Neurodegenerative Diseases and Parkinson's Pharmacotherapy

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Questions and Answers

What is the primary goal of pharmacotherapy in Parkinson's disease?

To enhance cognitive function in patients

To balance dopamine and acetylcholine levels (correct)

To promote rapid weight loss

To completely cure the disease

What is a necessary precaution when administering Levodopa?

It should be taken on an empty stomach (correct)

It can be taken with multivitamins without restriction

It is safe to consume alcohol while on this medication

It should be taken with high-protein meals

Which of the following is an adverse effect of Benztropine?

Hyperactivity

Increased sweating

Weight gain

Urinary retention (correct)

What is a significant consideration when treating Alzheimer's disease with donepezil?

Baseline liver and kidney function tests need to be obtained Signup and view all the answers

Which of the following conditions contraindicates the use of Benztropine?

Closed-angle glaucoma Signup and view all the answers

Which medication is primarily used in the pharmacotherapy of muscle spasms?

Cyclobenzaprine Signup and view all the answers

What does the treatment of overdose for donepezil typically involve?

Using anticholinergic drugs to reverse symptoms Signup and view all the answers

What are some common side effects associated with cholinesterase inhibitors used in Alzheimer's treatment?

Nausea, vomiting, and diarrhea Signup and view all the answers

Which condition is primarily characterized by demyelination and is considered an autoimmune disease?

Multiple sclerosis Signup and view all the answers

Which side effect might occur with the use of Dantrolene?

Muscle weakness Signup and view all the answers

What approach is effective in managing muscle spasticity according to nonpharmacologic therapies?

Physical therapy to increase movement and prevent contractures Signup and view all the answers

What should patients be monitored for when taking Pramipexole?

Orthostatic hypotension Signup and view all the answers

What is a common symptom of neurodegenerative diseases?

Progressive, irreversible loss of neurons Signup and view all the answers

Which of the following is a characteristic of muscle spasticity?

It includes irritability of deep tendon reflexes Signup and view all the answers

Study Notes

Neurodegenerative Diseases of the CNS

Also known as neurodegenerative diseases
Progressive and irreversible loss of neurons
Can affect individuals of any age
Pharmacotherapy treats symptoms; no cure exists
Depression is a common comorbidity

Parkinson's Disease Pharmacotherapy

Goal: Balance dopamine and acetylcholine
Treatment may take 2-3 weeks to show benefit
Dopamine Agonists: Increase available dopamine by various mechanisms
Anticholinergic Drugs: Block acetylcholine's excitatory action in the striatum, decreasing abnormal movement
Levodopa Considerations:
- Take on an empty stomach
- Avoid vitamins/B6, high-protein diets
- Monitor for dizziness, balance issues, assisting ADLs
- Monitor liver and kidney function
- Avoid alcohol
- Watch for mood/behavioral changes (aggression, confusion)
Pramipexole Considerations:
- Assess baseline vital signs and Parkinson's Disease symptoms
- Monitor for orthostatic hypotension
- Monitor for tardive dyskinesia
- Assess mental status
- Inform patient/family that treatment is not a cure, but may manage symptoms
Benztropine Adverse Effects:
- Common: Sedation, constipation, blurred vision, dry mouth, decreased sweating, urinary retention, confusion
- Serious: Paralytic ileus
Benztropine Contraindications/Precautions:
- Closed-angle glaucoma, myasthenia gravis, tardive dyskinesia, GI/urinary obstructions, prostatic hypertrophy, peptic ulcers, tachycardia, alcohol
Benztropine Drug Interactions:
- Additive toxicity with antihistamines, tricyclic antidepressants, phenothiazines, MAOIs, quinidine
- Additive sedative effect with alcohol, CNS depressants
- Reduced GI motility/absorption with antidiarrheals
Benztropine Pregnancy Category: C
Overdose Treatment: Physostigmine (subcutaneous or IV) to reverse anticholinergic effects

Alzheimer's Disease Pharmacotherapy

Treatments produce modest results and don't halt disease progression
Cholinesterase Inhibitors:
- Tacrine (Cognex)
- Cholinesterase breaks down acetylcholine
- Goal: Improve ADLs, behavior, and cognition
- All drugs in this class have similar efficacy
- GI issues (nausea, vomiting, diarrhea) are common. Liver also impacted
- Nursing considerations: Cognition, safety, independence, symptoms, baseline labs, vital signs, vision, weight, liver/kidney function.
Reversible Cholinesterase Inhibitors:
- Increase acetylcholine concentrations in the brain
- Fewer side effects than Tacrine
- Mostly GI-related side effects
- Serious side effects: Atrial fibrillation, sinus bradycardia, seizures
- Nursing considerations: Cognition, safety, independence, symptoms, baseline labs, vital signs, vision, weight, kidney function.
Donepezil Adverse Effects:
- Common: Nausea, vomiting, diarrhea, anorexia, muscle cramps, syncope, ecchymosis, fatigue, arthralgia, abnormal dreams/hallucinations/confusion/depression, headache
- Serious: Life-threatening dysrhythmias (atrial fibrillation, sinus bradycardia), seizures, renal failure, hepatotoxicity (monitor liver enzymes)
Donepezil Treatment & Considerations:
- Overdose treatment: Anticholinergic drugs
- Consider cognitive function, safety
- Obtain baseline lab tests (especially liver and renal)
- Assess Alzheimer's symptoms (depression, agitation, anxiety, aggression, confusion)
- Inform family to monitor for irregular heartbeats/chest discomfort
- Evaluate need for alternative living arrangements
- Encourage support groups (patient and family)
- Avoid alcohol

Multiple Sclerosis

Unknown exact cause
Demyelination secondary to inflammatory response (likely autoimmune)
Leading cause of neurological disability (20-40 age group)
Symptoms: Exacerbation and remission periods, balance problems, muscle weakness

Muscle Spasms

Treatment: NSAIDs and skeletal muscle relaxants

Cyclobenzaprine Considerations

Obtain history and physical (including vital signs)
Assess baseline neurological status and pain
Protect from falls due to drowsiness
Assess for skin reactions (urticaria, rash)
Advise patient not to drive

Similar Drugs to Cyclobenzaprine

Methocarbamol (Relaxin, Robaxin)
Metaxalone (Skelaxin)
Orphenadrine (Banflex, Myophen, Norflex)
Tizanidine (Zanaflex)

Muscle Spasticity

Continuous contraction
Pain is more intense than spasms
Irritable deep tendon reflexes
Scissoring movements of lower extremities
Fixed joint movement
Caused by neuromuscular diseases, not a disorder itself

Dantrolene Considerations

Obtain history and physical (including baseline neurological status and pain)
Assess vital signs during IV administration
Monitor for cardiopulmonary changes
Watch for liver issues (liver function tests, jaundice)
Avoid alcohol
Advise patient not to drive

Non-Pharmacologic Therapies

Physical therapy: Increases movement, prevents contractures
Herbal remedies: Black cohosh, castor oil packs, capsaicin (capsaicin topical - wear gloves)
B-complex vitamins (especially B6): Potentially helpful.

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Description

Explore the complexities of neurodegenerative diseases, focusing on the central nervous system and specifically Parkinson's disease. Understand the pharmacotherapy options available, including the mechanisms of dopamine agonists and anticholinergic drugs, as well as important considerations for medication management. Dive into the challenges of treating symptoms and managing comorbidities such as depression.