(2) Meds for Chronic Neurological Disorders

Donepezil

ALZHEIMER’S DISEASE

Class: Acetylcholinesterase (enzyme breaks down ACh) inhibitors

MOA: increases ACh lvls (more cholingeric activity in the brain) by prohibiting its breakdown

Uses: Alzheimer disease to dlow progression

SE: GI upset (ulcer risk and GI bleed as a result of increased gastric secretions), HOTN (dangerous in elderly - can increase risk of falls)

Edu: GI symptoms improve as you continue

medications for Parkinson’s

Goal: reduce symptoms seen w/ Parkinson’s — unfortunately does not slow the actual progression of disease

• tremor, rigidity, akinesia, staggering gait, drooling, dementia, dyskinesia

Symptoms can swing back and forth

• On-Off phenomenon (days when symptoms are worse than others even if taking meds as scheduled) even while on the same dose of levodopa

meds for Parkinson’s — classes include:

• MAO-B inhibitors

• dopamine modulator

• COMT inhibitor

• Ergot Derivative

• Anticholinergic

• Antihistamines

• Dopamine Replacement

meds for Parkinson’s — MOAs:

• aimed at increasing dopamine uptake in the brain

• goal is to correct the imbalance of dopamine and ACh

• treating muscular symptoms

• treating 2ndary cholingeric symptoms

Carbidopa-Levodopa

Parkinson’s disease

most common Anti-Parkinsonian agent

Class: Dopamine Replacements (can help w/ pt’s tremor - b/c smooth muscle mov)

CI: Glaucoma, Haloperidol use, MAOIs use

AE: cardiac dysrhythmias, HOTN, muscle cramps, dizziness, involuntary movs (seems backwards when this med helps w/ Parkinson’s (invol. mov. - temors)

NI:

• take on empty stomach but can be taken w/ food if GI upset occurs

• may need supplement drugs to control on-off periods

• effects likely only last for 5yrs

Selegiline

Parkinson’s disease

can be taken as monotherapy for Parkinson’s or in add. to levodopa to help decrease wear-off effect

Class: MOA-B (similar to MAOIs)

Used to help decrease wear off effect of levodopa;

Goal- increase lvl of dopaminergic stimulation;

Selegiline can be taken as monotherapy or in adjunct to levodopa.

AE: can cause hypertensive crisis (MOST dangerous [increase BP to dangerous lvl], wanna edu pts to take BP regularly at home), insomnia

Edu:

• do not eat tyramine containing foods (aged cheese, cured eat, wine/beer, sauerkraut, soy sauce)

• can have lots of med interactions so talk w HCP/PharmD

• could cause HTN crisis if taken w levodopa

Pramipexole

Parkinson’s disease

MOA: may delay the need for levodopa by increasing dopamine; can be taken as monotherapy or in adjunct to levodopa

AE: daytime sleepiness, postural HOTN, lack of impulse control (edu pt & loved ones abt this)

Edu:

• report sudden inability to stay awake

• avoid CNS depressants (other meds/alcohol)

Entacapone

Parkinson’s disease

Class: Catechol Ortho-Methyltransferase (COMT)(breaks down levodopa b4 reaches brain) Inhibitors

Indication: prolong duration of action of levodopa

• reduces wearing off effect

AE:

• GI upset

• urine discoloration

  • darken urine and even sweat

• can worsen dyskinesia that may already be present

• some forms have been associated w/ cases of severe liver failure

Benztropine

Parkinson’s disease

Class: Anticholinergics

Used to treat muscle tremors and muscle rigidity associated w PD

• these 2 symptoms are caused by excessive cholingeric activity

SE: “can’t see/spit, can’t pee/sh*t”

• dry mouth or decreased salivation, urinary retention, decreased GI motility (constipation), dilated pupils (mydriasis), and smooth muscle relaxation

NI:

• drinky plenty of fluids (2-3L)

• encourage regular voiding (helps avoid retention)

• take at bedtime

• avoid extreme heat

general nursing implications (for Parkinson’s)

• inform pt not to take other meds w PD drugs unless he/she checks w/ physician

• when starting dopaminergic drugs, assist pt w/ walking b/c dizziness may occur

• encourage pt to force fluids to at least 3000 mL/day (unless CIed)

• taking Levodopa w/ MAOIs may result in hypertensive crisis

• Entacapone may darken the pt’s urine and sweat

Interferon Beta 1a

for Neuralgia

Uses: Multiple Sclerosis (reduce freq/severity of MS relapses — doesnt cure tho → js relapse and slows progression) & various virsues

Admin: IV only (clinical admin. & consistent scheduling to maintain therapeutic dose)

SE:

• flu like symptoms

• hepatotoxicity (keep an eye on liver enzymes)

Edu:

• can give NSAIDs before IV dose to avoid flu like symptoms

• check liver function and assess for issues

• do not mix w/ alcohol

Pregablin

for Neuralgia

Class: gabapentinoid

Add. uses: most commonly used for neuropathic pain, postherpetic neuralgia (nerve pain that follows shingles), and fibromyalgia (widespread musculoskeletal pain)

SE:

• edema and weight gain (want pts to monitor weight gain and dont want them to stop abruptly)

• visual disturbances

Edu:

• report visual changes

  • trouble reading, halos, etc.

• controlled substance

Gabapentin

for Neuralgia

Class: gabapentinoids

Uses: Tx of neuropathy (often assoc. w/ diabetes), can also be used for post-op pain

SE:

• drowsiness (take at night if js starting it)

• dizziness “

• potential for OD (CNS symptoms)

NI:

• take w/ food if nausea is present

• educate on OD potential (so take as prescribed)

• stopping abruptly could increase seizure activity

• controlled substance (wasn’t always, but w/in last 7yrs #ppltrynamakemeth)

which condition will alert the nurse to a potential caution or CI regarding the use of a dopaminergic drug for Tx of mild Parkinson’s diease?

angle-closure glaucoma — remember glaucoma is a CI to using dopamine replacements such as Carbidopa-Levodopa

the pt has now been ordered an oral disintegrating form of the MOAB inhibitor drug selegiline. what shud the nurse consider when administering this drug?

tell the pt to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted — this dosage form is to be taken w/o liquids and given in the morning b4 breakfast. foods and fluids are not to be consumed for 5min b4/after drug is taken. postural HOTN may be a transient problem, so pt needs to move and change positions slowly and purposely.