week 7 pharm

Question 1

what is the MOA of levodopa

Answer 1

it enters the brain and converts to dopamine, restoring the balance btween acetylcholine and dopamine with Parkinsons

Question 2

why do you need to give levodopa in combo with decarboxylase

Answer 2

because only a small amount of levodopa actually crosses the BBB, so they usually add a dopamine enzyme antagonist so that the dopamine stays

Question 3

what is sinemet

Answer 3

levodopa/carbidopa combo. this is basically levodopa combined with a decarboxylase inhibitor to make levodopa more available

Question 4

what is decarboxylase

Answer 4

an enzyme that breaks down dopamine (including fake levodopa dopamine). when inhibited it increases amount of available levodopa in the brain

Question 5

which Parkinson’s drug can cause dark urine and sweat

Answer 5

levodopa

Question 6

what are 4 nursing considerations for levodopa

Answer 6

• patients should avoid high protein meals
• assess PD symptoms
• monitor BP
• Advise pt not to stand abruptly

Question 7

what are some adverse effects of levodopa

Answer 7

n/v
dyskinesias (involuntary movements in the face, leg, or trunk)
postural hypotension
psychosis
CNS effects (impulse issues, difficulty regulating mood, etc.)
dark sweat and urine

Question 8

whats the main differences between the on/off phenomenon and the wearing off effect

which drug does this occur with

Answer 8

on/off: abrupt, not dose dependent.
wearing off: gradual return of PD symptoms, dose dependent, usually seen at end of dose interval

these may occur with long term use of levodopa

Question 9

what are two ways to minimise the on/off phenomenon

Answer 9

• adding a dopamine agonist/MAOB inhibitor
• avoiding high protein meals

Question 10

what are ways to minimise the wearing off phenomenon with levodopa `

Answer 10

-increasing frequency of dose
- adding MAOB to prolong half life
- adding dopamine agonist

Question 11

which drug is the dopamine agonist

Answer 11

pramipexole (mirapex)

Question 12

what is pramipexole (mirapex) MOA

Answer 12

directly activates dopamine receptors by mimicking dopamine

Question 13

what is a unique adverse effect with mirapex

Answer 13

can cause sleep attacks!

Question 14

what are 4 nursing considerations with pramipexole

Answer 14

• don’t take with sedating meds or alcohol
• don’t drive
• discontinue if sleep attacks occur
• monitor BP regularly, advise patients to change positions slowly

Question 15

what kind of drug is Selegiline (deprenyl)

Answer 15

MAO-B inhibitor

Question 16

what is MAO-B

Answer 16

an enzyme that breaks down and inactivates dopamine in the brain

Question 17

whats the difference between decarboxylase and MAO-B

Answer 17

decarboxylase is an enzyme that converts levodopa into dopamine, but does it outside the BBB so the dopamine goes to other parts of the body leaving little to actually cross the BBB. inhibiting it will allow more levodopa to actually get to the Brian.

MAO-B is an enzyme that breaks down and inactivates dopamine.

Question 18

which drug can help slow disease progression in newly diagnosed parkinsons patients?

Answer 18

selegiline/ deprenyl

Question 19

what are some adverse effects for selegiline

Answer 19

insomnia, hypertensive crisis in high doses, down give with SSRIs (serotonin syndrome), can worsen adverse effects for levodopa
risk for falls

Question 20

how long do benefits of selegiline usually last

Answer 20

only about 12-24 months

Question 21

which if the big 3 Parkinsons symptoms do anticholinergics NOT improve

Answer 21

bradykinesia

Question 22

what are the anticholinergic side effects

Answer 22

mad, hot, dry, cant see, cant shit, cant piss

Question 23

why d0 anticholinergics help with Parkinson’s

Answer 23

blocks acetylcholine, corrects nt imbalance by focusing on acetylcholine.

Question 24

what is methylprednisone (soiu-medrol)

Answer 24

IV form of prednisone

Question 25

what are some monitoring paremeters for a patient on methylprednisone

Answer 25

mainly monitor for acute infection because its a pretty intense immunosuppressant
- fever
- UTI
- increased WBC
- cough
- pain/swelling

Question 26

what do interferon beta drugs (Betaseron) do and how do they help with MS

Answer 26

its an immunomodulator (very soft immunosuppressant )
MS is autoimmune which means the immune system is being dramatic, so this drug weakens the immune system a bit so that the patient gets relief of symptoms

Question 27

which meds should you not take with betaseron

Answer 27

hepatotoxic meds and other immunosuppressants

Question 28

which MS treating drug is similar to chemotherapy and originally made for cancer treatment

Answer 28

mitoxantrone (novantrone)

Question 29

what is the MOA of novantrone

Answer 29

it stops DNA replication of all rapidly dividing cells, especially immune cells
its good for MS because it basically destroys rapidly dividing immune cells

Question 30

what are 4 big adverse effects with mitoxantrone

Answer 30

• myelosupression (toxic to bone marrow cells because they are rapidly dividing and making blood cells)
• cardiotoxicity: monitor HR and BP (could lower ejection fraction)
• teratogenic so no preggo
• hair loss, N/V, cold sores

Question 31

what kind of drugs (class) is baclofen/Lioresel

Answer 31

it is a GABA agonist

Question 32

what is the MOA of baclofen/lioresel

Answer 32

it is a GABA agonist. GABA is inhibitory so it stops unnecessary excitation of the skeletal muscles. i

Question 33

what would adverse effects look like with baclofen/lioresel

Answer 33

• basically could be a little too inhibitory
  if you take with CNS depressants it could cause respiratory depression

if dose is too high it could also cause CNS depression

Question 34

what is Gabapentin (neurotin) and what does it usually treat

Answer 34

It is a GABA analog. it enhances the release of GABA and changes the way nerves send signals to the brain. its great for neuropathic pain