Shared Flashcard Set

Details

Antiparkinsonism Drugs
Roach Ch 29
88
Pharmacology
Undergraduate 1
11/06/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
Parkinsonism causes and S/Ss
Definition
 
  • Parkinsonism includes tremors, rigidity, slow movement (bradykinesia), slurred speech, maskface, difficulty chewing/swallowing; unsteady gait with upper body bent forward
  • Other conditions beside Parkinson’s disease can cause, though PD most common
  • Drug adverse reactions can cuase parkinsonism reactions = extrapyramidal symptoms
Term

levodopa

levodopa with carbidopa

 amantadine

 bromocriptine

 

rasaglinine 

selegiline

Definition

dopaminergic drugs (increase dopamine in CNS)

 

rasaglinine and selegiline are MAOI dopaminergics (dopamine agonists)

Term
Actions of dopaminergic drugs
Definition

 

a.        Increase dopamine (Parkinson's decrease in dopamine)

b.       Only crosses B-B Barrier in small amounts

c.        Carbidopa is only used with levodopa to increase levodopa absorption (no affect on own carbidopa)

d.       levodopa is converted into dopamine

e.        others work various mechanisms

Term
Treatment and route ofr restless leg syndrome
Definition

dopamine receptor agonists (other)

taken transdermally, not oral

Term
Uses of dopiminergic drugs
Definition

 

a.        parkinson's

b.       Extrapyramidal symptoms (parkinson's like)

c.        Restless leg syndrome

d.       viral infections

Term
Adverse reactions to levodopa (and any levodpa combinations)
Definition
  • levodapa/carbidopa effect decreases over time
  • dry mouth, difficulty swallowing
  • ab pain constipation
  • increased hand tremor
  • headache and dizziness
  • Most serious with levodapa are CHOREIFORM MOVEMENTS
  • Less common are mental changes like dementia, depression, psychotic episodes, paranoia, suicidal tendencies
 

 

Term
CHOREIFORM MOVEMENTS
Definition
  •   invol twitching of limbs or facial muscles, dystonic movements (spasms of tongue, jaw, eyes, neck usually)
  • can be caused by levodopa/carbidopa admin
  • If occurs, withhold and notify immediately
Term
Contraindications levodopa (and any levodopa combinations)
Definition

 

                                                               i.      narrow-angle glaucoma

                                                              ii.      MAOIs

                                                            iii.      can activate malignant melanoma

Term
contraindications of MAOI dopamine agoists
Definition

 

                                                               i.      opioid meperidine (Demerol) bc of antimetabolite conversion

Term
Precautions levodopa (or any levodopa combination)
Definition
  • CV or pulm disease
  • peptic ulcers
  • renal or hepatic disease
  • psychosis
  •  pregnancy and lactation (cat C)
Term
Precautions MAOI dopamine agonists
Definition
Any opioid
Term

1.        benztropine

2.        biperiden

3.        diphenhydramine

4.        procyclidine

5.        trihexyphenidyl

Definition
  • cholinergic blocking (anticholinergic) drugs for treatment of parkinsonism 
  • are used for other conditions as well
Term
Actions/uses of anticholinergics for tx of parkinsonism
Definition
    1. ACh is increased in Parkinson's, so drugs are used to block this to enhance dopamine transmission
    2. less effective than levodopa
    3. dosage limited by adverse reactions - diphenhydramine has least effects, best for elderly
    1. adjunct to all forms of parkinsonism
    2. control drug induced extrapyramidal effects
Term
Adverse reactions to anticholinergics
Definition
    1. dry mouth
    2. blurred vision
    3. dizziness
    4. mild nausea
    5. nervousness
    6. rash, urticaria
    7. urinary retention, dysuria
    8. tachycardia
    9. muscle weakness
    10. disorientation, confusion
    11. >60 often have sensitivity to anticholinergics, require close monitor, esp. confusion and disorientation; may need lower doses
Term
Contraindications of anticholinergics
Definition
    1. angle-closure glaucoma
    2. pyloric or duodenal obstruction
    3. peptic ulcers
    4. prostate hypertrophy
    5. achalasia (difficulty swallowing from lower esoph. muscles not relaxing)
    6. myesthenia gravis
    7. megacolon
Term
Precautions of anticholinergics
Definition
    1. tachydardia
    2. cardiac arrhythmias
    3. hyper/hypo tension
    4. tendency towards urinary retention
    5. decreased liver or kidney function
    6. obstructive disease of GI tract
    7. older adults

Remember that anticholinergics are drying, which can reduce blood volume.  This can increase heart rate to compensate.  Therefore, caution with existing tachycardia, arrythmias, BP issues, inability to pee, kidneys/liver preexisting problem and need blood flow, GI stasis

AND OLDER ADULTS MORE SENSATIVE TO ALL

Term

1.        entacapone

2.        tolcapone

Definition
COMT Inhibitors
Term
Action and Uses of COMT inhibitors
Definition
    1. prolong effect of levodopa by bloching the enzyme COMT (normally eliminates dopamine)
    2. increase plasma concentration and duration of action levodopa
Term
Uses of COMT inhibitors
Definition
    1. adjunct to levodopa/carbidopa for Parkinson's
    2. Tolcapone reserves for those not responding to other treatments bc very hepatotoxic
    3. Entacapone less stong than tolcapone
Term
Adverse reactions to COMT inhibitors
Definition
    1. dizziness
    2. dyskinesias, hyperkinesias
    3. nausea, anorexia, diarrhea
    4. orth hypo
    5. sleep disoreders, excessive dreaming, somnolence
    6. muscle cramps
    7. liver failure and death with tolcapone
Term
Contraindications of COMT inhibitors
Definition
    1. pregnancy and lactation (cat C)
    2. Tolcapone contra in those with liver dysfunction
Term
Precautions of COMT inhibitors
Definition
    1. hyper/hypo tension
    2. decreased renal and hepatic function (except tolcapone contraindication liver dysfunction)
Term

1.        apomorphine

2.        pramipexole

3.        ropinirole

Definition
  • Non-ergot dopamine receptor agonists
  • Not derived from ergot, which is a fungus
  • Early dopamine agonists were ergot-derived (are not included in book)

 

 

Term
Actions of the non-ergot dopamine receptor agonists
Definition
    1. not understood
    2. thought to act on postsynaptic dopamine receptors in brain, mimicking effect of dopamine
Term
Uses of the non-ergot dopamine receptor agonists
Definition
    1. Parkinson's
    2. apomorphine is used for "on-off" phenomenon and must be given with an antiemetic
Term
Adverse reactions of the non-ergot dopamine receptor agonists
Definition
  • pramipexole and ropinirole (apomorphine not included)
  • N/V, dizziness
  • Insomnia
  • somnolence, hallucinations, confusion, visual disturbances
  • postural hypotension
  • abnormal involuntary movements
  •  headache
  • dyspepsia


Term
Contraindications of the non-ergot dopamine receptor agonists
Definition
    1. safety not established for pregnancy (cat C)
Term
Precautions of the non-ergot dopamine receptor agonists
Definition
    1. dyskinesia
    2. ortho hypo
    3. hepatic or renal impairment
    4. CV disease
    5. hx hallucinations or psychosis
Term
Preassessment for admin of antiparkinsonism drug
Definition

a.        Hx may be hard to obtain from Parkinson pt bc of mental changes; may question family member, etc

b.       Assess symptoms, how long sxs, ADL ability, mental condition (memory, depression, withdrawal, etc.)

c.        Physical assessment for baseline

d.       Eval neuromuscular status, e.g. tremors, mask-face, gait, speech, etc

Term
Ongoing assessment of antiparkinsonism drug
Definition

a.        Observe neuromuscular status to evaluate response t odrug

b.       Improvement may be slow

Term
antiparkinsonism drugs and dosage titration
Definition

a.        Optimal response requires adjustments/titration, explain this to pt and family; Report all adverse reactions to help with dosage adjustments

Term
Mental changes and antiparkinsonism drug given for extrapyramidal adverse reactions of other drugs
Definition

a.        When given to manages adverse reactions to other drugs, antiparkinsonism drugs may worsen mental sxs leading to psychotic event – observe pt’s behavior frequently – if sudden behavioral change, withhold and immediately notify PCP

Term
tolcapone toxicity
Definition
  •   NURSING ALERT – tolcapone (Tasmar) can cause fatal hepatotoxicity.
  • Usually prescribed regular hepatic fnx tests including serum aminotransferase q 2 weeks for first year, and q 8 weeks afterwards. 
  • Tx DC if aminotransferase is high OR S/S of hepatic failure:
  • observe for persistent nausea, fatigue/lethargy, anorexia, jaundice, dark urine, pruritus and RUQ tenderness.
Term
Carbidopa/levodopa and choreiform movements
Definition

a.        for carbidopa/levodopa admin, watch for CHOREIFORM and dystonic movements such as facial grimacing, protruding tongue, exaggerated chewing, jerking of extremities.  If these occur, withhold dose and immediately notify PCP bc drug may need reduction of DC.

Term
On-off phenomenon
Definition

 

  • ON-OFF PHENOMENON can occur with LEVODOPA.  
  • Sudden change from improvement to loss of tx effect.
  •  Associated with long term levodopa use. 
  • Sometimes, PCP orders a “drug holiday,” where pt is completely w/drawn from levodopa for 5-14 days and gradually restarted at lower dose
  • Must monitor for COMPLICATIONS OF LEVODOPA WITHDRAWAL, which can be severe

 

Term
COMPLICATIONS OF LEVODOPA WITHDRAWAL
Definition

a.        AbruptDC of antiparkinsonism drugs is bad.  Can cause a “neuroleptic malignant-like syndrome,” including (watch for) muscle rigidity, high temp, mental changes.

Term

Re: antiparkinsonism drug admin:

“Imbalanced Nutrition: Less Than Body Requirements rt nausea, dry mouth"

Definition

a.        Help with dry mouth by suggesting sipping water, ice, hard candy if allowed. 

b.       If very severe dry mouth w/ difficulty swallowing or speaking, or if loss of appetite, dosage may need reduction (so report to PCP)

c.        Some have N/V and/or constipation which can affect nutrition.  So, small frequent meals, caml environment, and serve preferred food to help eat.  Also weigh daily.  Sometimes helped by giving med with food.

d.       Severe N/V may require DC or changing drug, although nausea usually decreases or resolves over time

Term

Re: antiparkinsonism drug admin:

 “Risk for Injury rt dizziness, lightheadedness, orthostatic hypotension, loss of balance”

Definition

a.        Parkinson’s alone caused problems with ambulation; with drugs can exacerbate:

b.       Antipark. drugs may cause blurry vision and diplopia (double vision)

c.        Report evidence of visual disturbance to PCP (pt may not verbalize problem)

d.       Also watch for sudden behavioral changes and report – hallucinations, depression, psychotic episodes

e.        Hallucinations more common with elderly taking antipark. drugs, esp. dopamine receptor agonists.  Assess older adults for hallucinations

f.         Adverse reactions of dizziness, muscle weakness and ataxia can worsen ambulation difficulty

g.       Parkinson pts prone to falls, good to help ambulate and encourage assistive devices like cane or walker, gripping shoes, good lighting, no throw rugs – carefully assess environment for obstacles, etc.

h.       Ortho hyp may result from drug tx – instruct accordingly (rise slowly, etc)

Term
Education re: antiparkinsonism drug admin
Definition

a.        evaluate pt’s understanding regimen, self-care ability, ability to comply.  If needs assistance, refer to social worker.

b.       Home environment should be set up to reduce likelihood of falling, e.g no throw rugs, hand rails,etc.

c.        For GI upset, take with food.

d.       Avoid hazardous tasks w/ dizziness, drowsiness, vision problems, etc

e.        Avoid alcohol unless approved

f.         If dry mouth interferes with dentures, consult dentist

g.       Ortho hypo teaching

h.       Dry mouth teaching

i.         When to notify PCP

                                                               i.      severe dry mouth

                                                              ii.      inability to chew or swallow

                                                            iii.      can’t urinate

                                                            iv.      depression, mood alterations

                                                             v.      severe dizziness

                                                            vi.      rapid or irregular heartbeat

                                                          vii.      ab pain

                                                         viii.      unusual movements

                                                             ix.      For levodopa, avoid B6 (pyridoxine) bc can interfere with action

                                                              x.      For diabetics taking levodopa, levodopa can cause inaccurate glucose and ketone testing, first report abnormal result to PCP (don’t alter doses of antidiabetic)

j.         For talcapone, especially important to keep appointments to test liver frequently; report any signs of liver failure, including persistent nausea, fatigue/lethargy, anorexia, jaundice, dark urine, pruritus and RUQ tenderness.

Term
Levodopa and diabetes testing
Definition
For diabetics taking levodopa, levodopa can cause inaccurate glucose and ketone testing, first report abnormal result to PCP (don’t alter doses of antidiabetic)
Term
What drugs are included in the one combo antiparkinsonism drug listed?  And what is it's trade name?
Definition
levodopa + carbidopa + entacapine = Stalevo
Term
Cautious use of Stalevo
Definition

COMT inhibitor portion is entacapone, precautions are:

  1. tachydardia
  2. cardiac arrhythmias
  3. hyper/hypo tension
  4. tendency towards urinary retention
  5. decreased liver or kidney function
  6. obstructive disease of GI tract
  7. older adults
dopaminergic portion is levodopa, precautions are
  1. cv disease
  2. pulmonary disease
  3. peptic ulcer
  4. renal or hepatic disease
  5. psychosis
  6. pregnancy and lactation (cat C)
Term
Action and use of carbidopa
Definition

Carbidopa has no effect alone

It is given with levodopa to increase amount of levodopa that reaches the brain

Levodopa alone doesn't cross BB barrier easily, and stays in periphery with adverse reactions

Carbidopa helps levodopa get to brain, therefore reducing dose of levodopa

Term
Source of levodopa and action in the body?
Definition

plant and animal derived

converted into dopamine in body

only small amount cross BB barrier (carbidopa increases this)

Term

ACHALASIA

With drug is contraindicated with this condition?

Definition
  • difficulty swallowing from lower esoph. muscles not relaxing
  • anticholinergics are contraindicated in those with achalasia
Term
DYSTONIA
Definition
  •  for carbidopa/levodopa admin, watch for CHOREIFORM and dystonic movements such as facial grimacing, protruding tongue, exaggerated chewing, jerking of extremities.  If these occur, withhold dose and immediately notify PCP bc drug may need reduction of DC.
  • ABNORMAL MOVEMENTS
Term
DRUG HOLIDAY
Definition

a.        Sometimes, PCP orders a “drug holiday,” where pt is completely w/drawn from levodopa for 5-14 days and gradually restarted at lower dose – MUST MONITOR FOR COMPLICATIONS:

b.       NURSING ALERT – AbruptDC of antiparkinsonism drugs is bad.  Can cause a “neuroleptic malignant-like syndrome,” including (watch for) muscle rigidity, high temp, mental changes.

Term
What to watch for if levodopa discontinued?
Definition
Abrupt DC of antiparkinsonism drugs is bad.  Can cause a “neuroleptic malignant-like syndrome,” including (watch for) muscle rigidity, high temp, mental changes.
Term
What type of drug is tolcapone?
Definition
A COMT inhibitor antiparkinsonism drug
Term
Drug that is used to control "on-off" phenomenon?
Definition

apomorphine (Apokyn)

a dopamine receptor agonist

Term
levodopa and pyridoxine (B6)
Definition

pyridoxine (B6) decreases effect of levodopa

Does not effect ACTION of levodopa if given with carbidopa)

B6 sometimes prescribed to lessen adv rxns (not action?) of levodopa

Term
Anticholinergics and the elderly
Definition

more sensitive to anticholinergics

carefully monitor

more confusion and disorientation

may need lower doses

Term
Antiparkinsonism drugs, elderly and hallucinations
Definition

Elderly more prone to hallucinations with antipark drugs

Especially with dopamine receptor agonists

Term
dopinergics and tricyclcs
Definition
increased risk of hyptertension and dyskinesia
Term
levodopa and antacids
Definition
increases effect of levodopa
Term
levodopa and anticonvulsants
Definition
decreased effect of levodopa
Term
levodopa and the blood brain barrier
Definition

levodopa only crosses in small amounts

carbidopa helps more cross BB barrier

Term
COMT inhibitor with MAOI
Definition
increases risk of toxicity of both
Term
COMT inhibitor and adrenergic drugs
Definition
increases risk of cardiac symtoms
Term
anticholinergic with amantadine
Definition
increases anti-cholinergic effects
Term
anticholinergic with digoxin
Definition
increases serum digoxin levels
Term
anticholinergic with haloperidol
Definition
increases psychotic behavior
Term
anticholinergic and phenothiazines
Definition
increases anticholinergic effects
Term
What is COMT?
Definition
  • catechol-O-methyl transferase
  • An enzyme involved in NT degradation
  • For parkinson's, prevents breakdown of dopamine
Term

AMANTADINE

What type of drug is it?

Definition
A dopinergic drug used for Parkinson's and extrapyramidal syndromes
Term

BROMOCRIPTINE

What kind of drug and what used for?

Definition
A dopinergic used for Parkinson's and female endocrine imbalances
Term

RASAGILINE

SELEGILINE

What class of drugs are these?

Definition
MAOI dopiminergics for Parkinson's
Term
Signs of phenytoin toxicity
Definition

slurred speech

ataxia

lethargy

dizziness

N/V

Term
 non-ergot dopamine receptor agonists and CNS depressants
Definition
increased risk of CNS depression
Term
 non-ergot dopamine receptor agonists and levodopa
Definition
increases effect of levodopa, increasing risk of hallucinations
Term
 non-ergot dopamine receptor agonists and ciprofloxacin
Definition
increases effect of  non-ergot dopamine receptor agonists
Term
 non-ergot dopamine receptor agonists and cimetidine
Definition
increases action of  non-ergot dopamine receptor agonists
Term
 non-ergot dopamine receptor agonists and verapamil
Definition
 increases the effect of non-ergot dopamine receptor agonists
Term
 non-ergot dopamine receptor agonists and quinidine
Definition
increases effect of  non-ergot dopamine receptor agonists
Term
 non-ergot dopamine receptor agonists and estrogen
Definition
increases effect of  non-ergot dopamine receptor agonists
Term
 non-ergot dopamine receptor agonists and phentiazines
Definition
decreases the effect of  non-ergot dopamine receptor agonists
Term
What is BENZTROPINE?
Definition
An anticholinergic used for parkinson's
Term
What is BIPERIDEN?
Definition
An anticholinergic used for parkinson's
Term
What is PROCYCLIDINE?
Definition
An anticholinergic used for parkinson's
Term
TRIHEXYPHERIDYL
Definition
An anticholinergic used for parkinson's
Term
ROPINIROLE
Definition
non-ergot dopamine receptor agonist
Term
PRAMIPEXOLE
Definition
non-ergot dopamine receptor agonist
Term
APOMORPHINE
Definition

non-ergot dopamine receptor agonist

Used to contol on-off syndrome

Term
How often is tolcapone monitored for toxicity?
Definition

q 2 weeks first year

q 8 weeks afterwards

Term
What is apomorphine used for and what must it be administered with?
Definition

For on-off phenom of levodopa in parkinson's

Must be given with an anti-emetic

Term
If a pt taking levodopa has chorieform movements, what is the nurse to do?
Definition
Withhold and report immediately
Term
what kind of drugs are entacapone and tolcapone?
Definition
COMT inhibitors
Term
When pt should report antiparkinson drug adverse effects
Definition
  • severe dry mouth
  •  inability to chew or swallow
  •  can’t urinate
  • depression, mood alterations
  • severe dizziness
  • rapid or irregular heartbeat
  • ab pain
  • unusual movements
Supporting users have an ad free experience!