drug for tremor/muscle rigidity; decreases
dyskinesia; anticholinergic properties
Nursing Care - Monitor for adverse effects of medications.
Urinary retention, dry mouth, hypotension, dizziness, orthostatic hypotension,
constipation, loss of appetite, confusion.
Obtain history and physical assessment.
Administer medications on time, even 30 minutes late can result in a decrease in
function or being "off" for hours
Monitor liver function.
Do not allow the elderly patient on anticholinergics (Cogentin benztropine) to become
overheated.
Teach patient to avoid alcohol, OTC drugs, and herbal meds unless approved by care
provider.
Monitor carefully when dopaminergic medications are begun. - Assistance with walking
due to dizziness and syncope SE
Give medication 30 minutes before a high protein meal
Drink 3,000cc/day
Include foods that are natural laxatives
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