NUR 5351 Final Exam Concept Outline
1. Parkinson’s disease, pharmacotherapy, patient teaching
● Patient needs and priorities change throughout disease progression
● Pharmacological treatment is guided by guidelines from Connolly et al
which contains different figures,tables, and algorithms that guide medication
management of parkinson’s
● The MDS released an evidenced based review update in 2018 for motor and
non-motor symptoms
● The American Academy of Neurology lists current parkinson’s disease
guidelines and tools for both health care professionals and patients
● Teach patients about organizations that have patient information including
the American Academy of Neurology, Parkinson’s Disease Foundation, the
Michael J Fox Foundation for Parkinson’s research, National Parkinson
Foundation,
● Nutrition and lifestyle vary based on patient specific factors and should
complement drug therapy
● Some patients will have swallowing difficulties which can be managed with
speech therapy,
● Some patients may be constipated and should increase fiber intake and fluid
intake and can also use pharmacological agents as needed
● Some medications cause nausea and loss of appetite which may diminish
over time, therefore these medications should be taken with a small snack to
alleviate discomfort
● High protein meals decrease the effectiveness of levodopa
● Patients should limit protein ounces to 3-4 ounces per meal (about a deck of
cards) but SHOULD NOT FULLY ELIMINATE PROTEIN FROM THE
DIET
● Levodopa administration should be separated from meals
● Protein consumption should be shifted to the evening
● Iron supplements may also decrease levodopa absorption so patients should
take iron at least 2 hours apart from levodopa
, ● Patients taking MAO-B inhibitors like rasagiline, selegiline, and safinamide
should avoid or limit tyramine rich foods because these can increase the
risks of serotonin syndrome. Foods like this include: aged cheeses, soybean
products, red wine, tap beer, fermented/cured/air dried meats
● PD patients are at higher risk of developing osteoporosis and should
therefore increase their intake of calcium rich foods into their diet like low
fat milk, yogurt, and hard cheeses.
● Patients should also increase intake of vitamin D through diet
● First Line drugs for PD is typically MAO-B inhibitor for mild motor
symptoms
● Patients who are experiencing moderate to severe impairment are typically
started on DA (dopamine agonists) or levodopa. DA’s cause less dyskinesia
and motor fluctuations. An example of one is pramipexole. DAs have no
major drug interactions but caution should be used with antipsychotics
2. Alzheimer’s disease, pharmacotherapy, goals of treatment
● Characterized by slow progressive decline in cognitive functions including
memory and thinking. Patients initially complain of short-term memory loss,
forgetfulness, and a decreased ability to learn and retain new information
● Optimal goal of drug therapy is to maintain and maximize the patient’s
functional ability, quality of life, and independence for as long as possible
while minimizing adverse events and cost
● A multidisciplinary approach to therapy is ideal
● Drug choices for cognitive symptoms are primarily cholinesterase inhibitors
and memantine
● Cholinesterase inhibitors like galantamine slow the progression of cognitive,
functional and behavioral domains, but do not cure the disease
● Mematine (Namenda) treats moderate to severe AD by reducing abundance
of glutamate by blocking NMDA receptor and neuronal degeneration is
inhibited
3. Alcohol use disorder, pharmacotherapy, side effects
● Acamprosate- oral drug indicated for post-withdrawal maintenance of
abstinence from alcohol
, ○ Side effects: excreted renally so not recommended in patients with
CrCl less than 30, patients with severe sulfite sensitivity should not
take, mainly causes diarrhea, insomnia, nausea, pruritis, and asthenia.
Can also cause anxiety, depression, and cardiovascular effects (HTN,
palpitations, vasodilation, syncope, peripheral edema)
● Disulfiram/ Antabuse- designed to aid in treatment of AUD, acts as deterrent
and produces unpleasant effects when alcohol is used with medication cause
disulfiram like reactions, should not be used in acute phase of detox,patient
should be fully ALCOHOL FREE
○ Disulfiram reaction can occur with small amounts of alcohol: causes
flushing, throbbing headache, respiratory difficulty, nausea, vomiting,
and sweating, chest palpitations, dyspnea, and hypertension
○ Severe reactions include respiratory depression, cardiovascular
collapse, arrhythmias and MI.
○ Intensity of reaction varies and is dependent on how much disulfiram
and alcohol is ingested
○ Patient should avoid any alcohol based sources like mouthwash,
cough syrups and sauces
○ Also contraindicated in people with CAD or heart failure and with
underlying psychoses
○ Peripheral neuropathy, optic neuritis, hepatic dysfunction
○ Common adverse events: drowsiness, fatigue, and headache
○ Can also have hepatic dysfunction and optic/peripheral neuritis
● Naltrexone:
○ Indicated for use in people already abstinent from alcohol
○ Generally well tolerated
○ Injection site reactions and pain are most common reactions for
injectable form
○ Headache and nausea
○ Hepatic toxicity
○ Sometimes syncope
4. ADHD, stimulants, side effects
, ● Psychostimulants are drug class of choice to treat adults and children with
ADHD
● I.e. Methylphenidate (Ritalin) or amphetamine, Lisdexamfetamine
(Vyvanse)
● Reuptake dopamine and norepinephrine
● Contraindicated in children with certain comorbidities like anxiety, tension,
agitation, glaucoma, history of tics or Tourette syndrome, existing CVD,
moderate to severe HTN, hyperthyroidism, and history of substance abuse
● MOST COMMON ADVERSE EFFECTS: cardiovascular, GI and
neurologic in nature
● Have sleep disturbance, appetite suppressant, associated weight loss,
agitation, nervousness (these are typically minimized by taking drug with
food and using ER formulation)
● More serious: palpitations, tachycardia, elevations in blood pressure,
rhythm disturbances, cardiomyopathy
● At onset of therapy typically changes in appetite, nausea, vomiting, and
other GI disturbances may occur
● Headaches, dizziness, appetite suppression, tics, dyskinesias, sleep
disturbances, abuse potential and in particular growth retardation in kids
may be of concern
● Diminished growth has been observed in children on higher and more
consistently administered doses
● Some patients will take drug weekends and holidays to minimize this affect
5. Insomnia, pharmacotherapy, first line agents
● Persistent trouble sleeping
● Goals of drug therapy are to improve sleep quality and quantity and to
improve insomnia related daytime impairment
● The key to pharmacotherapy is identifying sleep defect
● For short-term insomnia the recommended meds are:
○ BZRA (benzodiazepine receptor agonist) classes-Zolpidem,
eszopiclone, zaleplon, temazepam -they induce sleepiness by being
selective for alpha-1 receptors
○ Ramelton-melatonin receptor agonists, causes secretion of melatonin
1. Parkinson’s disease, pharmacotherapy, patient teaching
● Patient needs and priorities change throughout disease progression
● Pharmacological treatment is guided by guidelines from Connolly et al
which contains different figures,tables, and algorithms that guide medication
management of parkinson’s
● The MDS released an evidenced based review update in 2018 for motor and
non-motor symptoms
● The American Academy of Neurology lists current parkinson’s disease
guidelines and tools for both health care professionals and patients
● Teach patients about organizations that have patient information including
the American Academy of Neurology, Parkinson’s Disease Foundation, the
Michael J Fox Foundation for Parkinson’s research, National Parkinson
Foundation,
● Nutrition and lifestyle vary based on patient specific factors and should
complement drug therapy
● Some patients will have swallowing difficulties which can be managed with
speech therapy,
● Some patients may be constipated and should increase fiber intake and fluid
intake and can also use pharmacological agents as needed
● Some medications cause nausea and loss of appetite which may diminish
over time, therefore these medications should be taken with a small snack to
alleviate discomfort
● High protein meals decrease the effectiveness of levodopa
● Patients should limit protein ounces to 3-4 ounces per meal (about a deck of
cards) but SHOULD NOT FULLY ELIMINATE PROTEIN FROM THE
DIET
● Levodopa administration should be separated from meals
● Protein consumption should be shifted to the evening
● Iron supplements may also decrease levodopa absorption so patients should
take iron at least 2 hours apart from levodopa
, ● Patients taking MAO-B inhibitors like rasagiline, selegiline, and safinamide
should avoid or limit tyramine rich foods because these can increase the
risks of serotonin syndrome. Foods like this include: aged cheeses, soybean
products, red wine, tap beer, fermented/cured/air dried meats
● PD patients are at higher risk of developing osteoporosis and should
therefore increase their intake of calcium rich foods into their diet like low
fat milk, yogurt, and hard cheeses.
● Patients should also increase intake of vitamin D through diet
● First Line drugs for PD is typically MAO-B inhibitor for mild motor
symptoms
● Patients who are experiencing moderate to severe impairment are typically
started on DA (dopamine agonists) or levodopa. DA’s cause less dyskinesia
and motor fluctuations. An example of one is pramipexole. DAs have no
major drug interactions but caution should be used with antipsychotics
2. Alzheimer’s disease, pharmacotherapy, goals of treatment
● Characterized by slow progressive decline in cognitive functions including
memory and thinking. Patients initially complain of short-term memory loss,
forgetfulness, and a decreased ability to learn and retain new information
● Optimal goal of drug therapy is to maintain and maximize the patient’s
functional ability, quality of life, and independence for as long as possible
while minimizing adverse events and cost
● A multidisciplinary approach to therapy is ideal
● Drug choices for cognitive symptoms are primarily cholinesterase inhibitors
and memantine
● Cholinesterase inhibitors like galantamine slow the progression of cognitive,
functional and behavioral domains, but do not cure the disease
● Mematine (Namenda) treats moderate to severe AD by reducing abundance
of glutamate by blocking NMDA receptor and neuronal degeneration is
inhibited
3. Alcohol use disorder, pharmacotherapy, side effects
● Acamprosate- oral drug indicated for post-withdrawal maintenance of
abstinence from alcohol
, ○ Side effects: excreted renally so not recommended in patients with
CrCl less than 30, patients with severe sulfite sensitivity should not
take, mainly causes diarrhea, insomnia, nausea, pruritis, and asthenia.
Can also cause anxiety, depression, and cardiovascular effects (HTN,
palpitations, vasodilation, syncope, peripheral edema)
● Disulfiram/ Antabuse- designed to aid in treatment of AUD, acts as deterrent
and produces unpleasant effects when alcohol is used with medication cause
disulfiram like reactions, should not be used in acute phase of detox,patient
should be fully ALCOHOL FREE
○ Disulfiram reaction can occur with small amounts of alcohol: causes
flushing, throbbing headache, respiratory difficulty, nausea, vomiting,
and sweating, chest palpitations, dyspnea, and hypertension
○ Severe reactions include respiratory depression, cardiovascular
collapse, arrhythmias and MI.
○ Intensity of reaction varies and is dependent on how much disulfiram
and alcohol is ingested
○ Patient should avoid any alcohol based sources like mouthwash,
cough syrups and sauces
○ Also contraindicated in people with CAD or heart failure and with
underlying psychoses
○ Peripheral neuropathy, optic neuritis, hepatic dysfunction
○ Common adverse events: drowsiness, fatigue, and headache
○ Can also have hepatic dysfunction and optic/peripheral neuritis
● Naltrexone:
○ Indicated for use in people already abstinent from alcohol
○ Generally well tolerated
○ Injection site reactions and pain are most common reactions for
injectable form
○ Headache and nausea
○ Hepatic toxicity
○ Sometimes syncope
4. ADHD, stimulants, side effects
, ● Psychostimulants are drug class of choice to treat adults and children with
ADHD
● I.e. Methylphenidate (Ritalin) or amphetamine, Lisdexamfetamine
(Vyvanse)
● Reuptake dopamine and norepinephrine
● Contraindicated in children with certain comorbidities like anxiety, tension,
agitation, glaucoma, history of tics or Tourette syndrome, existing CVD,
moderate to severe HTN, hyperthyroidism, and history of substance abuse
● MOST COMMON ADVERSE EFFECTS: cardiovascular, GI and
neurologic in nature
● Have sleep disturbance, appetite suppressant, associated weight loss,
agitation, nervousness (these are typically minimized by taking drug with
food and using ER formulation)
● More serious: palpitations, tachycardia, elevations in blood pressure,
rhythm disturbances, cardiomyopathy
● At onset of therapy typically changes in appetite, nausea, vomiting, and
other GI disturbances may occur
● Headaches, dizziness, appetite suppression, tics, dyskinesias, sleep
disturbances, abuse potential and in particular growth retardation in kids
may be of concern
● Diminished growth has been observed in children on higher and more
consistently administered doses
● Some patients will take drug weekends and holidays to minimize this affect
5. Insomnia, pharmacotherapy, first line agents
● Persistent trouble sleeping
● Goals of drug therapy are to improve sleep quality and quantity and to
improve insomnia related daytime impairment
● The key to pharmacotherapy is identifying sleep defect
● For short-term insomnia the recommended meds are:
○ BZRA (benzodiazepine receptor agonist) classes-Zolpidem,
eszopiclone, zaleplon, temazepam -they induce sleepiness by being
selective for alpha-1 receptors
○ Ramelton-melatonin receptor agonists, causes secretion of melatonin
