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NPN130RoachCh - 29 30
NPN130CH29-30
Parkinsons Disease
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Parkinsons Disease
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dopamine Slurred speech Facial: Masklike/emotionless expression Difficulty chewing/swallowing Unsteady and shuffled gait Upper body bent forward
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Parkinsons Disease
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Parkinsons Disease
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Symptoms are treated with antiparkinsonism drugs. Supplement the dopamine in the brain Block excess acetylcholine (Ach)
Drugs:
Dopaminergic
agents (MAOI) Dopamine receptor agonists Cholinergic blocking drugs Catechol-O-methyltransferase inhibitors Non-ergot dopamine receptor agents
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Affect dopamine content of brain: Carbidopa/levodopa (Sinemet) Amantadine (Symmetrel) Bromocriptine (Parlodel) Rasagiline (Axilect)
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Dopaminergic Drugs
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Actions:
Blood-brain
Levodopa
barrier
(dopamine) only reached brain in small quantities. With carbidopa, more levodopa is able to reach the brain
that work to stimulate dopamine receptors (bromocriptine)
Agonist
Drugs
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Uses
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Parkinsons Disease Parkinson-like symptoms (extrapyramidal) Restless leg syndrome Viral infection (amantadine)
Influenza A prevention
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Adverse Reactions
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Headache/dizziness
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Adverse Reactions
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Serious-levodopa
Choreiform movements
Dystonic movements
If these symptoms occur, withhold the next dose and call PMD immediately; may need to lower dose or discontinue use of drug
Serious-less common
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Contraindications/Precautions
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Interactions
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effect of levodopa. BUT when levodopa is given with carbidopa, Vit B6 may decrease adverse effects
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(Ach)enhances dopamine transmission Less effective than levodopa r/t peripheral adverse reactions. Older adults-Benadryl fewer adverse effects
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Uses
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Adverse Reactions
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Nervousness
Urinary retention, dysuria
Clients older than 60 years old frequently develop increased sensitivity
to anticholinergic drugs. Monitor these clients carefully for adverse reactions-> may need lower doses
If any adverse reactions are severe, the drug may be d/c for several days
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Contraindications/Precautions
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Peptic ulcers
Prostatic hypertrophy (BPH) Achalasia (muscles of lower esophagus do not relax,
Theory: prolong the effect of levodopa Blocks COMT, an enzyme, that eliminates dopamine When given with levodopa, COMT inhibitors increase duration and action of levodopa
Entacapone (Comtan)
Tolcapone (Tasmar)
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Uses
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Adjunct to levodopa/carbidopa Tasmar is associated with liver damage/failure Only given for those not responding to other therapies Liver function tests (LFT) every 2 weeks for first year, every 8 weeks thereafter
Comtan -> milder COMT inhibitor Used to help manage fluctuations in the response of levodopa
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Adverse Reactions
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presence of involuntary movements, similar to tics) Hyperkinesias (state of excessive restlessness that affects the ability to control motor movement) Nausea, anorexia, diarrhea Sleep disorders Orthostatic hypotension Somnolence Muscle cramps **Liver failure
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Contraindications/Precautions
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Liver dysfunction-Tasmar
Hypertension
Hypotension
Decreased renal/hepatic function
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Action
Not
understood but theoretically, thought to work by acting directly on the postsynaptic dopamine receptors of nerve cells in the brain, mimicking the effects of dopamine in the brain
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Uses
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Treatment of signs/symptoms of
Parkinsons Disease
Pramipexole (Mirapex) Ropinirole (Requip)
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On-Off Phenomenon
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Client alternates btwn improved clinical status and loss of therapeutic effect Occurs with long term use of levodopa If sx occur, MD may order drug holiday in which complete withdrawal of medication is ordered x 5-14 days. Pt will then gradually restart drug at lower dose Monitor pts for complications -> neuroleptic malignantlike syndrome
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Adverse Reactions
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Mirapex/Requip
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Contraindications/Precautions
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Known allergy Cautiously: Dyskinesia Orthostatic hypotension Hepatic/renal failure Cardiovascular disease Hx. Hallucinations/psychosis
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Contraindications/Precautions
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Increase effects of levodopa-> will need lower dose of levodopa May have increased risk of hallucinations
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Unreliable history?
Symptoms of disorder
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Ongoing Assessment
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Response to drug therapy Therapeutic Improvement Adverse reactions Hallucinations occur more often in older client taking antiparkinsonism drugs. Monitor for visual, auditory or tactile hallucinations How to treat adverse effects?
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Anticonvulsants
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Anticonvulsants
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muscles of the body with possible LOC Seizures-periodic disturbances of the brains electrical activity
Idiopathic-no known cause Hereditary-genetically passed from parent to child Acquired-have a known cause: high fever, electrolyte imbalances, brain tumors, drug withdrawals
Anticonvulsants
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Epilepsy-Permanent, recurrent seizure disorder Causes include brain injury at birth, head injuries Each type of seizure disorder is characterized by a specific pattern of events, as well as a different pattern of motor or sensory manifestations Partial Seizures- most common type simple-consciousness is impaired and variable motor-uncontrolled stiffening/jerking in one part of the body (e.g., finger, mouth, hand) Can involve area of brain that interpret info; they may present as flashing lights or may have change in taste or speech. This is called a somatosensory seizure.
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Partial Seizure
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Anticonvulsants
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Generalized Seizures-LOC May or may not have convulsive movt Tonic-Clonic Seizure Alternate contraction (tonic phase-The person will quickly lose consciousness, and the skeletal muscles will suddenly tense, often causing the extremities to be pulled towards the body or rigidly pushed away from it, which will cause the person to fall if standing.) and relaxation (clonic phase-The person's muscles will start to contract and relax rapidly, causing convulsions. These may range from exaggerated twitches of the limbs to violent shaking or vibrating of the stiffened extremities. The person may roll and stretch as the seizure spreads ) +LOC Abnormal behavior Myoclonic Seizure Involve sudden, forceful contractions of single or multiple groups of muscles
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Tonic-Clonic Seizure
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Electroencephalogram (EEG)
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Anticonvulsants
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anticonvulsants Do not cure epilepsy Most drugs treat specific types of seizures, NOT a one-size fits all.
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Actions
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CNS.
Hydantoins (tonic-clonic seizures) -Dilantin Carboxylic acid derivatives (epilepsy)-Depakote Succinimides (partial seizures)- Celontin Oxazolidinediones (epilepsy)- Tridione Benzodiazepines (seizure disorders)- Klonopin, Valium, Ativan Barbituates-phenobarbital Miscellaneous-Tegretol, Neurontin, Keppra, Topamax
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Uses
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neurosurgery, tumors Seizures (all types) Neuropathic pain-Neurontin (e.g. diabetic neuropathy) Bipolar Disorders Anxiety disorders
activity with NO interruptions. May occur from abrupt discontinuation of anticonvulsant- concerned with what?
Ativan
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Adverse Reactions
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CNS Drowsiness, weakness, headache, dizziness, nystagmus (constnat, involuntary movt of the eyeball), slurred speech
GI Nausea, vomiting, anorexia, constipation, diarrhea, gingival hyperplasia (overgrowth of gum tissue)
Other Rash, itching (pruritus) urticaria, urinary frequency, blood dyscrasias-> monitor for thrombocytopenia (bleeding gums, easy bruising, increased menstual bleeding, tarry stools) or leukopenia (sore throat, fatigue, SOA) and notify PMD
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Adverse Reactions
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Gingival hyperplasia
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Adverse Reactions
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Nystagmus
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Dilantin
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effectiveness and low toxicity. Normal levels 10-20 mcg/mL Monitor for signs of toxicity (>20 mcg/mL)
Slurred speech Ataxia (lack of voluntary coordination of muscle movements) Lethargy Dizziness N/V
Give IV over IM-> Can cause muscle damage at injection site If rash occurs call PMD. Usually d/c unless rash is mild
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Tegretol
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amount of WBC)
Notify MD of sore throat, fever, malaise. Pt may not be able to fight off infection without treatment
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Contraindications
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2nd & 3rd degree block Tegretol- not given within 14 days of MAOIs, bone marrow depression, renal or hepatic impairment Pregnancy/lactation
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Precautions
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Renal/Hepatic disease Neurologic disorders Barbituates Pulmonary disease Hyperactive children Phenytoin (Dilantin) Hypotension Severe myocardial insufficiency
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Description of seizures Daily/weekly frequency Avg length Aura present? Description of impairment of consciousness What brings on seizures?
Ongoing Assessment
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Education Patient/Family
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What should family expect? How to protect patient? Postical state The postictal state is the altered state of consciousness that a person enters after experiencing a seizure. It is characterized by drowsiness, confusion, nausea and other disorienting symptoms. This period is often accompanied by amnesia or other memory defects. This is the time it takes the brain to recover from the seizure.
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Education
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Never omit or change drug dose unless advised by PMD Must monitor blood levels When seizing, the person should be placed on their side.
NEVER PUT ANYTHING IN THE MOUTH OF A SEIZING PERSON! Anticonvulsant drugs cause drowsiness/dizziness-> use caution Need medical ID: MedicAlert tag or bracelet Notify PMD of all meds: prescription and nonprescription Record all seizures
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Seizure Safety
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Seizure Safety
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