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Stack #152430
pharm ch 14, kilgore lvl1
| Question | Answer |
|---|---|
| parkinson's Disease (PD) | -chronic, progressive, degenerative disorder -no cures, only slowing progression |
| effects of PD | -dopamine-producing neurons in brain reduced -imbalance of dopamine & ACh in brain |
| onset of PD | -symptoms appearing when 80% of dopamine in substantia nigra of basal ganglia is depleted -progressive condition |
| symptoms of PD | -bradykinesia -rigidity -tremors -postural instability -worsens when too little dopamine is present -diskinesia occurs when dopamine is in excess |
| dyskinesia | difficultiy in performing voluntary movements -chorea: irregular, spasmodic, involuntary movements of limbs of face muscles -dystonia: abnormal muscle tone leading to imparied or abnormal movements |
| Levodopa | -precurser of dopamine -able to cross blood-brain barrier (dopamine cannot) -taken up by dopaminergic terminal & converted to dopamine to be released as needed |
| Levodopa therapy | -if started early in disease progress, positive results will last longer -typically will work successfully for 5-10 years b4 levodopa no longer controls PD |
| Drug therapy for PD | -aimed at increasing dopamine levels while there are functioning nerve terminals -antagonizes or blocks effects of ACh -slows progression of the disease |
| Anticholinergic drugs | benztrpine, biperiden, others |
| Anithistamines | diphenhydramine, others |
| Dopamine-receptor agonists (direct acting) | Levodopa, levodopa-caridopa, others |
| Indirect-acting dopamine-receptor agonists | -MAO-B inhibitor (selegiline) -COMT inhibitor (entacapone, tolcapone) -misc (amantadine) |
| selegiline (Eldepryl) | -used adjunctly w/ levodopa/levodopa-carbidopa to stablize client's response to levodopa potent, irreversible MAOI, inhibits MAO-B No Cheese-effect when under 10mg/day |
| Cheese effect | reaction to tyramine in foods while on MAOIs causes hyper/hypotention |
| selective monoamine oxidase inhibitor (MAOI)therapy | -breakdown catecholamines in CNS, primarily brain, thereby causing an increase in levels of dopaminergic stimulation in CNS -used in combination w/ levodopa or levodopa-carbidopa (adjunctive as well) -delays developement of levodopa therapy unresponsive |
| AEs of selegiline | usually mild -dosage higher than 10mg/day may cause hypertensive crisis |
| Dopaminergic therapy | used to provide exogenous replacement of lost dopamine or to enhance the function of the remaining neurons that still produce dopamine |
| Replacement dopaminergic therapy | -function presynaptically to increase brain levels of dopamine -large doses of levodopa needed to get to brain cause AEs -carbidopa reduces effective dosage of levodopa by inhibiting/preventing premature metabolism prior to crossing blood-brain barrier |
| direct acting/replacement dopaminergic therapy | (amantadine/Symmetrel) increases dopamine levels in brain by causing its release from the storage sites in intact nerve cells -typically only effective for 6-12 months, but may work again after drug holiday -blocks reuptake of dopamine, does not stimul |
| indirect acting dopaminergic therapy | COMT inhibitors (tolcapone/Tasmar, entacapone/Comtan) -inhibits COMT, enzyme that metabolizes levodopa |
| bromocriptine (Parlodel) | another direct acting med -stimulates dopamine receptors -activates dopamine receptors and stimulates production of dopamine |
| Ropinirole (Requip) red arrow | nonergot dopamine agonist used for PD and restless leg syndrome |
| AEs to dopaminergic therapy | Tolcapone = liver failure others- vary by drug |
| Anticholinergic Therapy (parasympathetic effects) | Blocks the effects of ACh -effects less tremors & rigidity -does not relieve bradykinesia -ACh accumulates in brain b/c of lack of dopamine |
| Benztopine mexylate (Cogentin) | anticholinergic drug used for PD |
| AEs for anticholinergic therapy | -SLUDD-type symptoms (parasympathetic) give candy/gum to aid salivation |
| teaching considerations for antiPD meds | -inform client not to take other meds w/ PD drugs w/o checking w/ Dr. -inform client not to discontinue antiPD drugs suddenly |
| Drug holidays | cessation of specific drug for specific length of time to restore level of efficacy (hopefully) |
| benztropine mesylate (cogentin) | -anticholinergic (and antihistaminic-like) -very useful in phenothiazine-induced extrapyramidal reactions (EPS-like) |
Created by:
gfcfnina
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