Ati Nervous System Meds (Antiparkinson Meds)

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levodopa

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crosses blood-brain barrier, whereas dopamine alone cannot cross this barrier and has a very short half-life
levodopa is taken up by dopaminergic nerve terminals and converted to dopamine
this newly synthesized DA is released into the synaptic space and causes stimulation of dopamine receptors

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caridopa

Back 2

used to augment levodopa by decreasing amount of levodopa that is concerted to DA in the intestine and periphery

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Levodopa/caridopa (Sinemet, Parcopa) MOA

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symptomatic relief from dyskinesthias and an increase in the ability to perform ADLs by maintaining the balance between dopamine and acetylcholine in the extra pyrimidial nervous system

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Levodopa/caridopa use

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most effective for PD treatment, but beneficial effects diminish by end of year five

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levodopa/caridopa adverse

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nausea, vomiting, drowsiness
dyskinesias- administer amantadine (releases and uptakes DA) to decrease dyskinesthias
orthostatic hypotension
cardivascular effects from beta 1 stimulation
psychosis- administer 2nd gen antipsychotic meds
(2nd gen meds do not block dopamine receptors in the striatum)
avoid concurrent use with conventional antipsychotics such as haloperidol (Haldol), which block dopamine receptors
do not use with MAOI- result in hypertensive crisis
discoloration of sweat and urine- harmless side effect
activation of malignant melanoma

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dopamine agonists MOA

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activate dopamine receptors

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pramiprexole (Mirapex),

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dopamine agonist

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bromocriptine (Parlodel),

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dopamine agonist

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ropinirole (Requip)

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dopamine agonist

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apomorphine Apokyn

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dopamine agonist

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dopamine agonist adverse

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sudden inability to stay awake
daytime sleepiness
orthostatic hypotension
psychosis- 2nd gen antipsychotic such as clozapine (Clozaril)
impulse control disorder
dyskinesis
nausea

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dopamine releaser (amantadine)

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releases dopamine where it is stored in the neurons, prevents dopamine reuptake, and may block cholinergic and glutamate receptors

Front 13

dopamine releaser (amantadine) Adverse

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CNS effects, atropine-like effects, discoloration of skin (livedo reticularis)- advise that discoloration will subside when meds are discontinued

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catecholamine-O-methyltransferase (COMT) MOA

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enhances the effect of levodopa by clocking it's breakdown

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entacapone (Comtan)

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COMT

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tolcapone (Tasmar)

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COMT

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COMT adverse

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when administered with levodopa: psychosis- 2nd gen antipsychotic such as clozapine (Clozaril),impulse control disorder,dyskinesis,nausea
GI symptoms
discoloration of urine to yellow-orange- harmless side effect
caution with hepatic function

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MAO-B inhibitors MOA

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prevents dopamine breakdown

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selegiline (Carbex, Zelapar)

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MAO-B inhibitor

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rasagiline (Azilect)

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MAO-B inhibitor

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MAO-B adverse

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insomnia- administer no later than noon
hypertensive crisis triggered from foods containing tyramine- avoid foods containing tyramine (avocados, soybeans, figs, smoked meats, dried or cured fish, cheese, yeast products, beer, chianti wine, chocolate, caffeinated beverages)
hypertensive crisis and death from certain meds: avoid merperidine (Demerol), fluoxetine (Prozac), MAO inhibitors, antidepressants, sympathomimetics)

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centrally acting anticholinergics MOA

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diminsh cholinergic effect (neuron excitability) due to increased dopamine, benztropine (Cogentin), trihexylphenidyl (Artane)

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centally acting anticholinergics adverse

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nausea, vomiting, atropine like effects, antihistamine effects

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education antiparkinson meds

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avoid high-protein meals and snacks
avoid pregnancy when taking levodopa or pramiprexole

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antiparkinson meds effectiveness

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absence of tremors, reduction of irritability and stiffness
increase in ability to perform ADLs

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traditional AEDs (antiepileptic drugs) MOA

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control seizures by various mechanisms:
slowing entrance of calcium and sodium back into the neuron, thus extending the time it takes for the nerve to return to it's active state
supressing neuronal firing
enhancing inhibitory effects of GABA

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phenobarbital (Luminal)

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traditional AED (barbiturate)
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic

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primidone (Mysoline)

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traditional AED (barbiturate)
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic

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phenytoin (Dilantin)

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traditional AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic

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carbamazepine (Tegretol)

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traditional AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic

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valproic acid (Depakote)

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traditional AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic
absence
myoclonic

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ethosuximide

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traditional AED
absence seizures

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lamotrigine (Lamictal)

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newer AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic
absence
myoclonic

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levetiracetam (Keppra)

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newer AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic
myoclonic

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topiramate (Topamax)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures
tonic clonic
myoclonic

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oxacarbazine (Trieptal)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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gabapentin (Neurontin)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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pregabalin (Lyrica)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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tiagavine (Gabitril Filmtabs)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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zonisamide (Zonegran)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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lacosamide (Vimpat)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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vigabatrin (Sabril)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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ezogabine (Potiga)

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Newer AED
treats simple, partial, complex partial, secondarily generalized seizures

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benzodiazipines

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used for status epilepticus (acute prolonged seizure)
diazepam (Valium)
lorazepam (Ativan)

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traditional AED (barbituate) adverse
phenobarbital, primidone

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CNS manifestations in adult manifest as drowsiness, sedation, and depression
older adult- confusion and anxiety
children- irritabilty and hyperactivity
toxicity
decrease the effectiveness of oral contraceptives

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traditional AED (barbiturate) interactions

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never administer primidone with phenobarbital since phenobarbital is an active metabolic
primidone is generally administered with phenytoin or carbamaze
decrease synthesis of vitamin k and D and increase effectiveness of warfarin (coumadin)
phenobarbital not recommended during pregnancy
decrease oral contraceptive effectiveness

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hydantoins

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phenytoin

Front 48

hydantoin adverse (phenytoin)

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CNS effects, gingival hyperplasia, skin rash, teratogenic, cardivascular effects, endocrine and other effects, interference with vitamin K dependent clotting factors causing bleeding in newborns

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phenytoin interactions

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causes decrease in effects of oral contraceptives
alcohol, diazepam, cimetidine (Tagament), and valproic acid increase phenytoin levels
carbamazepine (Tegretol), phenobarbital, and chronic alcohol use decreases phenytoin levels

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carbamazepine adverse

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cognitive function minimally affected
birth defects
hypoosmolarity- monitor serum sodium levels
skin disorders

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cabamazepine interactions

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decrease oral contraceptives
grapefruit juice inhibits metabolism and increases carbamazepine levels
phenytoin and phenobarbital decrease effects of carbamazepine

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valproic acid adverse

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GI, hepatotoxicity, pancreatitis, thrombocytopenia, teratogenic, CNS effects

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valproic acid interactions

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increases levels of phenytoin and phenobarbital

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ethosuximide adverse

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GI effects, CNS effects
indicated only for absence seizures

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lamotrigine (Lamictal) adverse

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CNS effects, skin disorders
teratogenic effects

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levetiracetam (Keppra) adverse

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CNS effects

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topiramate (Topamax) adverse

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CNS, teratogenic, metabolic acidosis, angle-closure glaucoma- inform client of signs of glaucoma
phyentoin and carbamzepine can decrease topiramate level
can increase phenytoin levels

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oxacarbazepine (Trileptal) adverse

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CNS effects, skin disorders, teratogenic, hyponatremia
decreases oral contraceptives, increase phenytoin levels
CNS depression with alcohol

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gabapentin (Neurontin) adverse

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CNS effects

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pregabalin (Lyrica) adverse

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CNS effects, peripheral edema, weight gain, dry mouth, instant birth defects
benzodiazipines, alcohol, and opioids intensify CNS effects