Podcast
Questions and Answers
What is the primary goal of pharmacotherapy in Parkinson's disease?
What is the primary goal of pharmacotherapy in Parkinson's disease?
Which of the following medications is a dopamine agonist?
Which of the following medications is a dopamine agonist?
What is a key nursing consideration when administering Levodopa?
What is a key nursing consideration when administering Levodopa?
What is a significant adverse effect associated with Benztropine?
What is a significant adverse effect associated with Benztropine?
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Which of the following side effects is common with cholinesterase inhibitors?
Which of the following side effects is common with cholinesterase inhibitors?
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What type of drug is Donepezil considered?
What type of drug is Donepezil considered?
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Which condition is listed as a contraindication for Benztropine use?
Which condition is listed as a contraindication for Benztropine use?
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What is the expected outcome of using cholinesterase inhibitors in Alzheimer's disease treatment?
What is the expected outcome of using cholinesterase inhibitors in Alzheimer's disease treatment?
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What serious side effect is associated with Donepezil?
What serious side effect is associated with Donepezil?
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What is a distinguishing feature of Multiple Sclerosis symptoms?
What is a distinguishing feature of Multiple Sclerosis symptoms?
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Which medication is indicated for treating muscle spasticity?
Which medication is indicated for treating muscle spasticity?
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What is one of the most common adverse effects of Dantrolene?
What is one of the most common adverse effects of Dantrolene?
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Which of the following herbal remedies is used topically for treating muscle spasms?
Which of the following herbal remedies is used topically for treating muscle spasms?
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Study Notes
Degenerative CNS Diseases (Neurodegenerative Diseases)
- Progressive, irreversible loss of neurons
- Affects all age groups
- Pharmacotherapy treats symptoms, no cure
- Depression is common
Parkinson's Disease Pharmacotherapy
- Goal: Balance dopamine and acetylcholine levels
- Treatment may take 2-3 weeks to show effect
Dopamine Agonists
- Increase dopamine availability by: directly replacing, decreasing breakdown, increasing release, or activating dopamine receptors.
Anticholinergic Drugs
- Block acetylcholine's excitatory action in the striatum, reducing abnormal muscle movements.
Levodopa Considerations
- Take on an empty stomach
- Avoid multivitamins/B6 and high-protein diets
- Watch for dizziness/ambulation safety, assist with 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 (PD) symptoms
- Monitor for orthostatic hypotension
- Monitor for tardive dyskinesia
- Assess mental status
- Inform patient and family that PD treatment is not a cure, but can help manage symptoms
Benztropine Adverse Effects
- Adverse effects: sedation, constipation, blurred vision, dry mouth, decreased sweating, urinary retention, confusion
- Serious adverse effects: paralytic ileus
Benztropine Contraindications/Precautions
- Closed-angle glaucoma
- Myasthenia gravis
- Tardive dyskinesia
- GI/urinary obstructions
- Prostatic hypertrophy
- Peptic ulcers
- Tachycardia
- Alcohol (caution)
Benztropine Drug Interactions
- Additive toxicity: antihistamines, tricyclic antidepressants, phenothiazines, MAOIs, quinidine
- Additive sedative effect: alcohol, CNS depressants
- Slow GI motility/decreased absorption: antidiarrheals
Benztropine Pregnancy Category & Overdose Treatment
- Pregnancy category C
- Overdose treatment: Physostigmine (1-2 mg subcutaneously or IV) to reverse anticholinergic intoxication
Alzheimer's Disease Pharmacotherapy
- Treatment produces modest results, ineffective at stopping disease progression
Cholinesterase Inhibitors
- Tacrine (Cognex)
- Cholinesterase breaks down acetylcholine, thus the drugs prevent the breakdown to increase ACh
- Goal: improve ADLs, behavior, and cognition
- All drugs in this class have equal efficacy
- Most common adverse effects are GI (nausea, vomiting, diarrhea)
- Liver issues are also possible
- Nursing considerations include: cognition, safety, independence, symptoms, baseline labs, vital signs, vision, weight, liver/kidney function
Cholinesterase Inhibitors (Reversible)
- Raise acetylcholine (ACh) concentrations in the brain
- Fewer side effects compared to tacrine (Cognex)
- Primary side effect are GI issues
- Serious side effects: atrial fibrillation, sinus bradycardia, seizures
Donepezil Adverse Effects
- Adverse effects: N/V/D, 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, hepatotoxicity (monitor liver enzymes)
Donepezil Treatment and Considerations
- Overdose treatment: Anticholinergic drugs to reverse cholinergic crisis
- Considerations: cognitive function/safety, baseline labs (especially liver/kidney), symptoms (depression, agitation, anxiety, aggression, confusion), monitor for irregular heartbeats or chest discomfort, living arrangements, support groups (patient & family), avoid alcohol
Multiple Sclerosis (MS)
- Unknown cause, characterized by demyelination (secondary to inflammatory response)
- Considered an autoimmune disease
- Leading cause of neurologic disability in 20-40 age group
- Symptoms: balance difficulty, muscle weakness; symptom exacerbation & remission patterns
Muscle Spasms Treatment
- NSAIDs and skeletal muscle relaxants
Cyclobenzaprine Considerations
- History & physical (including vital signs)
- Baseline neurologic status
- Assess for pain
- Protect from falls (drowsiness)
- Assess for skin reactions (urticaria, rash, pruritis)
- Inform patient not to drive
Cyclobenzaprine Similar Drugs
- Methocarbamol (Relaxin, Robaxin): adjunct to physical therapy interventions
- Metaxalone (Skelaxin): ineffective for spasticity-related neurological disorders
- Orphenadrine (Banflex, Myophen, Norflex): anticholinergic drug (related to diphenhydramine)
- Tizanidine (Zanaflex): for spasticity related to brain/spinal cord injuries or MS
Muscle Spasticity
- Continuous state of contraction
- Pain more intense than spasms, causing greater impairment
- Irritable deep tendon reflexes, scissoring movements of lower extremities, fixed joint movement
- Not a disorder, but a symptom of neuromuscular diseases
Dantrolene Considerations
- History & physical (baseline neurological/pain status)
- Monitor vital signs (especially during IV administration)
- Assess for cardiopulmonary changes (monitor breath/heart sounds)
- Watch liver function tests (report jaundice)
- Avoid alcohol
- Teach patient not to drive
Nonpharmacologic Therapies
- Physical therapy (increases movement, prevents contractures)
- Herbal remedies (black cohosh, castor oil packs, capsaicin - wear gloves)
- B complex vitamins (specifically B6)
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Description
This quiz covers the pharmacological treatment of Parkinson's Disease, focusing on dopamine agonists and anticholinergic drugs. It highlights important considerations for levodopa and pramipexole, including their effects and monitoring requirements. Test your knowledge on how to manage symptoms of this neurodegenerative disease effectively.
