Chapter 20: Drugs for Parkinson Disease and Alzheimer Disease

Flashcard set 3/4 for Pharm Exam 3

what is parkinson’s disease?

• they lack dopamine and have too much acetylcholine

• loss of neurons in a specific part of the brain called the substantia

S/S of parkinson disease

• rigidity

• tremors

• gait disturbance

• bradykinesia

what neurotransmitter do anticholinergics impact?

acetylcholine

what do anticholinergics end in?

-tropine

medication names for anticholinergics?

benztropine

side effects for anticholinergics?

• drying effects

• dry mouth, dry eyes, constipation, urinary retention

result of taking anticholinergics?

• decrease in Ach

• increase of dopamine

what are dopaminergics working on in the brain?

replacing dopamine

medication name for dopaminergics

levodopa

what does levodopa do?

man made levodopa is trying to get through the blood brain barrier to increase dopamine levels in the brain

if you administer large amount of levodopa, what happens?

large array of side effects

another name for dopaminergics?

carbidopa

what does carbidopa do?

this is a way to trick the BBB to let in levodopa → increase levels of dopamine in the brain (think of it like a car bringing the dopamine to brain)

what is the combo of carbidopa/levidopa?

• 1 part carbidopa

• 10 parts levidopa

side effects of dopaminergics?

• orthostatic BP

• tachycardia

• N/V

• dystonic movement

• psychotic behavior (nightmares, hallucinations)

• SI

• dark urine and sweat

how can we take dopaminergics?

take before meals or with food can help —> LOW/NO PROTEIN foods

how should dopaminergics be given?

at the same time everyday, regular intervals!

When do dopaminergic become effective in the body?

• they have a slow onset, takes 2-6 weeks to become effective

• started low and gradually increased

too much of a high dose of dopaminergics causes?

• dyskinesia

• involuntary movements

• facial tics

• tongue protrusion

how do we know dopaminergics are effective?

• better ambulation

• improvement in spontaneous movement

• patient’s symptoms are improving

how long does a patient take dopaminergics?

life long!! → NEVER stop abruptly

newer route for dopaminergics?

inhaled levodpa → expensive

what does inhaled levodopa do?

• can get into the system quicker

• taken during an off episode

• needing a boost during oral doses

what do dopamine agonists do?

these activate/mimic/help increase dopamine

giving dopamine agonists puts patients at risk for…

sleep attacks (falling asleep even if not feeling sleepy)

medication names for dopamine agonists

• bromocriptine

• apomorphine

• pramipexole

• ropinrole

when is bromocriptine tried?

after trying carbidopa/levodopa

what is apomorphine usually for

off episodes given in a hospital setting (need to be monitored by HCP)

what is the route of apomorphine?

parental

quick onset

what is pramipexole/ropinirole used for?

also used for restless leg syndrome, taken routinely

considerations for giving pramipexole/ropinirole?

cardiac (increase/decrease HR and BP)

what do monoamine oxidase B inhibitors do?

they stop the enzyme that breaks down dopamine

what happens if tyramine is taken with monoamine oxidase B inhibitors?

hypertensive crisis

medication name for monoamine oxidase B inhibitors?

selegiline

what does selegiline do?

prolongs the action of levodopa → all about dopamine

what do COMT inhibitors do?

inhibit the enzyme that breaks down dopamine → increase levodopa and dopamine in the brain

COMT inhibitors end in

-capone

medication names for COMT inhibitors

• entacapone

• tolcapone

tolcapone has what organ consideration?

LIVER → hepatotoxicity (monitor AST,ALT)

stopping COMT inhibitors can lead to

NMS, confusion

side effects of COMT inhibitors

• GI

• dark urine (watch liver here though)

what do dopamine receptor antagonists do?

acts on dopamine receptors → increase dopamine

medication name for dopamine receotpr antagonist?

amantadine

nursing considerations for parkinson’s medications

• are symptoms improving?

• having side effects?

• how often are off episodes? → may need dose/frequency change

• safety considerations

• not stopping abruptly

• is combining categories helping?

what happens in the brain with alzheimer disease

• talking about acetylcholine here

• plaque formation

what do acetylcholinesterase inhibitors do? (AChE)

they inhibit the enzyme that breaks down acetylcholine → increases acetylcholine

medication names for AChE inhibitors

• donepezil

• galantamine

• revastigimine (patch)

what are AChE inhibitors available in

immediate and extended release

when should donepezil be given?

at bedtime

what should we be mindful about with AChE inhibitors?

effect on the geriatric patient and the liver

How are these AChE inhibitors going to help the alzheimer’s patient

• slowing the disease process

• improving memory

• does not fix what already happened

• help with balance

• we can increase the dose as the disease progresses

side effects of AChE inhibitors?

• GI upset

• muscle spasms

• bradycardia

• dizziness

• wet pulmonary (increased secretions) → cholinergic crisis

how often revastigimine changed?

transdermal patch is reapplied every 24 hours (somewhere the patient cannot pick off)

what are NMDA receptor antagoists?

these calm things down from too much firing of neurotransmission

medication name for NMDA receptor antagonist?

Memantine

how can memantine be given

immediate or extended release in the severe phase, can be given with Ache inhibitors

side effects of NMDA receptor antagonist?

• dizziness (think safety)

• constipation

what do IgG1 monoclonal antibodies do?

these are antibodies that stop your body from forming plaques that cause alzheimer

IgG1 monoclonal antibodies medication name?

Aducanumab

how should Aducanumab be given?

IV at an infusion center, continued infusions to start in the mild phase

Aducanumab considerations

• brain bleed

• brain swelling

• brain edema

• monitor this patient!

Nursing with Alzheimer meds

• assess memory (can be tricky)

• family input

• is the patient taking meds consistently?

• monitor behaviors

• does medication need to be adjusted or is disease progressing?

• SAFETY