Parkinson's, Psychosis, and Alzheimers

use of carbidopa-levidopa (sinemet

parkinson’s disease

action of carbidopa-levodopa

inhibits peripheral dopamine decarboxylation and crosses the blood brain barrier to serve as a dopamine precursor.

use of carbidopa-levidopa (sinemet

parkinson’s disease

action of carbidopa-levodopa

inhibits peripheral dopamine decarboxylation and crosses the blood brain barrier to serve as a dopamine precursor.

admin of carbidopa-levodopa

IR adn XR, 10mg to 2000mg

side effects of carbidopa-levodopa

anticholinergic, NV so give with food, hypotension, dizziness and weakness, dark urine, delusions and halucinations (treated with pimavanserin)

contraindications of carbidopa-levodopa

angle closure glaucoma, melanoma, pyshcosis,

interactions of carbidopa-levodopa

multivitamins, alcohol, high protein deit, pimozide and thioridazine (QT prolongation), MAOIs

nursing for carbidopa-levodopa

fall precautions, potential for dyskinesias

education with carbidopa-levodopa

avoid ETOH, take with food, orthostatsis precautions

1st generation antipsychotics

anatagonize CNS D-2 receptors to create a dopamine blockade, not selectice to pathways associated with psychosis

2nd generation antispsychotics

less d-2 blockade but can antagonize other D receptor subtypes and seratonin receptors

can help with positive and negative symptoms, can cause less EPS and less risk for TD. Higher risk for metabolic changes

use of chloropromazine (thorazine)

psychosis, NV, preop sedation, intractable hiccupts, tetanus, porphyira

class of chloropromazine

1st generation

action of chloropromazine

block d2 receptor sites in mesolimbic pathway to inhibit positive symptoms. Peripheral actions.effects = partial histamine antagonism, acetylcholine blockage, and antagonism of the alpha adrenergic system

admin of cholpromazine

PO and IM, 200-400mg daily, indicated all the way down to 6 months old for severe behavioral disturbances

contraindications in chlorpromazine

comatose pts, CNS depression, bone marrow depression, Reye syncrome, electrolyte abnormalities, congneital Long QT syndrome

interactions with chloropormazine

antacids and antidiarrheals can cause absorption issues

drugs with potential to affect QT prolongation

Nursing for chloropromazine

give antidiarrheals and antacids 2 hours before to help absorption, monitor for EPSEs, monitor for NMS, monitor for dysrhythmias, fall precaitions, reduced WBC and agrandulocytosis

education on cholrpormazine

movement disorders, fall precautions, report sudden fevers (could be NMS)

Use of risperidone (risperdal)

schizophrenia, bipolar I acutre manic, irritability associated with ASD

action of risperidone

unknown but antagonizes dopamine D2 and seratonin receptors

admin of risperidone

PO and ODT (1-16mg daily), LAI (25-50)

contraindications

lactacting patients, dementai related psychosis, CNS depression, fall risk d/t orthostasis

interactions with risperidone

antihypertensives can potentiate effects, anti parkinsons are opposing

nursing for risperidone

monitor sedation, fall precautions, metabolic monitoring

education on risperidone

monitor metabolic symptoms, fall precautions, prolactin education, EPS education

adverse effects of antipsychotics

Extrapyramidal symptoms (EPS)

drug induced movement disorders, caused by dopamine receptor blocking agents

actute dystonia

severe muscle spasm, develops in hours to days, often invovles tongue, neck, face, back, can cause airway obstruction

treated with benadryl

oculogyric crisis

involuntarily looking up

treated with benztropine (cogentin) and trihexyphenidyl (artane)

pakinsonism

develops in the first month usually, tends to resolve spontaneously, commonly manifests as akinesia, muscle rigidity and posture changes, tremor, hypersalivation and drooling, mask-like faces

treated with benztropine (cogentin) and trihexyphenidyl (artane)

Akathisia

usually develops in the first 2 months of use, extremely uncomfortable profound sense of restlessness, inability to sit or stand still, internal feelings of restlessness, anxiety, and uneasiness

treated with propanalol

tardive dyskinesia

involuntary twisting movements beginning with tongue and face but can progress to limbs and trunk, can be irreversible and can onset from months to years

treated with slow taper of offending drug, ingrezza (valbenzaine) or austedo (deutrabenazine), or switch to clozapine

atropine psychosis

psychotic delirium caused by excess anticholinergic effects, agitation, confusion, tachycardia, and dry flushed skin, caused of too high dose overtime

neuroleptic malignant syndrome

severe rigidity and tremors, sudden hgih fever, severe sweating and drooling, autonomic instability, changing LOC, seizures, 10-20% fatality rate

agranulocytosis

severely decreased WBCs, unexplained sore throat, fever, malaise during first two months of medication initation - potentially lethal if infections become overwhelming

other adverse effects of antipsychotics

hypotension, sedation, seizures, arrhythmias, sudden death, macular papular rashes, jaundice, gynecomastia, galactorrhea, menstrual irregularities, decreased libido, impaired organsm erectile dysfuncion

metabolic side effects of antipsychoticsq

glucose dysregulation, weight gain, lipid dysregulation: insulin resistence, HTN, high lipid serum, obesity, coagulation abnormalities

alzheimers neuro

decreased in acetylcholine, increase in glutamate

use of donepezil

alzheimers, mild mod and severe

action of donepeszil

reversiby binds to and inactivates acetylcholinesterase

admin of donepezil

PO, ODT, 5-10mg

complications of donepezil

NV, diarrhea, loss of appetite, insomnia, dizziness, HA, syncope

contraindications of donepezil

GI bleed, caridac diseae, hyperthyroidism

interactions of donepezil

antihistamines (reduce effectiveness) NSAIDs (increase GI bleed risk)

nursing with donepezil

give with food, monitor weight GI bleed insomnia, dizzines, fall precautions

education on donepezil

take with food at bedtime, report severe NV and diarrhea, education on GI bleeds

use of memantine

mild and severe Alzheimers

action of memantine

NMDA receptor antagonist

admin of mementine

PO 5-20mg but divide into 5mg increments

complicaitons of memantine

dizziness, HA, confusion, constipation

contraindications of memantine

renal failure, caution in renal and liver disorders (lower dose), caution in seizure disorder

interactions of memantine

antacids, drugs that increase pH of urine can raise serum levels

nursing for memantine

comfort meds for constipation, monitor for dizziness and increased confusion

educaiton on memantine

educate caregivers to monitor for increasing confusion, look out for dizziness and HA