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Dopamine

An inhibitory neurotransmitter. Maintains control of acetylcholine and inhibits it's excitatory response.

Acetylcholine

An excitatory neurotransmitter.

What happens when you have an increased stimulation GABA in Parkinsons disease?

Symptomatic movement disorders occur

Treatment regimen for Parkinsonism "Anticholinergics"

Block cholinergic receptors

X

Treatment regimen "dopaminergics"

Convert to dopamine (which increases mobility)

->

Treatment regimen "dopamine agonists"

Stimulate dopamine receptors

Sts

Treatment regimen "MAO-B inhibitors"

Inhibit MAO-B enzyme that interferes with dopamine

/

Treatment regimen "COMT inhibitors"

Inhibit COMT enzyme that inactivates dopamine

/

Anticholinergics are sympatholytics or parasympatholytics?

Parasympatholytics

Examples of anticholinergics

Benzotropine (Cogentin)


Trihexyphenidyl HCL (Artane)


Biperiden (Akineton)

Action of anticholinergics

Inhibit the release of acetylcholine.


Reduce the rigidity and some tremors.


Minimal effect on bradykinesia.


Used to treat DRUG INDUCED Parkinsonism.

4 things

Nursing interventions for anticholinergics

Monitor vitals.


Monitor urine for early detection of retention.


Increase fluid intake, fiber, and exercise to avoid constipation.


Observe for involuntary movements.


Advise to avoid alcohol, cigs, caffeine, and aspirin to decrease gastric acidity.


Encourage to relieve dry mouth with ice chips, hard candy, and sugar free gum.


Suggest sunglasses for photophobia.

7 things

Example of dopaminergics

Carbidopa-levodopa (sinemet)

Side effects of dopaminergics

Fatigue, insomnia, dry mouth, blurred vision, orthostatic hypotension, palpitations, dysthymias, urinary retention, nausea, vomiting, dyskinesia, psychosis, and severe depression

14 things, know the important ones

Carbidopa-levodopa (Sinemet) interactions that decrease sinemet effect

Anticholinergics, phenytoin, tricyclic antidepressants, MAO inhibitors, benzodiazepines, phenothiazines, vitamin B6

7 drugs

Example of dopamine agonists

Amantadine (Symmetrel)

Amantadine (Symmetrel) can also be used as an ____________________

Antiviral drug for influenza A

Amantadine (Symmetrel) can be taken alone or in combination with ________ or _______________

Levodopa or anticholinergic

Amantadine (Symmetrel) use

Early treatment of Parkinsonism as drug tolerance develops.


Improvement of symptoms.

2 things

Nursing interventions for amantadine (Symmetrel)

Monitor for orthostatic hypotension.


Administer drug with LOW protein foods.


Avoid vitamin B6, alcohol, other depressants.


Do not abruptly discontinue.


Warn of harmless BROWN discoloration of URINE AND SWEAT.


Assess for suicidal tendencies.


Assess symptoms status and "on-off" phenomenon.


Monitor blood cell counts, liver and kidney fxn.

8 things

Why should amantadine be taken with low protein foods?

To decrease GI upset.


High-protein foods interfere with drug transport to CNS

2 things

What kind of foods are high in vitamin b6?

Lima, navy, kidney beans. And cereals.

4 things

Vitamin b6 inhibits conversion of ________ to ________

Levodopa, dopamine

What happens if you abruptly discontinue amantadine (Symmetrel)?

Rebound parkinsonism

Acetylcholinesterase inhibitors / Cholinesterase inhibitors (examples)

Tacrine (Cognex)


Donepezil (Aricept)


Rivastigmine (Exelon)


Galantamine (Razadyne)

4 drugs

Action of Acetylcholinesterase / Cholinesterase inhibitors

Allow more acetylcholine in neuron receptors.


Increase cognitive fxn.

2 things

Acetylcholinesterase/ Cholinesterase inhibitors are used for what level of Alzheimers

Mild to moderate

Rivastigmine (Exelon) increases the amount of ___ at the ___________ synapses

ACh, cholinergic

Side effects of Rivastigmine (Exelon)

Anorexia, nausea, vomiting, diarrhea, constipation, abdominal pain, GI bleed, dizziness, depression, peripheral edema, dry mouth, dehydration, restless leg syndrome, nystagmus

Adverse effects of Rivastigmine (Exelon)

Seizures, bradycardia, orthostatic hypotension, cataracts, myocardial infarction, heart failure