8/3/2019 Pharmacology - Park in Sons

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PARKINSONS DISEASE

DRUG ACTION NURSING IMPLICATIONS

I.Dopamine Replacement Drugs

EXAMPLES:a. Carbidopa (Lodosyn)b. Carbidopa-Levodopa (Sinemet)

Replace dopamine in the body

Used only when patients have a

markedly impaired lifestyle

Often used as a last resort after other drug classes have failereached a wearing-off effect

Should not be used concurrently with catecholamines (due trisks)

Should not be taken until at least 14 days after thediscontinuation of therapy with MAOIs (except for Selegiliand Rasagiline)

II. Anticholinergics

EXAMPLES:a. Benztropine (Cogentin)

b. Trihexyphenidyl

Block cholinergic within the striatumto reduce acetylcholine uptake;improve the balance between

dopamine and acetylcholine

Monitor for side effects: urinary retention, constipation, drymouth, blurred vision, mental confusion, hallucinations

Used to control tremor and relieve rigidity

Not tolerated well in Pts over 60

III. Presynaptic Dopamine Release

Enhancer

EXAMPLES:a. Amantadine Hydrochloride (Symmetrel)

Causes the release of dopamine fromvesicles in presynaptic fibers ofnerve cells

Also blocks the reuptake of

dopamine into nerve fibers

Adverse effects are mild and include dizziness, insomnia, annausea

Indicated for treatment of early Parkinsons Disease

IV. Dopamine Receptor Agonists

EXAMPLES:a. Bromocriptine (Parlodel)b. Ropinirole (Requip)

c. Pramipexole (Mirapex)

Directly stimulate presynaptic and/orpostsynaptic dopamine receptors in

the brain

Used to treat early PD in youngerpatients

Can be used in early or late stages of Parkinsons Disease

Should not be used concurrently with catecholamines (due t

risks)

Should not be taken until at least 14 days after thediscontinuation of therapy with MAOIs (except for Selegilin

and Rasagiline)

Bromocriptine is contraindicated in Pts with severe ische

disease of any kind (e.g. PVD)

V. MAO-B Inhibitors

EXAMPLES:a. Selegiline (Eldepryl)b. Rasafiline (Azilect)

Prevent the breakdown ofcatecholamines (dopamine, NE,

Epinephrine) by blocking theaction of MAO-B enzyme

Used to treat early PD

Adverse effects more likely with dosages >10 mg (e.g. Chee

Effect)

Selegiline used as adjunctive drug normally used incombination with Levodopa or carbidopa-Levodopa

Rasafiline can be used alone during early stages of Parkinso

Disease

Pharmacology - PD

Risk Factors for PD

>40 years

Male

estrogen levels

Exposure to pesticides/herbicides

Drinking well water

Complications of PD

Orthostatic hypotension

Dysphagia

Urinary dysfunction (frequency,

urgency, or incontinence)

Pathophysiology