1What is Parkinson's Disease?
imbalance between dopamine and acetylcholine (ACh)
no cure for motor symptoms
progressive disease
dyskinesias -> tremor at rest, bradykinesia (slowed movement)
2What is the therapeutic goal for giving pt drugs for Parkinson's?
goal is to improve the patient's ability to carry out ADLs
3What are the two main categories of Parkinson's Drugs?
Dopaminergic agents -> most commonly used
Anticholinergic agents prevent activation of cholinergic receptors
4Levodopa
higly effective
dopaminergic
adverse effect: dyskinesias, nausea, vomiting, postural hypotension, psychosis, visual hallucinations, behavioral changes
always combined with carbidopa
PO
taking with food can help stop GI upset but causes delays in absorption, spread out high protein bc can reduce response of levodopa
can gradually "wear off" as you take it
5What is MOA of levodopa?
reduces symptoms by increased dopamine synthesis
levodopa is converted into dopamine
6Levodopa/Carbidopa (Sinemet)
most effective therapy for PD
prevents nausea and vomiting
7Dopamine Agonists
first-line drugs for mild to moderate symptoms of PD
less effective than levodopa
8Benztropine (Cogentin)
Class: anticholinergic
Use: Parkinson's tremor and rigidity
Adverse:
Nursing Implication: avoid in the elderly
9Nonmotor Symptoms
90% of patients develop nonmotor symptoms
depression - Amitriptyline, only effective drug