Neurodegenerative Diseases and Parkinson's Pharmacotherapy

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.

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.