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What is Parkinson's Disease?
- Pathophysiology
- - degeneration of substantia nigra
- - imbalance of dopamine and acetylcholine
- - disruption of extrapyramidal system
- Symptoms
- - Bradykinesthia
- - Tremor
- - Rigidity
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Major Classes of Drugs for Parkinson's
- - Levodopa/Carbidopa (Sinemet)
- - Dopamine Agonists:
- - Pramipexole (Mirapex)
- - Ropinirole (Requip)
- - Anticholinergics
- - Benztropine (Cogentin)
- - COMT Inhibitors
- - Entacapone (Comtan)
- - Combination Product
- - Levodopa/Carbidopa with Entacapone (Stalevo)
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Levodopa/Carbidopa (Sinemet)
- - Carbidopa prevents breakdown in preiphery
- - Decreased efficacy over time
- - MOA:
- - promotes synthesis of dopamine
- Adverse Effects:
- - N/V
- - Dyskinesias
- - Orthostatic Hypotension
- - Psychosis
- Nursing Implications:
- - Dosage Timings
- - Freezing
- - Protein intake
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Dopamine Agonists
- - First-line agents
- - MOA
- - direct action on dopamine receptors
- Adverse Effects:
- - nausea
- - dizziness
- - sedation
- - psychosis
- - compulsive behavior
- Nursing Implications:
- - give with food
- - titrate dose
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Benztropine (Cogentin)
- - primarily for tremor
- - MOA
- - decreases acetylcholine levels in CNS
- Adverse Effects:
- - anticholinergic
- Nursing Implications:
- - caution in elderly
- - cognitive impairment
- - assess elimination
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COMT Inhibitors
prevents breakdown of Sinemet
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What is Alzheimer's Disease
- Pathophysiology:
- - Neurodgenerative disorder
- - Neurofibrillary tangles and plaques
- - Decreased levels of acetylcholine
- - increased risk with aging and family hx
- Symptoms:
- - progressive memory loss
- - global cognitive deficits and executive planning
- - impaired speech/communication
- - decreased self-care
- - eventual death
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Cholinesterase Inhibitors
Alzheimer's
- - Prototype
- - Donepezil (Aricept)
- - MOA
- - prevent breakdown of acetylcholine
- - increase availability of acetylcholine in CNS
- - Effect
- - mild symptom improvement or delay in progression
- Adverse Effects:
- - Cholinergic (GI and CV)
- Nursing Implications:
- - Assess for adverse effects
- - realistic expectations
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Memantine (Namenda)
- Alzheimer's
- - MOA
- - NMDA receptor antagonist
- - prevents over stimulation of neuron by glutamate
- - Effect
- - mild symptom improvement or delay in progression
- Adverse Effects:
- - Dizziness
- - Sedation
- Nursing Implications:
- - can be combined with Cholinesterase inhibitor
- - realistic expectations
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What is Multiple Sclerosis (MS)?
- Pathophysiology:
- - Demyelinization of CNS
- - autoimmune
- Symptoms:
- - highly variable in presentation and progression
- - exacerbations and remissions
- - weakness, numbness, pain, visual impairment, bowel and bladder issues
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Interferon beta
MS
- - MOA
- - inhibits passage of inflammatory leukocytes into CNS
- Adverse Effects:
- - flu-like symptoms
- - hepatotoxicity
- - bone marrow suppression
- - injection site reactions
- - depression
- Nursing Implications:
- - assessments
- - monitor labs
- - patient education
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Glatiramer Acetate (Copaxone)
MS
- - MOA
- - increases production of anti-inflammatory cells
- Adverse Effects:
- - injection site reactions
- - post injection reactions
- Patient education
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Treatment for MS Exacerbation
- - IV Corticosteroids
- - Methylprednisolone (Solu-Medrol)
- Adverse Effects:
- - hyperglycemia
- - peptic ulcer disease
- - sodium and fluid retention
- - psychosis
- - immune suppression
- - fat redistribution
- - loss of bone and muscle mass
Need to taper (ween)
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Anticonvulsants (Antiepileptic Drugs) Indications
- Seizures
- - uncontrolled discharge of neurons
- - different types
- Bipolar Mania
- Migraine Headaches
- Neuropathic Pain
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Phenytoin (Dilantin)
- Indication:
- - seizure control
- MOA
- - selective suppression of sodium channels
- Narrow Therapeutic Index
- - therapeutic level 10-20 mcg/ml
- Adverse Effects:
- - CNS Suppression
- - Gingival hyperplasia
- - skin rash (can result in Stevens-Johnson syndrome)
- Drug Interactions:
- - induces hepatic metabolism of warfarin and OCPs (oral conctraceptive pill)
Patient Education
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IV Phenytoin (Dilantin)
Incompatibilities
- Rapid dministration Results in CV Collapse
- IV Vesicant (blistering)
- Fosphenytoin (Cerebyx)
- - prodrug
- - less CV risk
- - less caustic
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Carbamazepine (Tegretol)
- Indication:
- Seizure control
- Bipolar disorder
- Trigeminal neuralgia
- MOA:
- Selective suppression of sodium channels
- Narrow Therapeutic index:
- therapeutic level 4-12 mcg/ml
- Adverse Effects:
- - CNS depression
- - bone marrow suppression
- - Stevens-Johnson syndrome
- - test for HLA-B 1502 in Asians
- Drug Interactions:
- - induces hepatic metabolism of warfarin and OCPs
Patient Education
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Valprioc Acid (Depakote)
- Indication:
- Seizure control
- Bipolar Disorder
- Migraine Prophylaxis
- MOA:
- Selective suppression of sodium channels
- suppression of Neuronal Calcium channels
- Augments GABA
- Narrow Therapeutic Index:
- therapeutic level 40-100 mcg/ml
- Adverse Effects:
- - CNS Depression
- - Hepatotoxicity
- - pancreatitis
- - hair loss
- - Tremor
- - bone marrow suppression
Patient Education
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Gabapentin (Neurontin)
- Indication:
- - primarily used for neuropathic pain
- MOA:
- - enhanced GABA release
- Adverse Effects:
- - CNS Depression
Patient Education
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Levetiracetam (Keppra)
- Indication:
- - becoming drug of choice for control of tonic-clonic seizures
- Adverse Effects:
- - sedation
- Advantages:
- - no significant interactions
- - no need to monitor levels
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Management of Status Epilepticus
- Status Epilepticus:
- - continuous tonic-clonic seizures for 30 minutes
- - seizures lasting greater than 5 minutes impending status
- - can result in brain damage, acidosis, hypoglycemia, death
- Administration of IV Benzodiazepine
- - Lorazepam (Ativan)
Administration of Fosphenytoin (Cerebyx)
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