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Chp 16 AntiParkinson
Lee College Nursing Program Exam 5 Chp 16: AntiParkinson
| Question | Answer |
|---|---|
| Define: Akinesia | A reduction or absence of psychomotor activity that results in a masklike facial expression and impaired postural reflexes. A classic characteristic of Parkinson's disease |
| Define: Bradykinesia | Slowness of movement: classic characteristic of Parkinson's disease |
| Define: Chorea | A condition characterized by voluntary, purposeless, rapid motions such as flexing and extending the fingers, raising and lowering the shoulders, or grimacing. |
| Define: Dyskinesia | an impaired ability to execute voluntary movements |
| Define: Dystonia | impaired or distorted voluntary movement due to a disorder of muscle tone |
| Define: Exogenous | a term describing any substance produced outside of the body that may be taken into the body (medication/food) |
| Define; On-off phenomenon | A common experience of patients taking medication for Parkinson's disease in which they experience periods of greater symptomatic control ("on" time) alternating with periods of lesser symptomatic control ("off" time) |
| Define: Parkinson's Disease | A slowly progressive, degenerative neurological disorder characterized by resting tremor, pill-rolling of the fingers, mask-like facies,shuffling gait, forward flexion of the trunk, loss of postural reflexes, and muscle rigidity and weakness. |
| Define: Postural instability | A decrease or change in motor and muscle movements that leads to unsteadiness and hesitation in movements and gait when the individual starts or stops walking; occurs in Parkinson's disease |
| Define: Presynaptic | Drugs that exert their antiparkinsonian effects before the nerve synapse |
| Define: Rigidity | Resistance of the muscles to passive movements; leads to the "cogwheel" rigidity seen in Parkinson's disease |
| Define: Tremor | In Parkinson's disease, shakiness of the extremities seen mostly at rest. |
| Wearing off phenomenon | a gradual worsening of Parkinsonian symptoms as a patient's medications begin to lose their effectiveness, despite maximal dosing with a variety of medications |
| ______is an inhibitory neurotransmitter and ______is an excitatory neurotransmitter. | Dopamine acetylcholine |
| Parkinson's disease is an imbalance between ________ and _______. | Dopamine acetylcholine |
| What are the 6 classic symptoms of Parkinson's disease? | akinesia, bradykinesia, postural instability, rigidity, and tremors |
| Symptoms of Parkinson's disease occur when ____% of the dopamine stored in the sunstania nigra of the basal ganglia is depleted. | 80 |
| Symptoms of Parkinson's disease can be partially controlled as long as _________ | there are functioning nerve terminals that can take up dopamine |
| When dopamine is too low it causes ________ | Parkinson's disease (to worsen) |
| __________ occurs when too much dopamine is present | Dyskinesia |
| what are the 2 types of Dyskinesia? | chorea: irregular, spasmodic, involuntary movements of the limbs or facial muscles dystonia:abnormal muscle tone leading to impaired or abnormal movements |
| Blood-brain barrier does not allow exogenously supplied dopamine to enter, but it does allow _______ in. | Levadopa (you canot give regular dopamine) |
| Levadopa only works if______ | patients has functioning nerve terminals that allow for the uptake of dopamine |
| Ultimately, levadopa no longer controls the Parkinson's disease, and the patient is seriously debilitated. This generally occurs after ____ to ____ years after the start of levadopa. | 5 to 10 |
| 3 Goals of Drug therapy for PD (parkinsons disease) | 1. increase levels of dopamine as long as there are functioning nerve terminals remaining 2. antagonize/block the effects of ACh 3. Slow the progression of the disease |
| what is the cheese effect? | A major adverse effect of the nonselective MAOIs is that they interact with tyramine-containing foods (cheese, red wine,beer, yogurt) because of their inhibitory activity against MAO-A. Results can be as severe as hypertension |
| Selegline is what type of MAOI? | a selective MAO-B inhibitor |
| ________ causes an increase in the levels of dopaminergic stimulation in the CNS. | selegiline |
| _______ is an adjunct drug used when patient's response to levadopa is fluctuating. | selegiline |
| ________ _______ use may delay the development of serious debilitating Parkinson's disease for 9 to 18 years. | prophylactic selegiline |
| Contraindications for selegiline use? | drug allergy/ opioid analgesic meperidine |
| Adverse effects of selegiline at doses of 10mg/day | dizziness/dyskinesias/nausea/syncope/lightheadedness/abdominal pain/insomnia/confusion/dry mouth |
| Adverse effects of selegiline at doses higher than 10mg/day | the drug becomes a nonselective MAOI, which contributes to the development of the cheese effect: hypertensive crisis |
| If you mix selegiline with meperidine what is the outcome? | delirium, muscle rigidity, hyperpyrexia (high fever), and hyperirritability |
| Because selegline is a MAO-B it does not elicit the ______ _____ | cheese effect |
| MAOIs are also used to treat ______ | depression |
| ______allows the dose of levadopa to be decreased and also delays the development of unresponsiveness to levadopa therapy | seregiline |
| _______ may show a decrease in severity, and improve functioning ability, but only ____ to ___% of people show a positive response to therapy. | Selegiline/ 50-60% |
| Amantadine is used to treat ______ and _____ | PD/ flu |
| Amantadine is a ______-acting drug that causes______of dopamine from storage sites at the ____ of the nerve cell that are still intact. | indirect release end |
| ________ blocks reuptake of dopamine into the nerve endings, allowing more to accumulate both centrally and peripherally | amantadine |
| Amantadine does or doesn't stimulate dopamine receptors directly? | does not |
| When is Amantadine used in PD and how long is it usually effective? | early stages 6 to 12 months |
| How do direct acting dopamine receptor agonist work? | directly stimulate dopamine receptors/ activate dopamine receptors and stimulate production of more dopamine |
| Carbidopa is given with _______ because carbidopa does not cross the blood-brain barrier but _____ does and can be converted to dopamine | levadopa levadopa |
| How does Levadopa-Carbidopa work? | works presynaptically to increase levels of dopamine in the brain Levadopa is able to cross the blood-brain barrier, and then convert into dopamine |
| Selegiline may interact with several drugs such as: | meperidine and other opioids tramadol MAOIs serotonergic antidepressants sympathomimetic amines carbamazepine oral contraceptives buspirone |
| Levadopa-Carbidopa may interact with several drugs such as : | antacids metoclopramide antichloinergics benzodiazepines tricyclic antidepressants |
| Advers effects of levadopa-carbidopa | heart palpitations hypotension urinary retension depression psychosis dyskinesia rhinorrhea |
| Dopamine replacement drugs are often used as a _______ after other drugs classes have failed or reached a wearing off effect | last resort |
| indications for levadopa-carbidopa | PD excessive undesired breast milk production (galactorrhea) restless leg syndrome |
| Contraindications for levadopa-carbidopa therapy | drug allergy not to be used with catecholamines not to be used within 14 days of MAOIs (except selegline because its a MAO-B) |
| why is carbidopa given with levadopa? | because very large oral doses of levadopa must be given to obtain adequate dopamine replacement in the brain. |
| what would high doses of levadopa cause? | high peripheral levels of dopamine and lead to confusion, involuntary movement, GI distress, hypotension, and even cardiac dysrhthmias. |
| Dopamine replacement drugs are used to___________ | directly restore dopaminergic activity in Parkinson's disease. |
| what does SLUDGE stand for? | salivation lacrimation (tearing of the eyes) urination diarrhea increased GI motility emesis (vomiting) |
| Adverse effects of levadopa-carbidopa? | cardiac dysrhythmias hypotension chorea muscle cramps GI distress |
| Anticholinergics are used as ______ in Parkinson's disease due to their ______ properties | adjunct antidyskinetic |
| Anticholinergics help to alleviate ________,________, and _________ associated with PD | cogwheel rigidity pill-rolling bobbling of the head |
| what does SLUDGE stand for? | salivation lacrimation urination diarrhea increased GI motility emesis (vomiting) |
| use anticholinergics with caution in the elderly because they may cause : | confusion, urinary retention, visual blurring, palpitations, and increased intraocular pressure |
| Anticholinergics block the effects of ___ | ACh |
| Anticholinergics are used to treat ______ and ______associated with PD | tremors rigidity |
| Muscle tremors and muscle rigidity are caused by | excessive cholinergic activity |
| Anticholinergics do not relieve ________ | BRADYKINESIA ( extremely slow movements) |
| ______ is often given to relieve the side effects of PD therapy | trihexyphenidyl |
| what are the 4 signs and symptoms of Parkinson's disease | masklike expression speech problems dysphagia (difficulty swallowing) rigidity of arms, legs, and neck |
| Adverse effects of anticholinergics | drowsiness, confusion, disorientation, constipation, nausea, vomiting, urinary retention, pain on urinating, blurred vision,dilated pupils, photophobia, dry skin, decreased salivation, dry mouth |
| Indications of Anticholinergics | treatment of PD to cause smooth muscle to relax, resulting in reduced muscle rigidity and akinesia |
| "Other" indication for anticholinergic drugs | to treat drug-induced extrapyramidal reactions to certain antipsychotic drugs |
| outcome of PD drug therapy? | improved sense of well-being increased appetite ability to concentrate abilty to think clearer less intense parkinsonian manifestations such as less tremors, shuffling gait, muscle rigidity, and involuntary movements |
| anticholinergics should be taken with ______ and may take several ______ to show effects | a snack weeks |
| Anticholinergics are generally taken ______ because _____ | at bedtime of their sedating properties |
| oral disintergrating dosage forms should be _________ | placed on the tongue and not swallowed until the dosage form is melted. NO liquids! Nothing 5 minutes before or after medication |
| if patient is taking levadopa-carbidopa they should continue to eat high protein, but | use portion control and take the drug 30 minutes before a protein containing meal |
| amantadine usually looses its effectiveness after | 3-6 months |
| when taking cogentin avoid ______ and ______ | alcohol hot weather/ extreme exercise |
| Which of the following should alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for the treatment of mild PD? a. diarrhea b. tremors c. angle-closure glaucoma d.unstable gait | c. angle-closure glaucoma |
| During a patient teaching session about anti-Parkinson drugs, the nurse will include what statement? | change positions slowly to prevent falling due to postural hypotension urine may become dark if you miss a dose never double up keep taking medication even after tremors and weakness are relieved |
| A patient taking selegeline, 10 mg daily, in addition to dopamine replacement therapy for PD. The nurse will implement which precaution regarding selegiline? | monitor for tachycardia and palpitations |
| a patient with PD has difficulty performing voluntary movements. What is the correct term for this symptom? | Dyskinesia |
| which drug may be used early in treatment of PD but eventually loses effectiveness and must be replaced by another drug? | amantadine |
| A patient asks the nurse why a second drug is given with his drugs for PD. The nurse notes that this drug, an anticholinergic, is given to control or minimize which symptoms? a. drooling b. constipation c. muscle rigidity d.bradykinesia e. dry mouth | a. drooling c. muscle rigidity |
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