Parkinson's Disease Medications Overview

Parkinson's Disease Medications

• Levodopa:
  • Taken on an empty stomach.
  • Avoid multivitamins and vitamin B6.
  • Avoid high-protein diets.
  • Monitor for dizziness and safety during ambulation and activities of daily living (ADLs).
  • Monitor liver and kidney function.
  • Avoid alcohol.
  • Watch for changes in mood or behavior (e.g., aggression, confusion).
• Pramipexole:
  • Assess baseline vital signs (VS) and Parkinson's Disease (PD) symptoms.
  • Monitor for orthostatic hypotension.
  • Monitor for tardive dyskinesia(TD).
  • Assess mental status.
  • Inform the patient and family that PD treatment is not a cure but may help symptoms for a time.

Benztropine Considerations

• Adverse Effects:
  • Sedation
  • Constipation
  • Blurred vision
  • Dry mouth
  • Decreased sweating
  • Urinary retention
  • Confusion
  • Serious adverse effects include paralytic ileus.
• Contraindications/Precautions:
  • Closed-angle glaucoma
  • Myasthenia gravis
  • Tardive dyskinesia
  • Gastrointestinal/urinary obstruction
  • Prostatic hypertrophy
  • Peptic ulcers
  • Tachycardia
  • Alcohol (interaction).
• Drug Interactions:
  • Additive toxicity with antihistamines, tricyclic antidepressants, phenothiazines, MAOIs, and quinidine.
  • Additive sedative effects with alcohol and CNS depressants.
  • Can slow GI motility and decrease absorption if taken with antidiarrheals.
• Pregnancy Category: C
• Treatment of Overdose:
  • Physostigmine (1-2 mg subcutaneous or IV) to reverse anticholinergic intoxication.

Alzheimer's Disease Pharmacotherapy

• General: Produces only modest results; ineffective at stopping disease progression.
• Cholinesterase Inhibitors:
  • Increase acetylcholine concentrations in the brain.
  • Tacrine (Cognex) is a cholinesterase inhibitor.
  • All drugs have similar efficacy in improving ADLs, behavior, and cognition.
  • The GI system is most commonly affected with nausea, vomiting, and diarrhea.
  • Nursing considerations include monitoring cognition, safety, independence, symptoms, baseline labs, VS, vision, weight, and liver/kidney function.
• Cholinesterase Inhibitors (Reversible):
  • Fewer side effects than tacrine.
  • Side effects primarily affect the gastrointestinal (GI) system.
  • Serious side effects include atrial fibrillation, sinus bradycardia, and seizures.
  • Nursing considerations include monitoring symptoms, cognition, safety, independence, baseline labs, VS, vision, weight, and kidney function.

Donepezil Adverse Effects and Considerations

• Adverse Effects:
  • Nausea, vomiting, diarrhea, and anorexia.
  • Muscle cramps
  • Syncope
  • Ecchymosis
  • Fatigue
  • Arthralgia
  • Abnormal dreams, hallucinations, confusion, depression.
  • Headache.
  • Serious adverse effects: life-threatening dysrhythmias (atrial fibrillation, sinus bradycardia), seizures, renal failure, and hepatotoxicity (monitor liver enzymes.)
• Treatment of Overdose: Anticholinergic drugs to reverse symptoms of cholinergic crisis.
• Considerations:
  • Assess cognitive function and safety.
  • Obtain baseline lab tests (especially liver and renal).
  • Determine Alzheimer's disease symptoms (depression, agitation, anxiety, aggression, confusion).
  • Inform family to monitor for irregular heartbeats or chest discomfort.
  • Evaluate need for alternative living arrangements.
  • Encourage patient and family participation in support groups.
  • Avoid alcohol.

Multiple Sclerosis (MS)

• Cause: Unknown, considered an autoimmune disease, characterized by demyelination secondary to inflammation.
• Prevalence: Leading cause of neurologic disability in the 20-40 age group.
• Symptoms: Exacerbation and remission cycles of symptoms like balance issues, muscle weakness.

Muscle Spasms Medications

• Cyclobenzaprine:
  • Obtain history and physical examination (including VS).
  • Assess baseline neurologic status and pain.
  • Protect from falls due to drowsiness, and assess for skin reactions.
  • Instruct the patient not to drive.
• Similar Medications:
  • Methocarbamol (Relaxin, Robaxin): Adjunct to physical therapy. Do not drive.
  • Metaxalone (Skelaxin): Ineffective for spasticity-related neurological disorders.
  • Orphenadrine (Banflex, Myophen, Norflex): Anticholinergic; closely related to diphenhydramine.
  • Tizanidine (Zanaflex): Treats spasticity related to brain or spinal cord injury or MS.

Muscle Spasticity

• Description: A continuous state of muscle contraction, with pain being more intense than spasms and causing greater impairment.
• Characteristics:
  • Irritable deep tendon reflexes.
  • Scissoring movements of lower extremities.
  • Fixed joint movement.
  • A symptom, not a disease itself, caused by neuromuscular disorders.

Dantrolene Considerations

• General:
  • Obtain history and physical examination including baseline neurologic and pain status.
  • Monitor vital signs during IV administration.
  • Assess for cardiopulmonary changes (monitor breath and heart sounds).
  • Monitor liver function tests. Report signs of jaundice; avoid alcohol.
  • Instruct patient not to drive.

Non-Pharmacologic Therapies

• Physical Therapy: Increases movement and prevents contractures.
• Herbal Remedies: Black cohosh (topical), castor oil packs (topical), capsaicin (topical – use gloves, active chili peppers), B complex vitamins (specifically B6).

This quiz covers key information on medications used in the management of Parkinson's Disease, including Levodopa and Pramipexole. Additionally, considerations regarding Benztropine, its adverse effects, and contraindications are discussed. Test your understanding of these essential pharmacological concepts and safe practices when treating PD.