Mobility drug cabinet

Tx of parkinson’s disease with Dopamine-enhancing drugs

Dopamine agonist activity & MAO inhibitors and COMT inhibitors

Dopamine agonist activity drugs

amantadine, apomorphine, bromocriptine, levodopa, carbidopa, istradefylline, entacapone, pramipexole, ropinirole, rotigotine

Dopamine agonist activity action

stimulates dopamine receptors

Dopamine agonist activity SIde effects

• Skin irritation, dizziness, lightheadedness, difficulty concentrating, confusion, anxiety,

• HA, sleep dysfunction, weight loss, fatigue, N/V, constipation, orthostatic hypotension, choreiform movements,

• dystonia, dyskinesia, MI, shock, NMS, hallucinations, SI, depression, EPS, liver failure

Dopamine agonist activity intervent.

Do not stop abruptly. Dyskinesia requires lower doses. Monitor for NMS Monitor liver function. Teach the patient about the “wearingoff” period. Monitor BP, SI, EPS If taking for restless leg syndrome-take before bed.

MAO Inhibitors and COMT Inhibitors drugs

Entacapone, opicapone, rasagiline, safinamide, selegiline, tolcapone

MAO Inhibitors and COMT Inhibitors action

Block breakdown of dopamine

MAO Inhibitors and COMT Inhibitors SIde effects

N/V, cramps, heartburn, HA, joint pain, muscle pain, dry mouth, insomnia, mental confusion,

constipation, gastric upset, mouth sores, hallucinations, hepatotoxicity, seizures, convulsions

MAO Inhibitors and COMT Inhibitors intervent.

Monitor liver function.Monitor LOC. Monitor the integrity of oral mucosa. Monitor BP

levodopa, carbidopa, entacapone action

Dose/Route: PO

Antiparkinson drug/Dopamine precursor; dopamine-enhancing drug combination.

levodopa, carbidopa, entacapone adverse effects

Uncontrolled and purposeless movements (extending the fingers and shrugging the shoulders),

loss of appetite, N/V, orthostatic hypotension, psychosis develops (clozapine to control hallucinations and paranoid feelings)

Muscle twitching and spasmodic winking-S/S toxicity

levodopa, carbidopa, entacapone uses

Uses: Parkinson's symptoms: tremors, bradykinesia, gait, muscle rigidity Action: restores the neurotransmitter dopamine in extrapyramidal areas

Onset: < 30 Min

Peak: 1-2 H

Duration: Variable

levodopa, carbidopa, entacapone interactions

Drug-haloperidol, methyldopa, antihypertensives, anticonvulsants, antacids (magnesium, calcium, sodium bicarbonate), pyridoxine

Food-Kava

Treatment overdose-supportive measures, immediate gastric lavage, IV fluids, and airway management

levodopa, carbidopa, entacapone contraindications

Narrow-angle glaucoma, suspicious pigmented lesions, history of melanoma, acute psychoses, and severe psychoneurosis w/in 2 weeks of MAOI therapy

levodopa, carbidopa, entacapone admin alerts and intervent.

Patient may need assistance to self-administer -Abrupt withdrawal of drug can cause Parkinsonlike symptoms or NMS.

Do not stop abruptly. Dyskinesia requires lower doses. Monitor for NMS Monitor liver function. Teach the patient about the “wearing-off” period.

Teach patients that high protein, excess acidity, and iron salts may reduce effectiveness.

TX of Parkinson's Disease with Anticholinergic Drugs

Benztropine, diphenhydramine, trihexyphenidyl

Anticholinergic Drugs action

Inhibits action of acetylcholine

Anticholinergic Drugs side effects

Sedation, N, constipation, dry mouth, blurred vision, drowsiness, dizziness, tachycardia, hypotension, confusion, nervousness, paralytic ileus, cardiovascular collapse, loss of balance, hallucinations

Anticholinergic Drugs intervent.

Avoid driving, monitor BP, and change positions slowly. Avoid alcohol. Take at bedtime

benztropine class

Dose/Route: PO, IV, IM,

Antiparkinson drug/Centrally acting cholinergic receptor blocker

benztropine actions

Uses: Parkinson-like symptoms, EPS, tremors

Action: blocks excess cholinergic stimulation of neurons

Onset: 15 Min IM/IV, 1 H PO

Peak: 1-2 H

Duration: 6-10 H

benztropine adverse effects

Anticholinergic side effects-dry mouth, constipation, tachycardia Sedation, drowsiness, dizziness, restlessness, irritability, nervousness, insomnia, muscle weakness

benztropine interactions

Drug-aripiprazole, lorazepam, docusate, Divalproex, sodium, gabapentin, ziprasidone, haloperidol, clonazepam, lamotrigine, lisinopril, lithium, metformin, fluoxetine, risperidone, quetiapine, levothyroxine, topiramate, trazodone, bupropion, sertraline, olanzapine, OTC cold medicine, haloperidol, alcohol, antihistamines, phenothiazines, tricyclic antidepressants, disopyramide, quinidine, antidiarrheals

Food-unknown

Treatment overdose-physostigmine 1-2 mg subcutaneously or IV will reverse symptoms of anticholinergic intoxication, symptomatic treatments.

benztropine contraindications

Narrow-angle glaucoma, myasthenia gravis, blockage of the urinary tract, severe dry mouth, hiatal hernia, severe constipation, enlarged prostate, liver disease

benztropine admin alerts/interventions

-May be unable to self-administer meds -Can be taken in divided doses, 2-4 times a day, or at bedtime -If muscle weakness occurs, reduce doses

Monitor BP and ambulation. Teach the patient to report signs of urinary hesitancy or retention.

TX of Multiple Sclerosis with

Disease-Modifying Drugs

MISC drugs for MS

Alemtuzumab, cladribine, dalfampridine, dimethyl fumarate, fingolimod, glatiramer, interferon beta-1a and peginterferon beta-1a, interferon beta1b, mitoxantrone, monomethyl fumarate, natalizumab, ocrelizumab, ofatumumab, ozanimod, peginterferon beta-1a, ponesimod, siponimod, teriflunomide

MISC drugs for MS side effects

Dizziness, HA, weakness, confusion, anxiety, mental depression, conjunctivitis, constipation, diarrhea, sexual dysfunction, sweating, menstrual disorders, neutropenia, flulike symptoms,

spasticity, pain, and itching at the injection site, N/V, fever, mouth sores, diarrhea, hair loss, anemia, increased susceptibility to infection,

seizures, anaphylaxis, hepatotoxicity, spontaneous abortion, cardiotoxicity, dysrhythmia, shortness of breath, SI (interferons), urine turns bluegreen color (mitoxantrone)

MISC drugs for MS intervent.

Monitor for flu-like symptoms-treat as needed. Monitor for hepatotoxicity and cardiotoxicity. Monitor for SI. Mitoxantrone-Notify patients about possible urine color change.

Tx of ALS

Riluzole-extend survival by reducing levels of glutamate within CNS, given Q12H on an empty stomach; if the patient has swallowing difficulties, give tiglutik (thickened liquid form) or exservan (ODT),

SE: seizures, HA, dizziness, confusion, difficulty concentrating, anxiety hypotension, edema

Tx of ALS

Edaravone-IV infusion slows the decline in daily functioning, administered for 14 days, followed by a drug-free period of 2 weeks. Then, the infusions are for 10 days followed by 2 weeks drug-free.

SE: bruising, HA, difficulties with mobility.

TX of muscle spasms with

Skeletal Muscles Relaxants

Skeletal Muscles Relaxants drugs

Baclofen, carisoprodol, chlorzoxazone, cyclobenzaprine, deuterobenzene and tetrabenazine, metaxalone, methocarbamol, orphenadrine, tizanidine

Skeletal Muscles Relaxants actions

Inhibit upper motor neuron activity within the brain and alter simple reflexes in the spinal cord

Skeletal Muscles Relaxants side effects

Drowsiness, dizziness, dry mouth, sedation, ataxia, lightheadedness, urinary hesitancy or retention, hypotension, bradycardia,

angioedema, anaphylaxis, respiratory depression, coma, laryngospasm, cardiovascular collapse, hallucinations

Skeletal Muscles Relaxants intervention

Monitor for sedation, lightheadedness, hypotension, angioedema, respiratory depression, and allergic reactions.

Benzodiazepines drugs

Clonazepam, diazepam, lorazepam

Benzodiazepines action

Skeletal muscle relaxant properties

Benzodiazepines side effects

Drowsiness, dizziness, sedation, ataxia, lightheadedness, respiratory depression

Benzodiazepines intervent.

Monitor for sedation and respiratory depression.

cyclobenzaprine class

Dose/Route: PO

Centrally acting skeletal muscle relaxant/Catecholamine reuptake inhibitor

cyclobenzaprine action

Uses: muscle spasms,

Action: inhibits upper motor neuron activity with the brain Onset: 1 H

Peak: 3-8 H

Duration: 12-24 H

cyclobenzaprine adverse effects

Drowsiness, blurred vision, dizziness, dry mouth, rash, tachycardia, angioedema (rare)

cyclobenzaprine interactions

Drug-alcohol, phenothiazines, CNS depressants, MAOIs Food-unknown

Treatment overdose-IV admin of 1-3 mg of physostigmine reverses anticholinergic activity

cyclobenzaprine contraindications

Myocardial infarction, dysrhythmias, hypothyroidism, severe cardiovascular disease

cyclobenzaprine admin alert/intervent.

-Not recommended for pediatric use

-Caution with elderly, 65 or older, are more likely to experience confusion, hallucinations, and adverse cardiac events.

-Maximum effects may take 1-2 weeks.

Assess for anticholinergic effects of the elderly, SS, and drowsiness.

Teach patients not to drive or operate machinery. Avoid alcohol. Take with food and increase fluids.