Antiparkinson agents

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Antiparkinson agents

• Broyles chapter 31

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Terms

• Parkinsons symptoms
• Mask like face, fine tremors,
• Intention tremor, slurred speech, shuffling gait,
  mask like face

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Medications

• Use treatment of parkinsions disease.. Relieve
  the symptoms and increase the movement
• Parkinsons diseasehas decreased dopamine and
  increased acetylcholine
• Action levodopa crosses the blood brain barrier
  and is converted into dopamine to replace body
  dopamine

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Dopaminergic

• 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 parkinsons drug

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Dopaminergic

• Food high in b 6 reverse effect of dopamine (
  increases the breakdown)fish, chicken, organ
  meat, oats, potatoes, egg yolk
• Take multivitamins without b6larobec
• No alcohol

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Carbidopa/levodopa

• 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

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Dopaminergic agents

• 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

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Eldepyl/seligiline

• With levodopaallows 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..

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Comt inhibitors

• 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

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Apomorphine/apokyn

• Dopaminergic agonist
• Can be used for undermedicated state
• Used by injection and subcut med lasts 45-60 min
• Gives rapid results (4-8 min)

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Non-ergot dopamine receptor agonist

• 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

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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

• Cogentin/artane..
• Do not use with peptic ulcer, myesthenia gravis,
  prostatic hypertrophy

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Nsg

• 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.