1. parkinsons diseas
    • degenerative disorder of CNS caused by defciency of dopamine & excess acetylcholin
    • S/S- Trembling, ridigity, problems walking & w/ balance, fine tremors, & rigidity of some mucsle groups & weakness, bradykinesia(slow movement), slurred speech, mask-like face(emotionless), difficulty chewing & swallowing
  2. Parkinsonism
    refers to symptoms of parkinsons disease & parkinson-like symptoms (extrapyramidal)seen w/ use of drugs, head injury, & encephalitissymptoms caused by depletion of dopamine in CNS
  3. dopaminergic drug
    • affect dopamine content of brain
    • Uses:
    • parkinson & parkinson-like symptoms, restless leg, viral infections
    • Ex. carbidopa- doesnt cross, no effect if given alone
    • carbidopa/levodopa- lower levodopa AR so better outcome
    • levodopa- crosses BBB, high incidence of AR doses increases as disease progresses
    • AR: choreiform movements (involuntary twitching of limb/facial muscles), dystonic movements (muscular spasm affecting tongue, jaws, eyes, neck), mental changes, anorexia, GI problems, abd. pain, dry mouth, dysphagia, headache, dizziness

    • contr:
    • narrow-angle glaucoma & pt recieving MAOI antidepressents, pt should be screened 4 unusual skin lesion b/c levodopa could activate malignant melanoma, & cardiovascular & pulmonary disease, peptic ulcers, renal hepatic disease & psychosis

    • Inter:
    • antidepressent- increases risk 4 HTN & dyskinesia
    • antacids- increases effect of levodopaanticonvulsant- decreases effect of levodopa
  4. anticholinergic drugs
    • inhibits acetylcholine in CNS, less effective then levodopa, limited dose by peripheral AR
    • Uses- adjunctive therapy in parkinsons & in control of drug-induced extrapyramidal disorders
    • Ex. benzotropin (cogentin)

    AR: dry mouth, blurred vision, dizziness, nausea, nervouseness, rash, urticaria, urinary retention, dysuria, tachycardia, muscle weakness, disorientation & confusion especially in elders

    • Cont:
    • closed- angled glucoma, pyloric & duodenal obstruction, peptic ulcer, prostatic hypertrophy, achalasia(failire of lower esophagus to relax leading to difficulty swallowing), myathenia gravis, & megacolon

    • Inter:
    • amentidine(antiparlikson)- increased antichinergicdigoxin(heart)- increases digoxin levelhaloperidol(antipsychotic)- increases psycotic behaviorphenothiazines(antipsycotic)- increases anticholinergic effect
  5. COMT inhibitor
    • prolong effect of levodopa by blocking enzyme, COMT, which eliminates dopamine, increases plasma concentrationused as adjuncts to other drugs
    • Ex.entacapone(Comtan)- milder, to help manage fluctuaton in response to levodopa
    • tolcapone(Tasmar)- potent, easily crosses BBB, associated w/ liver damage/failure
    • AR: Dyskinesias, hyperkinesias, orthohypertension, dizziness, GI problems, sleep disorders, dreaming, somnolence, mucsle cramps
    • Inter:MAOI- Increase risk 4 toxicity of both drugs
    • adrenergic drugs (Tx cardiac & B/P)- increases risk of cardiac problems
  6. Dopamine-receptor agonist
    • act directly on postsynaptic dopamine receptors of nerve cells in brain, mimicking effect of dopamine in brain
    • Ex.apomorphine (apokn)- used as "on/off" phenomena, give antimetic before
    • pramipexole (mirapex) & ropinirole (requip)- Tx of S/S of parkinson

    • AR: hallucination, somnolance, postural hypotension, nausea, dizziness, vominting, confusion, visiual disturbance, abnormal
    • involuntary movements, headache

    Cont: pt w/ dyskinesia, ortho hypotension, hepatic & renal failure, CVD, hx of hallucination, psychosis

    • Inter:
    • CNS depressant- increases risk of CNS depression
    • levadopa- increases effect of levodopa & hallucination
    • ciprofloxacin- increase effect of dopamine receptor agonistcimetidine/ranitidine(GI)- increase dopamine receptor effectivenessverapamil/quinidine(cardiac)- same
    • estrogen- same
    • phenothiazines(antipsychotic)- decreased dopamine agaonist effectiveness
  7. b/c of some metal impairments sometimes HX should b taken from familiy
    • symptoms, length of symptoms
    • pt ability of ADL
    • pt current mental conditions
    • physical assessment for baseline
    • pts. neuromuscular status: tremors of hand/head while pt @ rest, mask-like facial expression, changes in gait, type of speech, postural deformities, muscular rigidity, drooling, difficulty in chewing/swallowing, change in thought process, pt ability to do ADL

    Ongoing assessment: to evaluate all symptoms above 4 changes
  8. Implementation
    • psychological support
    • pt/family teaching, doses depends on pt activities (family usually given range of dosages to give)
    • antiparkinson also used 4 Tx of symptoms that happen w/ other antiparkinson dugs, when used 4 this drug may exacerbate mental symptoms & precipitate a psychotic event
    • nurse should observe behaviors frequently, if sudden changes seen, nurse holds drug & notifies DR
    • Nurse observes pt getting carbidopa/lovadopa for choreiform & dystonic movement like facial grimacing, protruding tongue, exaggerating chewing/head movements, & jerking movements of arms/legs, if any happen hold next dose & motify DR
  9. When imbalance nutrition
    • Dry mouth- sips of water, ice chips, hard candy
    • Sever dry mouth- that hard to swallow or speak , loss of appetite & wt loss drug dose reduced
    • GI disturbance- create calm environment, sm. Frequent meals, foods pt prefer, monitor pt wt. & take drugs w/ meals,
    • If nausea & vomiting severe necessary to d/c drug or change to another, w/ continued use of drug nausea usually decreases or resolves
  10. Constipation
    changes in facial expressions & posture may indicate abd. Pain/discomfort from urinary retention, paralytic ileus, constipation,

    nurses stresses the need 4 diet high in fiber & increase fluids, stool softener
  11. Nursing alert
    • Fatal AR to Capone is hepatic injury.
    • Blood test 4 liver function RX
    • Test serum aminotransferase levels q 2wk 1st year & q 8wk after
    • Med d/c if level high or symptoms of lever failure (nausea, fatigue, lethargy, anorexia, jaundice, dark urine , pruritus, upper right quad tenderness
  12. Risk 4 injury
    • b/c of visual disturbance, pt show signs of refusal to read, watch tv, bumps into things
    • Assist w/ ambulation, Teaching of assistive devises, clear pt enviroment
    • observe sudden changes in behaviors/actvities, could also be b/c of hallucinations, depression, or psychotic episodes
    • Instruct to rise slowly b/c meds could lead to ortho hypotension

    • Geri alert
    • Hallucination when on ant Parkinson especially dopamine receptor agonist
    • Assess 4 signs of visual, auditory, or tactile hallucination
  13. On/off phenomenon occurs w/ levadopa, pt alternates between inproved status & loss of theraputic effect (when levadopa used long-term
    Drug-holiday- given low doses & reserving for servere cases, or stoping drug (5-14days), slowly restarting drug in sm. Dose
  14. Educating pt/ family
    • Take med as rx, If GI problems take w/ food
    • If dizziness, blurred vision, avoid activites that req. alertness
    • Relief dry mouth,hard candy, sips of water, may interfers w/ dentures or dental problems
    • Caustion about ortho hypotension
    • Notify Dr. if dry mouth, cant chew/swallow, urinary retention, depression, dizziness, drowsiness, irregular HR, abd, changes, mood changes, unusual movement of head, eyes, tongue, neck, arms, legs, feet, mouth
    • Keep appt.
    • When taking levadopa avoid vitB6 b/c could interfere w/ action of levadopa
    • Pt w/ DM levadopa could interfere w/ urine test (glucose or ketones)
    • ToCapone: keep appt. b/c of liver testing, report signs of liver failure like persistent nausea, fatigue, lethergy, anorexia, jaundice, dark urine pruritis, & upper right quad tenderness
Card Set
ch 29