20. Parkinson's and Alzheimer's Meds

Question 1

chronic neurological disorder w/ degeneration of dopaminergic neurons leading to a lack of dopamine and imbalance of NTs dopamine and ACh (more excitatory ACh than inhibitory dopamine)

Answer 1

Parkinson’s disease

Question 2

frequently occurs as an adverse reaction to various drugs, carbon monoxide, manganese, or disorders (encephalitis, stroke, or trauma)

Answer 2

Pseudoparkinsonism

Question 3

symptoms of Parkinson’s disease

Answer 3

• involuntary tremors of limbs (triad)
• rigidity of muscles (triad)
• bradykinesia (triad)
• postural changes (head and chest forward)
• shuffling walk
• lack of facial expression
• pill-rolling motions of hands

Question 4

5 treatment regimens for Parkinson’s disease

Answer 4

• anticholinergics (block cholinergic receptors)
• dopamine replacements (stimulate dopamine receptors)
• dopamine agonists (stimulate dopamine receptors)
• MAO-B inhibitors (inhibits MAO-B enzyme that interferes w/ dopamine)
• COMT inhibitors (inhibits COMT enzyme that inactivates dopamine)

Question 5

what type of drug is Benztropine Mesylate

Answer 5

anticholinergic (antiparkinson)

Question 6

MOA of bneztropine

Answer 6

• blocks cholinergic (muscarinic) receptors
• decreases ACh to reduce excess cholinergic activity
• blocks dopamine reuptake

Question 7

uses of benztropine

Answer 7

• helps decrease muscle stiffness, sweating, and production of saliva
• improves walking ability in people w/ Parkinson’s disease

Question 8

administration of benztropine

Answer 8

PO

Question 9

side effects/adverse effects of benztropine

Answer 9

• drowsiness
• dizziness
• constipation/illeus
• flushing
• nausea
• nervousness
• blurred vision
• dry mouth
• urinary retention

Question 10

contraindications for benztropine

Answer 10

• glaucoma
• myasthenia gravis
• tardive dysinesia

Question 11

pt teaching for benztropine

Answer 11

• don’t drive car or operate machinery until you know how the drug affects you
• avoid long term sun exposure (drug can cause skin sensitivity to sunlight)
• avoid alcohol
• hard candy (sour) can help w/ dry mouth

Question 12

what type of drug is carbidopa-levodopa

Answer 12

dopaminergic

Question 13

MOA of carbidopa-levodopa

Answer 13

• transmission of levodopa to brain cells for conversion to dopamine
• carbidopa blocks conversion of levodopa to dopamine in intestine and peripheral tissues

Question 14

uses of carbidopa-levodopa

Answer 14

• treat Parkinson’s disease
• Parkinsonism
• relieves tremors and rigidity

Question 15

side effects of carbidopa-levodopa

Answer 15

• anorexia
• N/V
• dysphagia
• dyskinesia
• erythema
• fatigue
• dizziness
• HA
• dry mouth
• constipation
• bitter taste
• twitching

Question 16

adverse effects of carbidopa-levodopa

Answer 16

• blood dyscrasia
• cardia dysrhythmias
• abrupt discontinuation can cause neuroleptic malignant syndrome

Question 17

administration of carbidopa-levodopa

Answer 17

take w/ food to decrease GI upset (can slow absorption rate)

Question 18

pt teaching

Answer 18

• don’t discontinue abruptly
• urine may be discolored or appear dark/stain clothes (harmless)
• don’t chew or crush ER tablets

Question 19

what type of drug is tolcapone (Tasmar)

Answer 19

catechol-o-methyltransferase inhibitor

Question 20

MOA of tolcapone

Answer 20

inhibits metabolism of levodopa in the bloodstream -> increases duration of drug in body

Question 21

use of tolcapone

Answer 21

idiopathic PD

Question 22

administration of tolcapone

Answer 22

only in conjunction w/ levodopa/carbidopa

Question 23

Adverse effects of tolcapone

Answer 23

• fulminant liver failure
• disorientation
• confusion
• hallucinations
• psychosis

Question 24

what to monitor for w/ tolcapone

Answer 24

• acute fulminant liver failure -> LFTs initially and Q 2 weeks

Question 25

contraindications for tolcapone

Answer 25

• liver disease
• non traumatic rhabodomylosis
• hyperpyrexia (high fever)
• confusion

Question 26

pathophysiology of Alzheimer’s disease

Answer 26

• cholinergic neuron degeneration and acetylcholine deficiency
• neuritic plaques form
• neurofibrillary tangles are in neurons

Question 27

what is the goal of Alzheimer’s therapy

Answer 27

slow memory and cognition loss

Question 28

what type of drug is Rivastigmine

Answer 28

acetylcholinesterase (AChE) inhibitor

Question 29

MOA of rivastigmine

Answer 29

elevates ACh concentration

Question 30

use of rivastigmine

Answer 30

improves milk to moderate memory loss in Alzheimer’s disease

Question 31

side effects of rivastigmine

Answer 31

• ABD pain
• anorexia
• N/V/D
• dehydration
• weight loss
• weakness
• dizziness
• drowsiness
• depression
• peripheral edema
• dry mouth
• nystagmus
• shakiness (tremor)
• HA

Question 32

adverse effects of rivastigmine

Answer 32

• seizures
• bradycardia
• orthostatic hypotension
• cataracts
• MI
• heart failure
• hepatotoxicity
• suicidal ideation
• SJS

Question 33

administration of rivastigmine

Answer 33

• oral: BID w/ food (peak onset 1 hour)

- transdermal patch: applied daily to clean skin same time each day with rotating sites (peak 8-16 hours)

Question 34

contraindications of rivastigmine

Answer 34

• liver and renal diseases
• urinary tract obstruction
• orthostatic hypotension
• bradycardia
• active GI bleed
• asthma/COPD
• peptic ulcer disease
• surgery
• smoking

Question 35

pt teaching for rivastigmine

Answer 35

• increases effects of general anesthetics
• NSAIDs increase GI effects
• tobacco increases clearance
• TCAs decrease effects
• don’t double dose or stop abruptly