Transcript Antiparkinson agents Broyles: chapter 31

Antiparkinson agents
Broyles: chapter 31
Terms
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Parkinson’s symptoms:
Mask like face, fine tremors,
Intention tremor, slurred speech,
shuffling gait, mask like face
Medications
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Use: treatment of parkinsion’s disease..
Relieve the symptoms and increase the
movement
Parkinsons disease=has decreased
dopamine and increased acetylcholine
Action= levodopa crosses the blood brain
barrier and is converted into dopamine to
replace body dopamine
Dopaminergic
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Medication: levodopa
Adverse: nausea, vomiting, orthostatic
hypotednsion dystonic movements,
anorexia, dysphagia, chorieform
movements,
On off effect= long term use of the drug
may have an irregulr response to the
drug…..
Reduce the maintanence dose and
substitute another anti parkinson’s drug
Dopaminergic
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Food high in b 6 reverse effect of
dopamine ( increases the
breakdown)=fish, chicken, organ
meat, oats, potatoes, egg yolk
Take multivitamins without
b6=larobec
No alcohol
Carbidopa/levodopa
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Sinemet (mg of carbidopa/mg of
levadopa)
Used in combination, less levodopa
can be used
Prevents breakdown in peripheral
circulation, more levodopa for entry
into brain (pg 699)
Carbidopa (lodosyn) is available
without levodopa
Dopaminergic agents
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Meds: symmetrel/amantadine
Action-medication given with levodopa
causes more dopamine to reach the brain
Adverse: depression, orthostatic
hypotension, insomnia
Parlodel/bromocriptine= stimulates
dopamine receptors in brain
Adverse: drowsiness, sedation, epigastric
distress
Eldepyl/seligiline
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With levodopa=allows less to be used to
achieve similar effects to larger doses of
levodopa
Adverse: hallucinations, confusion, loss of
balance,
Dyskinesia
Risk of hypertension when given in doses
over 10 mg and tyramine foods as beer,
wine,
Aged cheese…..
Comt inhibitors
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Action: prolong effect of levodopa by blocking
enzyme
That eliminates levodopa
(Catecho-0-methytransferease)
Not given with monoamine oxidase inhibitors
Meds: tasmar/tolcapone
Adverse: orthostatic hypotension, insomnia,
dystonia, anorexia,confusion, disorientation liver
damage/liver failure
Apomorphine/apokyn
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Dopaminergic agonist
Can be used for undermedicated
state
Used by injection and subcut med
lasts 45-60 min
Gives rapid results (4-8 min)
Non-ergot dopamine receptor agonist
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Action: not known
Med: mirapex/pramipexole
Adverse: nausea, vomiting, postural
hypotension, hallucinations syncope,
dyspepsia
Requip/ropinorole hcl
Adverse: syncope, constipation, dry
mouth, urinary frequency
Do not use with monoamine oxidase
inhibitors
Anticholinergic
Action: inhibits acetycholine
Meds: cogentin artane benedryl
Side effect: (antichloinergic effects)
dry mouth, palpitations, urinary
retention, constipation, blurred
vision
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Anticholinergic
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Cogentin/artane..
Do not use with peptic ulcer,
myesthenia gravis, prostatic
hypertrophy
Nsg
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Use sips of water or hard candy for dry
mouth
Liver function q 2 weeks for 1 year and if
exceeds normal limit or liver failure
develops stop the medication… esp
tasmar/comtan
Do not rush pt.
Effectiveness of drug is based on pts
ability to speak, ambulate, provide self
care.