Podcast
Questions and Answers
What is a primary advantage of dopaminergic therapy?
What is a primary advantage of dopaminergic therapy?
What condition may occur if levodopa is taken with non-selective MAOIs?
What condition may occur if levodopa is taken with non-selective MAOIs?
Which of the following is NOT an adverse effect of anticholinergic therapy?
Which of the following is NOT an adverse effect of anticholinergic therapy?
What implication should be communicated to clients when starting dopaminergic agents?
What implication should be communicated to clients when starting dopaminergic agents?
Signup and view all the answers
Which of the following medications is classified as an anticholinergic drug?
Which of the following medications is classified as an anticholinergic drug?
Signup and view all the answers
What is a critical client care implication for patients on levodopa?
What is a critical client care implication for patients on levodopa?
Signup and view all the answers
Anticholinergic agents are primarily used to treat which symptoms associated with Parkinson's disease?
Anticholinergic agents are primarily used to treat which symptoms associated with Parkinson's disease?
Signup and view all the answers
Which of the following does NOT represent a common side effect of anticholinergic drugs?
Which of the following does NOT represent a common side effect of anticholinergic drugs?
Signup and view all the answers
Which motor symptom is characterized by a slowing of movement in Parkinson's disease?
Which motor symptom is characterized by a slowing of movement in Parkinson's disease?
Signup and view all the answers
What is the primary purpose of levodopa in the treatment of Parkinson's disease?
What is the primary purpose of levodopa in the treatment of Parkinson's disease?
Signup and view all the answers
Which drug combination helps to prevent the peripheral metabolism of levodopa?
Which drug combination helps to prevent the peripheral metabolism of levodopa?
Signup and view all the answers
What adverse effect is commonly associated with levodopa therapy?
What adverse effect is commonly associated with levodopa therapy?
Signup and view all the answers
Which of the following drugs can cause an increased release of dopamine from nerve endings?
Which of the following drugs can cause an increased release of dopamine from nerve endings?
Signup and view all the answers
What mechanism does selegiline follow to assist in the management of Parkinson's disease?
What mechanism does selegiline follow to assist in the management of Parkinson's disease?
Signup and view all the answers
What is the 'on-off' phenomenon in relation to levodopa treatment?
What is the 'on-off' phenomenon in relation to levodopa treatment?
Signup and view all the answers
Which additional therapy is often considered for patients with drug-resistant Parkinson's disease?
Which additional therapy is often considered for patients with drug-resistant Parkinson's disease?
Signup and view all the answers
What role does carbidopa play in the therapy for Parkinson's disease?
What role does carbidopa play in the therapy for Parkinson's disease?
Signup and view all the answers
Which of the following is characterized by involuntary muscle movements as an adverse effect of levodopa therapy?
Which of the following is characterized by involuntary muscle movements as an adverse effect of levodopa therapy?
Signup and view all the answers
Which agent is used to inhibit the enzyme COMT in combination therapies for Parkinson's disease?
Which agent is used to inhibit the enzyme COMT in combination therapies for Parkinson's disease?
Signup and view all the answers
When is a dopamine receptor agonist typically recommended in the treatment of Parkinson's disease?
When is a dopamine receptor agonist typically recommended in the treatment of Parkinson's disease?
Signup and view all the answers
Which of the following is a potential effect of using a monoamine oxidase inhibitor (MAOI) in Parkinson's disease treatment?
Which of the following is a potential effect of using a monoamine oxidase inhibitor (MAOI) in Parkinson's disease treatment?
Signup and view all the answers
Flashcards
Dopamine Receptor Agonists
Dopamine Receptor Agonists
Medications that stimulate dopamine receptors in the brain, used to treat Parkinson's disease symptoms.
Levodopa
Levodopa
A medication that increases dopamine levels in the brain, a primary treatment for Parkinson's.
Anticholinergic Therapy
Anticholinergic Therapy
Medication that blocks acetylcholine, used to treat muscle tremors and rigidity in Parkinson's.
Anticholinergic Drugs
Anticholinergic Drugs
Signup and view all the flashcards
Parkinson's Disease
Parkinson's Disease
Signup and view all the flashcards
Impulse Control Disorders
Impulse Control Disorders
Signup and view all the flashcards
Hypertensive Crisis
Hypertensive Crisis
Signup and view all the flashcards
Client Care Implications
Client Care Implications
Signup and view all the flashcards
Parkinson's Disease (PD)
Parkinson's Disease (PD)
Signup and view all the flashcards
Motor symptoms of PD
Motor symptoms of PD
Signup and view all the flashcards
Dopamine (DA)
Dopamine (DA)
Signup and view all the flashcards
Acetylcholine (ACh)
Acetylcholine (ACh)
Signup and view all the flashcards
Carbidopa
Carbidopa
Signup and view all the flashcards
COMT inhibitors
COMT inhibitors
Signup and view all the flashcards
Wearing-off effect
Wearing-off effect
Signup and view all the flashcards
On-off phenomenon
On-off phenomenon
Signup and view all the flashcards
MAO-B inhibitor
MAO-B inhibitor
Signup and view all the flashcards
Selegiline
Selegiline
Signup and view all the flashcards
Amantadine
Amantadine
Signup and view all the flashcards
Study Notes
Parkinson's Disease (PD) Overview
- Chronic, progressive, degenerative neurological disorder
- Affects control of body movements and other functions
- Characterized by motor symptoms including bradykinesia (hypokinesia), rigidity, tremor, postural instability, gait disturbances, mask-like face, and dystonias
- Other symptoms: sleep disturbances, depression, psychosis, dementia, loss of smell, apathy, and autonomic dysfunction (e.g., orthostatic hypotension, urinary urgency, constipation)
- Affects dopamine-producing neurons in the brain
- Symptoms caused by an imbalance of two neurotransmitters: dopamine (DA) and acetylcholine (ACh)
- Symptoms occur when ~70-80% of dopamine neurons in the substantia nigra (SN) of the basal ganglia are lost
- DA is inhibitory and ACh is excitatory; Imbalance leads to disturbed movement
Parkinson's Disease (PD) Treatment and Interventions
- Treatments and interventions focus on managing movement abnormalities and include medications, deep brain stimulation (DBS), exercise, and socialization programs
- Drug therapy mainly targets the DA pathway by:
- Replacing dopamine precursors (e.g., levodopa/carbidopa)
- Preventing dopamine metabolism (e.g., MAO-B inhibitors like selegiline, rasagiline)
- Using dopamine receptor agonists (e.g., pramipexole, ropinirole, rotigotine)
- Anticholinergic agents (e.g., benztropine, trihexyphenidyl, diphenhydramine) are also used to treat muscle tremors and rigidity
Levodopa Therapy
- Levodopa is a dopamine precursor that crosses the blood-brain barrier while dopamine cannot
- After transport to the dopaminergic terminal neurons it is converted to dopamine and then released
- Combination therapy with carbidopa or benserazide is common to prevent peripheral breakdown of levodopa, leading to lower doses, reduced nausea, and vomiting
- COMT inhibitors (e.g., entacapone, opicapone) further increase the amount of levodopa available to the brain
- Therapy usually maintains functional mobility for years, prolongs quality of life, and life expectancy
- Response may take several months to fully develop
- As PD progresses, levodopa becomes less effective in controlling symptoms, and alternative treatments like DBS may be considered
- "Wearing-off" effect and "on-off" phenomenon are common issues with levodopa therapy
Levodopa Therapy Adverse Effects
- Common adverse effects include nausea, vomiting, dyskinesias (involuntary movements), cardiovascular effects (hypotension, dysrhythmias), and psychosis (hallucinations, paranoid ideation)
Other Dopaminergic Therapies (Selegiline and Amantadine)
- Selegiline: Selectively inhibits MAO-B, preventing dopamine breakdown, useful in milder cases or for managing fluctuations
- Amantadine: Promotes dopamine release and blocks reuptake, effective as an adjunctive agent; useful in managing "on-off' fluctuations
- Selegiline doesn't have the "cheese effect" of other MAOIs.
Dopamine Receptor Agonists
- Direct-acting drugs such as bromocriptine (older), pramipexole, ropinirole, and rotigotine (transdermal patch) directly stimulate dopamine receptors. They are often the first-line treatment for younger patients with mild-to-moderate symptoms, used to reduce the "wearing-off" effect of levodopa, and tend to cause less dyskinesia but still can have serious side effects. These include hallucinations, postural hypotension, drowsiness, and impulse-control disorders (e.g., gambling, shopping, hypersexuality).
Client Care Implications
- Clients should inform the prescriber about all medications
- Patients taking dopaminergic agents may experience dizziness upon initiation; assistance with ambulation might to be required
- Patients on levodopa should avoid high-protein diets
- Combination of levodopa or levodopa-carbidopa with other drugs should be avoided or checked with a physician before using it
- Careful skin assessment during levodopa therapy may be needed to monitor for malignant melanoma activation.
Anticholinergic Therapy
- Anticholinergics block the effects of acetylcholine (ACh), which helps reduce tremor and rigidity in Parkinson's Disease. Although these drugs are helpful they are not used to alleviate issues like bradykinesia.
- Adverse effects can be similar to atropine, including drowsiness, confusion, disorientation, constipation, nausea, vomiting, urinary retention, blurred vision, dilated pupils, photophobia, dry mouth, dry skin, and fever
Additional Notes
- Deep brain stimulation (DBS) can be an alternative therapy for patients with drug-resistant PD.
- Non-pharmacological approaches to manage symptoms such as exercise, occupational therapy, and speech therapy can improve the overall quality of life.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Explore the key aspects of Parkinson's Disease, a chronic and progressive neurological disorder. This quiz covers symptoms, affected brain areas, and the imbalance of neurotransmitters. Additionally, it delves into treatment strategies aimed at managing movement abnormalities.
