Antiparkinsonism Agents

Antiparkinsonism Agents

Parkinson’s Disease

  • Progressive chronic neurologic disorder
  • May develop in people of any age
  • Usually affects those who are past middle age and entering their 60s
  • No cure for the disease
  • Therapy is aimed at management of signs and symptoms

Progression of Parkinson’s Disease

  • Lack of coordination
  • Rhythmic tremors
  • Rigidity/weakness
  • Trouble maintaining position or posture
  • Bradykinesia
  • Problem walking
  • Drooling and affected speech
  • Mask-like expressions

Theories About the Cause of Parkinson’s Disease

  • Viral infection
  • Blows to the head
  • Brain infection
  • Atherosclerosis
  • Exposure to certain drugs
  • Environmental factors

The Degeneration of Neurons Leads to Parkinson’s Disease

The Degeneration of Neurons Leads to Parkinson’s Disease

The Degeneration of Neurons Leads to Parkinson’s Disease

 

 

Management of Care for Patients With Parkinson’s Disease

  • Encourage patients to:
    • Be as active as possible
    • Perform exercises
    • Attend to their own care as long as they can
    • Follow drug protocols
  • Caregivers should:
    • Monitor adverse effects
    • Provide encouragement and support

Anticholinergics Used to Treat Parkinson’s Disease

  • Benztropine (Cogentin)
  • Biperiden (Akineton)
  • Diphenhydramine (Benadryl)
  • Procyclidine (Kemadrin)
  • Trihexyphenidyl (Artane)

Anticholinergics

  • Action
    • Block the action of acetylcholine in the CNS to help normalize the acetylcholine–dopamine imbalance
  • Indications
    • Treatment of parkinsonism
    • Relief of extrapyramidal symptoms
  • Pharmacokinetics
    • Absorbed from the GI tract
    • Peak in 1 to 4 hours
    • Metabolized in the liver, excreted by cellular pathways
    • Cross the placenta and enter the breast milk
  • Contraindications
    • Known allergy
    • Narrow angle glaucoma
    • GI obstruction
    • GU obstruction
    • Prostatic hypertrophy
  • Cautions
    • Arrhythmias
    • Hypertension
    • Hypotension
    • Hepatic dysfunction
    • Pregnancy and lactation
  • Adverse reactions
    • Disorientation
    • Confusion
    • Agitation
    • Delirium
    • Nausea, vomiting, and paralytic ileus
  • Drug-to-drug interactions
    • Tricyclic antidepressants
    • Phenothiazines

Levodopa

  • Mainstay of treatment for parkinsonism
  • Precursor of dopamine that crosses the blood–brain barrier, where it is converted to dopamine
  • Almost always given in combination form with carbidopa as a fixed-combination drug (Sinemet)
    • Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain
    • The dosage of levodopa can be decreased, reducing adverse side effects

Other Dopaminergics Used in the Treatment of Parkinsonism

  • Amantadine (Symmetrel)
  • Bromocriptine (Parlodel)
  • Pergolide (Permax)
  • Pramipexole (Mirapex)
  • Ropinirole (Requip)

Dopaminergics

  • Actions
    • Increase the levels of dopamine in the substantia nigra
    • Directly stimulate the dopamine receptors in that area
    • Help to restore the balance between the inhibitory and stimulating neurons
  • Indications
    • Relief of the signs and symptoms of idiopathic Parkinson’s disease
  • Pharmacokinetics
    • Well absorbed from the GI tract and widely distributed in the body
    • Metabolized in the liver and peripheral cells
    • Excreted in the urine
    • Cross the placenta
  • Contraindications
    • Known allergy
    • Angle closure glaucoma
    • GI obstruction
  • Cautions
    • CV disease
    • Bronchial asthma
    • H/O peptic ulcer
    • Urinary tract obstruction
    • Psychiatric disorders
  • Adverse reactions
    • Anxiety
    • Nervousness
    • Headache
    • Blurred vision
    • Arrhythmias
  • Drug-to-drug interactions
    • MAOIs
    • Vitamin B6

Goals of Therapy in Treating Parkinson’s Disease

Goals of Therapy in Treating Parkinson’s Disease

Goals of Therapy in Treating Parkinson’s Disease

Use of Antiparkinsonism Agents Across the Lifespan

Use of Antiparkinsonism Agents Across the Lifespan

Use of Antiparkinsonism Agents Across the Lifespan

Prototype Anticholinergics

Prototype Anticholinergics

Prototype Anticholinergics

Prototype Dopaminergic

Prototype Dopaminergic

Prototype Dopaminergic

Nursing Considerations for Anticholinergics/Antiparkinsonism Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation

Nursing Considerations for Dopaminergic Antiparkinsonism Drugs

  • Assessment (history and physical exam)
  • Nursing diagnosis
  • Implementation
  • Evaluation
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