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exam 3 pharm

ch 23

nonpharm for parkinson's (PD) exercise, nutrition, fiber and fluids to decrease constipation
patho of parkinson's ☺degeneration of dopaminergic neurons ☻dopamine controls ACh which is excitatory ♥when less dopamine is produced ACh exceeds inhibitory response of dopamine ♦ACh stimulates the release of GABA which is responsible for the movement disorders
anticholinergics ☺reduce rigidity and tremors of PD but have minimal effect on bradykinesia ♥benadryl is similar to anticholinergics and is used for older adults that can't tolerate dopamine agonists
NC anticholinergics ☺report hx of glaucoma, GI dysfunc, urinary retention, angina, myasthenia gravis (MG) ☻all anticholinergics are CI if pt has glaucoma ♥HR may increase on these meds ♦monitor VS, urine output, bowel sounds dry mouth-use gum or sugarless candy, use sunglasses, void before taking drug, have routine eye exams, ingest high fiber foods and increase fluids
carbidopa/levodopa (dopaminergics) ☺blood brain barrier admits levodopa but not dopamine, the enzyme dopa decarboxylase converts levodopa to dopamine ☻99% of levodopa is converted before it reaches the brain so large doses are needed ♥high doses s/e: n/v, dyskinesia, ortho HoTN, dysrhythmias, and psychosis ♣carbidopa inhibits the conversion of levodopa so more reaches the brain - smaller doses are required
carbidopa/levodopa (c/l) (dopaminergics) continued ☺s/e of combo: n/v, dystonic movement (involuntary), psychotic behavior, dysrhythmia, palpitations, ortho HoTN, ☻usually not used to treat pseudoparkinsonism
dopamine agonists ☺stimulate dopamine receptors
amantadine (symmetrel) ☺is an antiviral drug that works on the receptors, taken alone or with carbidopa/levodopa or an anticholinergic ☻amantadine initially improves symptoms but b/c of tolerance the improvement doesn't last ♥txs early onset PD, drug induced PD, influenza A ♦effective at treating ridgidity and braydkinesia but not for tremors
bromocriptine (parlodel) ☺acts directly on dopamine receptors in CNS, GI and CV systems ☻more effective than amantadine and anticholinergics but is not as effective as carbidopa/levodopa ♥given to pt that can not tolerate c/l ♦s/e: HoTN, lightheadedness, syncope
MAO-B inhibitors causes catabolism of dopamine
selegiline ☺inhibits MAO-B thus prolonging the action of levodopa ☻ordered for newly dx PD pt ♥use could delay c/l therapy for a year ♦large doses may inhibit metabolism of tyramine in GI tract, ingestion of foods high in tyramine produce HTN crisis ♣severe DI with this drug are TCAs, SSRIs ♠may cause SI
COMT inhibitors ☺catechol O-methyltraserase inactivates dopamine, when taken with levodopa it increases the amt of levodopa in the brain
tolcapone (tasmar) ☺affects liver cell function, closely monitor liver function ☻prolongs action of levodopa ♥may cause fatal hepatotoxicity
entacapone (comtan) ☺does not affect liver ☻combo or c/l, COMT, and entacapone (Stalevo) ♥provides greater dosing flexibility and individualization to the pt ♦lessens the wearing off effects of levodopa ♣levodopa should be decreased when taking this drug
C/L prototype chart (sinemet) ☺CI: narrow angle glaucoma, severe cardiac, renal or liver disease, suspicious skin lesions - activates malignant melanoma ☻caution: PUD, psych disorders, seizures, SI ♥uses: PD, tremors and rigidity
C/L prototype chart (sinemet) continued ♦s/e: n/v, dysphagia, fatigue, dizziness, HA, dry mouth, bitter taste, blurred vision, insomnia, dark urine ♣a/e: invol movements, palpitations, ortho HoTN, urine retention, priapism, psychosis, severe depression with SI, hallucinations, agranulocytosis, hemolytic anemia, thrombocytopenia, dysrhythmias, neuroleptic malignant syndrome
precautions for drugs used to treat PD ☺restlessness and confusion in elderly ☻C/L stimulates chemoreceptor trigger zone in medulla which stimulates the vomiting center ♥take them with food but food slows absorption rate ♦↑HR and HoTN when using C/L early in treatment ♣pts with emphysema can have dry, thick muscous secretions with large doses of anticholinergics
pramipexole (mirapex) and ropinirole (requip) ☺mirapex: dizziness, HoTN, hallucinations ☻requip: nausea, fatigue, somnolence ♥these drugs intensify the dyskinesia and hallucinations caused by levodopa ♦used to treat restless leg syndrom
major drug-drug CI for PD drugs MAOIs - cause HTN crisis
Alzheimer's Disease (AD) patho ☺degen of cholinergic neuron and deficiency of ACh ☻plaques from outside of neurons and in cerebral cortex ♥apolipoprotein E4 promotes formation of plaques ♦beta amyloid protein accumulates and contributes to neuronal injury ♣neurofibrillary tangles with twists inside neurons
acetylcholinesterase (AChE) inhibitors/cholinesterase inhibitors break down ACh
NC rivastigmine (exelon) ☺assess memory and judgement losses from family - declining interest in people or home, trouble with simple activities, wanders from home ☻observe for hyperactivity, hostility, wandering ♥note motor function ♦can family cope? ♣maintain consistency in care ♠assist with amb ☺watch for bradycardia and HoTN ☻teaching: purpose of drug therapy, clarify dosing schedule, safety, rise slowly, monitor liver function
rivastigmine (exelon) prototype chart ☺CI: liver and renal dx, urinary tract obstructions, ortho HoTN, bradycardia ☻caution: asthma, COPD, seizures, PUD ♥DI: ↑effect of theophylline, general anesthesia, cimetidine, NSAIDs ↑GI effects, tabacco ↑clearance of drug, TCAs ↓effect ♦uses: improves memory loss
rivastigmine (exelon) prototype chart continued ♣s/e: anorexia, n/v/d, constipation, abd pain, GI bleed, dizziness, depression, peripheral edema, dry mouth, dehydration, restless leg syndrome, nystagmus ♠a/e: seizures, bradycardia, ortho HoTN, cataracts, MI, HF, hepatotoxicity, SI, S-J syndrome
donepezil (aricept) ☺↑ACh by inhibiting AChE ☻used to tx mild to moderate AD
tracine (cognex) ☺treats mild to moderate AD, AChE inhib ☻has ↑incident of peripheral cholinergic w/e
Created by: nursingTSJC2013



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