Term
| The "off-on phenomenon" that some pats with Parkinson's Disease (PD) experience is best explained as the |
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Definition
| answer: variable response to levodopa, resultint in periods of good control and periods of poor control of PD symptoms |
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Term
| Which drug used for the management of the pt with Parkinson's disease is most likely to cause postural hypotension? |
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Definition
amantadine (Symmetrel)
Amantadine, carbidopa-levodopa, and ropinirole are most likely to cause postural hypotension |
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Term
| The beneficial role of NDDRA ropinirole (Requip) is that it |
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Definition
appears to delay the start of levodopa therapy
the longer that levodopa therapy can be delayed, the longer the benefit of the therapy will be experienced once it is eventually started |
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Term
| When providing teaching to a pt receiving an anticholinergic for the treatment of PD, the nurse will include which information? |
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Definition
| Do not take this medication at the same time as other meds. Administer at bedtime. Fluid intake should not be restricted as they cause dry mouth, and it may take several days to weeks for the beneficial effects to become evident. |
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Term
| Nursing Implications - Assessment |
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Definition
1. perform thorough assessment, nursing history, and medication history
2. include questions about pt's: CNS, GI and GU tracts, psychologic and emotional status |
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Term
| Nursing Implications Assessment 2 |
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Definition
Assess for signs and symptoms of PD: Masklike expression, speech problems, dysphagia, rigidity of arms,legs, neck
Assess for conditions that may be contraindications |
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Term
|
Definition
1. administer drugs as directed by manufacturer
2. provide pt education reguarding PD and the medication therapy
3. inform pt not to take other meds with PD drugs unless he/she checks w/dr. |
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Term
|
Definition
1. When starting dopaminergic drugs, assist pt with walking b/c of dizziness
2. administer w/food to decrease GI upset
3. fluids at least 3000 mL/day (unless contraindicated)
4. taking levodopa with MAOIs may result in hypertensive crisis |
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Term
|
Definition
|
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Term
|
Definition
1. improved sense of well-being and mental status
2. increased appetite
3. increased ability to perform ADLs, to concentrate and to think clearly
4. less intense parkinsonian manefestations, such as less tremor, shuffling gait, muscle rigidity, and involuntary movements |
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Term
| Parkenson's disease have elevated _________ levels and lowered ____________ levels. |
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Definition
acetycholine; dopamine
drug therapy aimed at increasing dopamine and/or antagonizing the effects of acetycholine |
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Term
| Classic symptoms of PD include: |
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Definition
| bradykinesia, postural instability, rigidity, and tremors (TRAP = Tremors, Rigidity, Akinesea, Postural instability) akinesia really manifesting as bradykinesia |
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Term
| Dopamine agonists and L-dopa are more effective in the reduction of |
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Definition
|
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Term
| anticholinergic drugs are more effective in the reduction of |
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Definition
|
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Term
| in L-dopa/carbidopa drug, the carbidopa prevents the breakdown of |
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Definition
| levodopa in the periphery. There are side effects from peripheral breakdown of dopamine. |
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Term
| The wearing-off phenomenon occurs when |
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Definition
| anti-Parkinson's disease medications beging to lose their effectiveness, despite maximal dosing, as the disease progresses |
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Term
| Anticholinergic drugs can cause |
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Definition
| dry mouth or decreased salivation, urinary retention, decreased GI motility (constipation), dilated pupils (mydriasis) and smooth muscle relaxation |
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Term
Indirect-acting Dopamine Receptor Agonists (MAO-B inhibitors) MOA
selegiline and rasagiline |
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Definition
| causes an increase in the levels of dopaminergic stimulation in the CNS to counter the dopaminergic deficiency seen in PD |
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Term
Adverse Effects of MOA-B inhibitors
selegiline |
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Definition
| dizziness; insomnia; hallucinations; ataxia; agitiation; depression; paresthesia; somnolence; headache; dyskinesia; nausea; diarrhea; hypotension or hypertension; chest pain; wight loss, dermatologic reactions, rhinitis, pharyngitis |
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Term
Adverse effects of dopamine modulator
amantadine |
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Definition
| dizziness; insomina; agitiation anxiety; headache; hallucinations; nausea; orthostatic hypotension; peripheral edema; dry mouth; |
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Term
Adverse effects of COMT inhibitors
entacapone, tolcapone |
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Definition
| GI upset; dyskinesia; urine discoloration; orthostatic hypotension; syncope; dizziness; fatigue; hallucinations; anxieity; somnolence; rash; dyspnea; worsening of dyskinesia; in tolcapone - liver failure |
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Term
adverse effects of anticholinergic agents
benztropine |
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Definition
| Tachycardia; confusion; memory impairment; rash; hyperthermia; constipation; dry throat, nose or mouth; nausea; vomiting; urinary retention; blurred vision; fever |
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Term
Dopamine Modulator moa
amantadine |
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Definition
| causing release of dopamine and other catecholamines from their storage sites or vesicles in the presynaptic fibers of nerve cells withing the basal ganglia not destroyed yet by PD results in higher levels of dopamine |
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Term
| Catechol Orhto-Methyltransferase Inhibitors (COMT inhibitors) moa entacapone |
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Definition
| works presynaptically. Block COMT |
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Term
Nondopamine dopamine receptors agonists moa
ropinirole and bromocriptine |
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Definition
| inhibits the production of the hormone prolactin which stimulates normal lactation |
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Term
|
Definition
1. NDDRA
2. nonergot drugs also used to treat restless leg syndrome and late stage PD |
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Term
Dopamine replacement drugs - moas
carbidopa-levodopa |
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Definition
| stimulate the presynaptic dopamine receptors to increase brain levels of dopamine |
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Term
|
Definition
1. available orally
2. dopamine replacement
3. drug can be split one time but not crushed
4. interacts w/B6 and dietary protein |
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Term
| Lifespan considerations when taking carbidopa-levodopa |
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Definition
cabidopa levidopa must be used cautionsuly in elderly esp those w/history of cardiac renal, hepatic, endocrine, pulmonary, ulcer or psychiatric disease
2. elderly taking c-l are at an increased risk for experiencing confusion, loss of appetite and orthostatic hypotension
3. start at a low dose b/c of the increased sensitivity in older pts
4. overheating a problem when taking anticholinergics
5. effectiveness decreases over time |
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Term
| Two major kinds of PD drugs |
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Definition
| 1. anticholinergic and dopamine drugs |
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Term
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Definition
| first then switch to something else when it no longer works. It goes past the blood-brain barrier and convers to dopamine |
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Term
|
Definition
1. anticholinergic drug
2. used for PD and for extrapyramidal symptoms from antipsychotic drugs
3. use w/caution in hot weather- may cause hyperthermia
4. when used w/ amantadine, phenothiazine or tricyclic antidepressants associated w/ high incidence of anticholinergic effects
5. avoid alcohol |
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Term
| Which antiparkinson drug causes an increase in levels of dopaminergic stimulation in the CNS and therefore allows a decreased dose of other meds? |
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Definition
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Term
| A pt who has been taking ant-PD meds for years begins ot have increased symptoms on a constant basis. In documenting these symptoms, the nurse will use what term? |
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Definition
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Term
| when teaching pt about carbido-levodopa what information will nurse include? |
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Definition
| Carbidopa decreases levodopa's conversion in the periphery and increases the levodopa available to cross th blood-brain barrier |
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Term
| What is the goal of phramacologic therapy in treating PD? |
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Definition
| to balance cholinergic and dopaminergic activity in the brain |
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Term
| The nurse is providing care for a pt who has been diagnosed w/Parkinson's disease. Pt is in early stages of liver failure. Should not use |
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Definition
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Term
| Pt. w/PD responds positively to carbidopa-levodopa, but suddenly develops a relapse of symptoms. Which explanation is appropriate? |
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Definition
| This is called on-off phenomenom , your health care provider can change your med regime slightly to diminish effect |
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Term
| Pt complains of dark brown urine while taking entacapone |
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Definition
| this is normal occurrance related to entacapone |
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Term
| Pt w/PD has insomnia. Wants to take an old prescription of benzodiazepine while taking levodopa |
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Definition
| Use of benzodiazepine decreases the therapeutic effect of levodopa and may increase symptoms of PD |
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Term
| Pt asks nurse to explain dif btw carbidopa-levodopa and ropinirole |
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Definition
| Ropinirole is dopamine agonist that has fewer side effects than carbidopa-levodopa |
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