Antiparkinsonism Agents

Parkinson’s Disease

• Progressive chronic neurological disorder

• May develop in people of any age
• Usually effects those who are past middle age and entering their 60s
• No cure for the disease
• Therapy is aimed at management of signs and symptoms

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Progression of Parkinson’s Disease

• Lack of Coordination
• Rhythmic Tremors
• Rigidity/Weakness
• Trouble Maintaining Position or Posture
• Bradykinesia
• Difficulty Walking
• Drooling and Affected Speech
• Mask-like Expressions

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Theories About the Cause of Parkinson’s
Disease
• Viral Infection
• Blows to the Head
• Brain Infection
• Atherosclerosis
• Exposure to Certain Drugs
• Environmental Factors

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The Degeneration of Neurons that Leads to
Parkinson’s Disease

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Management of Care for Patients with
Parkinson’s Disease
• Encourage Patients To:
• Be as active as possible
• Perform exercises
• Maintain independency with ADL’s as long as possible
• Follow drug protocols
• Caregivers Should:
• Monitor adverse effects
• Provide encouragement and support

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Goals of Therapy in Treating Parkinson’s
Disease

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Anticholinergics Used to Treat Parkinson’s
Disease
• Benztropine (Cogentin)
• Biperiden (Akineton)
• Diphenhydramine (Benadryl)
• Procyclidine (Kemadrin)
• Trihexyphenidyl (Artane)

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Use of Antiparkinsonism Agents Across the
Lifespan

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Dopaminergic

• Actions
• Increasing the levels of dopamine in the substantia nigra
• Directly stimulating the dopamine receptors in that area
• Helping to restore the balance between the inhibitory and stimulating
neurons
• Indications
• Relief of the signs and symptoms of idiopathic Parkinson’s disease
• Pharmacokinetics
• Well absorbed from the GI tract and widely distributed in the body
• Metabolized in the liver and peripheral cells
• Excreted in the urine
• Crosses the placenta

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Dopaminergic

• Contraindications
• Known allergy
• Angle closure glaucoma
• GI obstruction, pregnancy and lactation
• Cautions
• CV disease
• Bronchial asthma
• H/O peptic ulcer
• Urinary tract obstruction
• Psychiatric disorders

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Dopaminergic

• Adverse Reactions
• Anxiety
• Nervousness
• Headache
• Blurred vision
• Arrhythmias
• Drug-to-Drug Interactions
• MAOI’s
• Vitamin B6

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Levodopa

• Mainstay of treatment for parkinsonism

• Precursor of dopamine that crosses the blood–brain barrier, where it
is converted to dopamine
• Almost always given in combination with carbidopa as a fixed-
combination drug (Sinemet)
• Carbidopa decreases the amount of levodopa needed to reach a therapeutic
level in the brain
• The dosage of levodopa can be decreased, reducing adverse side effects

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Prototype Dopaminergic

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Other Dopaminergics Used in the Treatment
of Parkinsonism
• Amantadine (Symmetrel)
• Bromocriptine (Parlodel)
• Pergolide (Permax)
• Pramipexole (Mirapex)
• Ropinirole (Requip)

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Nursing Considerations for Dopaminergic
Antiparkinsonism Drugs
• Assess:
• History and Physical Exam
• Known allergy, GI depression or obstruction, urinary hesitancy or
obstruction, benign prostatic hypertrophy, or glaucoma
• Pregnancy and lactation, level of orientation and neurological status,
including affect, reflexes, bilateral grip strength, gait, tremors, and spasticity
• VS and cardiac output

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Question

Please answer the following statement as true or false.

While caring for a patient with Parkinson’s disease the nurse would
encourage the patient to take care of him/herself as long as possible.

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Answer to Question

True

Rationale: Nurses would encourage patients to remain independent with ADLs as

long as possible.

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Anticholinergics

• Actions
• Block the action of acetylcholine in the CNS to help normalize the
acetylcholine-dopamine imbalance
• Indications
• Treatment of parkinsonism
• Relief of extrapyramidal symptoms
• Pharmacokinetics
• Absorbed from GI tract
• Peak 1-4 hours
• Metabolized in the liver, excreted by cellular pathways
• Crosses the placenta and enters the breast milk

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Anticholinergics

• Contraindications
• Known allergy
• Narrow angle glaucoma
• GI obstruction
• GU obstruction
• Prostatic hypertrophy
• Cautions
• Dysrhythmias
• Hypertension
• Hypotension
• Hepatic dysfunction
• Pregnancy and lactation

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Anticholinergics

• Adverse Reactions
• Disorientation
• Confusion
• Agitation
• Delirium
• Nausea, vomiting, paralytic ileus
• Drug-to-Drug Interactions
• Tricyclic antidepressants
• Phenothiazines

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Prototype Anticholinergics

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Nursing Considerations for Anticholinergics and
Antiparkinsonism Drugs

• Assess:
• History and Physical Exam
• Known allergy GI depression or obstruction, urinary hesitancy or
obstruction, benign prostatic hypertrophy, or glaucoma
• Pregnancy and lactation, level of orientation and neurological status,
including affect, reflexes, bilateral grip strength, gait, tremors, and spasticity
• VS, lung sounds, BS and urinary output

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Adjunctive agents

• Used to improve patient response to traditional therapy

• entacapone (Comtan)
• Tolcapone (Tasmar)
• selegiline (Eldepryl)

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Adjunctive agents

• Entacapone is used with carbidopa–levodopa to increase the plasma

concentration and duration of action of levodopa
• Tolcapone works in a similar way with carbidopa–levodopa to
further increase plasma levels of levodopa
• Selegiline is used with carbidopa–levodopa after patients have
shown signs of deteriorating response to this treatment.

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Adjunctive agents

• Pharmacokinetics
• Contraindications
• Adverse effects
• Drug-to-Drug Interactions
• Nursing considerations
• Similar to those for patients receiving the dopaminergic drugs.

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Question

The nurse is caring for a patient with Parkinson’s disease. Which of

the following would be an appropriate nursing diagnosis for this
patient?
A. Constipation related to dopaminergic effects
B. Diarrhea related to dopaminergic effects
C. Risk for injury related to CVS effects and incidence of orthostatic
hypotension
D. Risk for injury related to CVS effects and incidence of PVD

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Answer to Question

A. Constipation related to dopaminergic effects

Rationale: Nursing diagnoses related to drug therapy might include:

Constipation related to dopaminergic effects; Risk for injury related
to CNS effects and incidence of orthostatic hypertension

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