Utm Nursing 201 - Pharmacology: Chapter 14

Front 1

A chronic progressive degenerative disorder affecting the dopamine-producing neurons in the brain.

Back 1

Parkinson's disease (PD)

Front 2

What are other CNS disorders?

Back 2

Myasthenia gravis, dementia, and Alzheimer's.

Front 3

What two neurotransmitters have an imbalance that causes PD?

Back 3

Dopamine and acetylcholine in the basal ganglia. This is caused by a failure of the nerve terminals in substantia nigra to produce the essential neurotransmitter dopamine. Symptoms appear when 80% of dopamine has been depleted.

Front 4

An excitatory neurotransmitter.

Back 4

Ach
(Acetylcholine)

Front 5

Difficulty performing voluntary movements

Back 5

Dyskinesia

Front 6

Irregular, spasmodic, involuntary movements of the limbs and facial muscles.

Back 6

Chorea

Front 7

Abnormal muscle tone.

Back 7

Dystonis

Front 8

Slowness of movement.

Back 8

Bradykinesia

Front 9

Resistance to passive movement.

Back 9

Rigidity

Front 10

Pill rolling: tremor of the thumb against the forefinger; seen mostly at rest; is less severe during voluntary activity; starts usually on one side then progresses to the other; is the presenting sign in 70% of cases

Back 10

Tremor

Front 11

Involuntary writhing, ballistic, or dance like movements. Gradually worsens; emotional and behavioral disturbances/dementia; inherited gene.

Back 11

Huntingdon's Chorea

Front 12

Prescription drug for Huntingdon's?

Back 12

Haldol

Front 13

What are MAOIs?

Back 13

Monoamine Oxidase Inhibitors; first medications used to treat depression; major adverse effect is that they interact with tyramine-containing foods (cheese, red wine, beer, and yogurt) "cheese effect.” One side effect is severe hypertension.

Front 14

Never give _____ to MAOI patients.

Back 14

Demerol. Causes serotonin syndrome and fatal hypertensive episodes.

Front 15

Drugs used to provide exogenous replacement of the lose of dopamine to enhance the function of the few neurons that are still producing their own dopamine.

Back 15

dopaminergic drugs

Front 16

Three categories of dopaminergic drugs

Back 16

1) Those that release dopamine from remaining dopamine vesicles (indirect acting)
2) Those that increase brain levels of dopamine by providing exogenous dopamine in tablet form (direct-acting/replacement)
3) Dopaminergic agonists that act as dopamine substitutes and stimulate dopamine receptors directly in place of dopamine (direct-acting).

Front 17

What is the ultimate goal of dopaminergic drugs?

Back 17

To increase the levels of dopamine in the brain, reversing akinesias.

Front 18

The most detrimental complications of Parkinson’s Disease. Symptoms such as a masklike face and impaired postural reflexes.

Back 18

akinesias

Front 19

Is the biologic precursor of dopamine required by the brain for dopamine synthesis. Considered the cornerstone treatment of PD. also referred to as presynaptic drugs of replacement drugs. Dopamine must be administered this way because Levodpa can pass through the blood-brain barrier.

Back 19

Levodopa

Front 20

Adverse effects of large doses of Levodopa

Back 20

Confusion, involuntary movements, GI distress, hypotension, and dysrhythmias. These problems are avoided when given with Carbidopa.

Front 21

A peripheral decarboxylase inhibitor that does not cross the blood brain barrier. It prevents Levodopa breakdown in the periphery.

Back 21

Carbidopa

Front 22

Originally developed and used for the prophylaxis and treatment of viral disorders (flu); appears to exert its anti-Parkinson effect by causing the release of dopamine and other catecholamines from their storage sites in the ends of nerve cells that are still intact and have not yet been destroyed by the disease process. It also blocks the reuptake of dopamine into the nerve endings which allows more dopamine to accumulate both centrally and peripherally. Triggers release of dopamine indirectly. Adults PO: 100-400 mg/day divided q 12 hr.

Back 22

Symmetrel
(amantadine)

Front 23

Dopaminergic agonists that directly stimulate the dopamine receptors. Permax is 20x more potent than Parlodel and has a half life that is 3x longer. This is used in women who don't want to breast feed after labor. It stops the flow of milk.

Back 23

Parlodel and Permax

Front 24

Sinemet, Sinemet CR – cornerstone in treatment of PD. Contradindicated in narrow-angle glaucoma, melanoma, history of seizures, and MAOIs.
-Sinemet: 10/100 – 1 tab 3-8x day
25/100 – 1 tab 3-6x day
25/250 – 1 tab tid-qid.
-Sinemet CR: Do not crush – 1 tab bid; up to 1-8 tabs at 4-8 hour intervals.

Back 24

Levodopa-Carbidopa

Front 25

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

Back 25

A new strategy for prolonging the duration of action of Levodopa. It is a natural occurring enzyme in the body that breaks down dopamine molecules. Two compounds were developed : Tasmar and Comtan

Front 26

Has a longer duration of action than Comtan; acts centrally and peripherally.

Back 26

Tasmar

Front 27

Cannot cross the blood brain barrier so it only acts peripherally. It does not appear to be hepatotoxic which is a problem in Tasmar. It is taken with Levodopa and should be effective on the first dose.

Back 27

Comtan

Front 28

Drugs that block the effects of Ach. Useful in treating the muscle tremors and muscle rigidity associated with PD.

Back 28

Anticholinergic drugs

Front 29

Treats muscle tremor by blocking effects of Ach. The first drugs in this category to be used were Belladonna alkaloids, atropine, and scopolamine. Side effects: dry mouth, urinary retention, blurred vision.

Back 29

Anticholinergic therapy

Front 30

Tell me about acetylcholine (Ach).

Back 30

Effects of Ach accumulation are muscle tremors, muscle rigidity, pill rolling movements at rest and bobbing of head.

SLUDGE: salivation, lacrimation, urination, diarrhea, increased GI motility, and emesis

Anticholinergic therapy blocks all of this.

Front 31

What is Cogentin?

Back 31

A synthetic anticholinergic drug that resembles both atropine and diphenhydramine (Benadryl). Used as adjunct in the treatment of all forms of Parkinson’s Disease. Also useful in treating phenothiazine-induced extrapyramidal reactions. PO: 0.5-6 mg/day. Contraindicated in: known drug allergy, narrow angle glaucoma, myasthenia gravis, urinary retention, history of peptic ulcer disease, megacolon or prostate hypertrophy, and children under 3 years of age.

Front 32

What is Artane?

Back 32

Used as adjunct with Cogentin (anticholinergic effect).
PO: 6-10 mg/day; take at night to reduce falls; must take with food.