Chapter 20 - Drugs for Degenerative Diseases of the Nervous System

Question 1

Levodopa, Carbidopa, and Entracapone Class: Antiparkinson’s

Answer 1

Action:
Attempt to restore the functional balance of dopamine and acetylcholine in the corpus striatum of the brain. Combining levodopa (Laradopa) with the carbidopa (combined drug name Sinemet) increases its effectiveness

Uses:
Parkinson’s Disease

Contraindications:
Allergy, malignant melanoma, history of malignant melanoma or undiagnosed skin lesions resembling melanoma

Adverse Effects:
Nausea and vomiting, dyskinesias, postural hypotension, psychosis, dark urine and sweat, and activation of malignant melanoma.

Patient Teaching:

• Change positions slowly to prevent orthostatic hypotension
• Report side effects of twitching, due spasms because these indicate overdose
• Urine or sweat may darken
• Use as prescribed and do not stop abruptly
• MAOI’s can react and cause a hypertensive crisis
• Liver and kidney labs

Pregnancy Category: C

Question 2

Benztropine Class: Antiparkinson’s Agent

Answer 2

Action:
Centrally acting drugs that block the effect of the neurotransmitter acetylcholine. This inhibits the overactivity of acetylcholine that occurs with Parkinson’s disease. These drugs are not as effective as dopaminergic

Uses:
Early stages of Parkinson’s disease

Contraindications:
Children under the age of 3, allergy, narrow-angle glaucoma, dementia, tardive dyskinesia

Adverse Effects:
Peripheral anticholinergic effects and include dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, and aggravation or precipitation of glaucoma. GI upset

Patient Teaching:

• Do not stop abruptly
• May cause drowsiness
• Do not use any OTC medications unless approved by a physician
• Take with food or milk, use gum or water for dry mouth

Pregnancy Category: C

Question 3

Donepezil Class: Acetylcholinesterase (AchE) inhibitors

Answer 3

Action:
Prevent the breakdown of acetylcholine by AchE, which increases the availability of acetylcholine at cholinergic synapses. This enhances the transmission in the cholinergic neurons that have not been destroyed by the disease

Uses:
Slow the progression of Alzheimers disease

Contraindications:
Allergy to this medications or piperidine derivatives

Adverse Effects:
Nausea/vomiting, dizziness and headache, and bronchoconstriction, abnormal dreams

Patient Teaching:

• Signs of cholinergic crisis
• To use as prescribed
• Slows the progression, does not cure the disease

Pregnancy Category: C