NURS Clinical Science Exam 2 Prep - Parkinson's Disease

What is the most common degenerative CNS disease?

Parkinson’s

What is Parkinson’s?

progressive loss of dopamine

What are symptoms of Parkinson’s?

tremors, pill rolling, muscle rigidity, bradykinesia, postural instability, affective flattening

How many people in the US are diagnosed with parkinson’s yearly?

90,000

What is primarily affected in Parkinson’s?

muscle movement

What are other health issues associated with parkinsons?

anxiety, depression, sleep disturbances, dementia, autonomic nervous system disturbances (difficulty urinating)

What is degenerated and destructed during parkinsons?

dopamine-producing neurons

What part of the brain is affected in parkinsons?

substantia nigra and corpus striatum

What does the corpus striatum affect?

controls unconscious muscle movement

What is the affect of dopamine and acetylcholien in the corpus striatum?

balance, posture, muscle tone, involuntary movmeent

What is the result of the absence of dopamine?

allows acetylcholine stimulation

What are dopamine-enhancing drugs?

restore balance of dopamine and acetylcholine in brain

What is the goal when treating parkinsons?

restore dopamine function, block acetylcholine, avoid extrapyramidal side effects

What do dopaine-enhancing drugs increase?

dopamine

What do dopamine-enhancing drugs reduce?

amount of acetylcholine

What are dopaminergic drugs?

help ambulation and appetite

What is the wearing off period?

dose needs to be adjusted/increased, dose intervals needs to be changed, add a medication

What are symptoms associated with the wearing off period?

eye twitching and tremors

What are kinds of dopaminergic drugs?

levodopa, amantadine, apomorphine, bromocriptine

What do dopamine-enhancing drugs inhibit?

enzymes that break down dopamine

What is tolcapone?

inhibit enzymes that break down dopamine

What do dopamine-enhancing drugs activate?

dopamine receptors (dopamine agonists)

What is ropinirole?

activate dopamine receptors (dopamine agonists)

What is amantadine?

cause dopamine release from nerve terminals

What are catechol-o-methyl transferase (COMT) inhibitors?

redue requirement for levodoepa-carbidpoa

What do COMT inhibitors increase?

concentration of existing dopamine in nerve terminals; improve motor fluctuations

What is stalevo?

entacapone in combination with carbidopa and levodopa

What are side effects of COMT inhibitors?

mental confusion, nausea and vomiting, headache, diarrhea, possible liver damage

What is the therapeutic drug of stalevo (levodopa, carbidopa, and entacapone)?

antiparkinson drug

What is the pharmacological class of stalevo?

dopamine precursor; dopamine-enhancing drug combination

What is the MOA of stalevo?

resotres the neurotransmitter dopamine in extrapyramidal areas of the brain, thus relieving some parkinson symptoms, especially tremor, bradykinesia, gait, and muscle ridigity

How long does stalevo take to achieve maximum therapeutic effects?

several months

Why is levodopa combined with two other drugs (carbidopa and entacapone)?

increase its effect; prevent its enzymatic breakdown

What are admin. alerts of stalevo?

not a self-administer medication; abrupt withdrawal can result in parkinson like-symptoms or non-motor symptoms

What is the onset of stalevo?

less than 30 minutes

What is the peak of stalevo?

1-2 hours

What is the duration of stalevo?

variable

What are adverse effect of stalevo?

muscle twitching and spasmodic winking are signs of toxicity, orthostatic hypotension

What develops in up to 20% of patient taking levodopa?

psychosis

What are contraindications of stalevo?

treatment of narrow-angle glaucoma, suspicious pigmented lesions, or a history of melanoma

When should stalevo be avoided?

acute pyshcoses and severe psychoneurosis within 2 weeks of therapy with MAOIs

What are drug-drug interactions of stalevo?

haloperidol, methyldopa, antihypetensives, anticonvulsants, antacids, pyridozine

What herb/food worsens the symptoms of parkinsons?

kava

What is the treatment of stavelo overdose?

immediate gastric lavage, IV fluid, adequate airway should be maintained

How do anticholinergic drugs treat parkinson’s?

centrally acting; block acetylcholine, inhibit oveactivity in brain

What is not as effective as doapminergcis?

anticholineric drugs

When are anticholinergic drugs used?

early stages of Parkinson’s disease therapy

When are anticholinergic drugs most beneficial?

when primary symptom is tremor

What are prominent autonomic effects of anticholinergic drugs?

dry mouth, blurred vision, tachycardia, urinary retention, constipation

What are kinds of anticholinergic drugs?

benztropine, biperiden, trihexyphenidyl

What is the therapeutic class of benzotropine?

antiparkinson drug

What is the pharmacologic class of benzotropine?

centrally acting cholinerfic receptor blocker

What is benzotropine?

acts by blocking excess cholinergic stimulation of neurons in the corpus striatum

What is benzotropine used for?

relief of parkinson-like symptoms and for the treatment of EPS brought on by antipsychotic pharmacotherapy

What does benzotropine supress?

tremors; however is not effective at relieving tardive dyskinesia

What are the doses of benzotropine?

taken 2 to 4 times a day, or entire dose at bedtime

When shoudl the dose of benzotropine be reduces?

if muscle weakness occurs

What is the onset on benzotropine?

15 min IM/IV; 1 hr PO

What is the peak of benztropine?

1-2 hr

What is the duration of benzotropine?

6-10 hrs

What are the side effects of benztropine?

dry mouth, constipation, and tachycardia

What are adverse effects of benztropine?

sedation, drowsiness, dizziness, restlessness, irritability, nervousness, and insomnia

What are contraindications of benztropine?

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

What treats an overdose of benztropine?

pysostigmine 1 to 3 mg subq or IV will reverse symptoms of anticholinergic intoxication

What is VYALEV?

prescription medication used to treat motor fluctuations in adults with advanced Parkinson's disease

What is deep brain stimulation?

surgical treatment that uses a pacemaker-like device to send mild electrical impulses to specific areas of the brain to block or regulate faulty nerve signals

What is a focused ultrasound?

non-invasive, incisionless medical technology used to treat specific motor symptoms of Parkinson's disease

What is the first hospital care standard for parkinsons?

custom medication orders

What is the second hospital care standard for parkinsons?

timely medication administration

What is the third hospital care standard for parkinsons?

harmful medications eliminated

What is the fourth hospital care standard for parkinsons?

routine mobilization

What is the fifth hospital care standard for parkinsons?

screenings for dysphagia