Parkinsons & Dementia (week 11)

Question 1

A slowly progressive neurodegenerative disorder that affects more than 1 million Americans with symptoms of tremors, rigidity, postural instability, and slowed movement.

Answer 1

Parkinson’s Disease

Question 2

With Parkinson’s, you have too little ____ and too much ____.

Answer 2

Dopamine

Acetylcholine

Question 3

What does Parkinson’s medication provide?

Answer 3

Symptomatic relief, does not delay progression

Question 4

What are the two types of drugs to treat Parkinsons?

Answer 4

Dopaminergic agents

Anticholinergic agents

Question 5

What are the 5 Dopaminergic agents for Parkinsons?

Answer 5

Levodopa/Carbidopa
Pramipexole
Entacapone
Selegiline
Amantadine

Question 6

What is the MOA of Levodopa?

Answer 6

Can cross the BBB

Converted into Dopamine after it closes the BBB

Question 7

What are the two Motor fluctuations with Levodopa?

Answer 7

Long term use leads to dyskinesias

‘Off-times’ lead to loss of symptom relief

Question 8

What is the MOA or Carbidopa?

Answer 8

Prevents conversion of levodopa in the intestines

Strictly a carrier drug

Question 9

Name two Dopamine replacements

Answer 9

Levodopa/Carbidopa

Question 10

What are some side effects of Levodopa/Carbidopa?

Answer 10

Psychosis
Dyskinesia 
N/V
Postural Hypotension
Dysrhythmias

Question 11

What is an alternate name for Levodopa/Carbidopa?

Answer 11

Sinamet

Question 12

What do you want to know in the MAR before administering Levodopa/Carbidopa?

Answer 12

MAOI

Anticholinergic drugs

Question 13

What kind of meals should be avoided with Levodopa/Carbidopa?

Answer 13

High-protein meals

Question 14

What harmless effect can levodopa/carbidopa cause?

Answer 14

Some people experience darkened urine and sweat

Question 15

Name a Dopamine Receptor Agonist

Answer 15

Pramipexole (Mirapex)

Question 16

What is a first line drug used for PD that is used in conjunction with Levodopa/Carbidopa to allow for lower doses?

Answer 16

Pramipexale )Mirapex)

Question 17

What is the MOA of Pramipexole (Mirapex)?

Answer 17

Direct activation of dopamine receptors in the striatum

Question 18

What are the adverse effects of Pramipexole? (Mirapex)?

Answer 18

Nausea/Dyskinesia/Postural hypotension
Hallucinations
Sleep Attacks
Impulse control disorders

Question 19

What are some nursing implications you should know with Pramipexole (Mirapex)?

Answer 19

Cautious use in older adults

May be taken with food to reduce nausea and vomiting

Question 20

What are the three other Anti-parkinsons Medications?

Answer 20

Entacapone
Amantadine
Selegiline

Question 21

Name a COMT Inhibitor

Answer 21

Entacapone

Question 22

What is the MOA of Entacapone?

Answer 22

Inhibiting COMT prevents early breakdown of Levodopa

Question 23

What is the MOA of Amantadine?

Answer 23

Promotes release of DA from remaining DA Neurons

Question 24

What drug is the only drug recommended for dyskinesias?

Answer 24

Amantadine

Question 25

Name an MAO-B inhibitor

Answer 25

Selegiline

Question 26

What is the MOA of Selegiline?

Answer 26

Prevents dopamine breakdown

Question 27

What drug is the 1st line of defense to decrease 'off-times' effect?

Answer 27

Selegiline

Question 28

What disease does not have enough acetylcholine?

Answer 28

Dementia | Alzheimer's

Question 29

Treatment of _______ with these drugs can yield improvement that is statistically significant but clinically marginal

Answer 29

Alzheimer's

Question 30

What are the four drugs approved for Alzheimers?

Answer 30

Memantine (Nemanda) Donepezil (Aricept) Galantamine (Razadyne) Rivastigmine (Exelon)

Question 31

Name a Cholinesterase Inhibitor

Answer 31

Donepezil (aricept)

Question 32

What is the MOA of Donepezil (Aricept)?

Answer 32

Prevents the breakdown of Acetylcholine by (AChE) and increases the availability if acetylcholine

Question 33

What are some side effects of Donepezil (Aricept)?

Answer 33

Nausea and diarrhea weight loss Prolonged QT Interval BRADYCARDIA

Question 34

What are some nursing implications you want to know with Donepezil (Aricept)?

Answer 34

Cautious use in patients with asthma or COPD Urinary retention or obstruction May be taken with food Symptoms typically get better over time

Question 35

Name an NMDA Receptor

Answer 35

Memantine (Namenda)

Question 36

What is the MOA of Memantine (Namenda)?

Answer 36

Creates blockade of further calcium entry