NUR 3145 Pharmacology Exam 3 Questions And
Answers
Parkinson's Disease Medications ANS Mechanism of action: increase levels of dopamine and/or
antagonize effects of Ach
Indirect acting dopaminergic drugs ANS selegiline (Zelapar) -indirect acting dopamine receptor
agonists (MAO-B inhibitor); inhibits the action of the enzyme monoamine oxidase; primary role of
MAO is the breakdown of catecholamines; prevents breakdown of lepadopa
used in early stage ; adjunct drug.
Adverse effect: interaction with tyramine foods;(cheese; wine, beer , yogurt) produces severe
hypertension
MAO (monoamine oxidase) causes ANS the breakdown of catecholamines in the body; the
catecholamines are epi; norepi; and dopamine.
MAO inhibitors ; selegiline and rasagiline causes an increase in the levels of dopaminergic
stimulation in the CNS; both are approved for use in combo with carbidopa-levodopa; do not use
concurrently with meperidine
Dopamine Modulator: ANS amantadine (Symmetrel) - anti viral used in the early stage; nerve
fibers release dopamine in the basal ganglia & blocks the reuptake of dopamine reduces tremor and
rigidity; also used for influenza; effective for 6-8 months.
Adverse effects: dizziness, insomnia and nausea; this med has anticholinergic effects, if used with
other anticholinergic meds will have additive effects
COMT Inhibitor: both drugs block COMT ANS talcapone (Tasmar)- adjunct drug to carbidopa-
levodopa; treats symptoms; levodopa dose-sparing effect. Works both centrally and peripherally
entacapone (Comtan) - adjunct; Works only peripherally, can not cross BBB
Adverse effect: GI upset, urine discoloration; associated with severe liver failure.
Direct acting dopamine receptor agonist
,first line agents; stimulate pre/post synaptic dopamine receptors in the brain stimulate production of
more dopamine; all dopamine agonists ANS
direct acting dopamine receptor agonists (drugs) ANS bromocriptine (Parlodel)..Adverse effects:
ataxia, dizziness, headache, depression, Caution: can produce vasoconstriction in peripheral tissues;
can worsen PVD
Pramipexole (Mirapex)..Adverse Effects: edema, fatigue, syncope, dizziness, drowsiness
Ropinirole (Requip)..Adverse effects: drowsiness; ortho hypotension
Dopamine replacement drugs: ANS carbidopa-levodopa (Sinemet) - drug of choice for elderly
patients; used when patient functionally impaired. Carbidopa prevents breakdown in periphery and
thus prevents s/s of too much levodopa and also requires lesser dose of levodopa
Large doses of levodopa:
involuntary movements, GI distress, hypotension and cardiac arrhythmias
Adverse effects: palpitations, hypotension, urinary retention, depression, dyskinesia
parkinsons adjunct meds Anti-cholinergic Drugs ANS Cogentin (benztropine): secondary drug
for tremor/muscle rigidity; action is to block acetylcholine; does not help bradykinesia; meds can
cross the BBB
parkinson adjunct meds: Antihistamines:
Benadryl (diphenhydramine): secondary drug for tremor/muscle rigidity; decreases dyskinesia;
anticholinergic properties
Adverse effects: urinary retention, confusion, visual blurring, palpitations, and increased intraocular
pressure ANS
Nursing Care ANS Monitor for adverse effects of medications.
, Urinary retention, dry mouth, hypotension, dizziness, orthostatic hypotension, constipation, loss of
appetite, confusion.
Obtain history and physical assessment.
Administer medications on time, even 30 minutes late can result in a decrease in function or being
"off" for hours
Monitor liver function.
Do not allow the elderly patient on anticholinergics (Cogentin benztropine) to become overheated.
Teach patient to avoid alcohol, OTC drugs, and herbal meds unless approved by care provider.
Monitor carefully when dopaminergic medications are begun. ANS Assistance with walking due
to dizziness and syncope SE
Give medication 30 minutes before a high protein meal
Drink 3,000cc/day
Include foods that are natural laxatives
For dry mouth give fluids, hard candy
May take several weeks to become effective
Anticholinergic drugs should be taken after meals and at bedtime.
Take bromocriptine as directed and with a snack
MAO-B inhibitors should be taken exactly as ordered; given in the am before breakfast and without
food or drink .
Change positions slowly to avoid ortho hypotension.
Assistance with walking due to dizziness and syncope SE
Give medication 30 minutes before a high protein meal
Drink 3,000cc/day
Answers
Parkinson's Disease Medications ANS Mechanism of action: increase levels of dopamine and/or
antagonize effects of Ach
Indirect acting dopaminergic drugs ANS selegiline (Zelapar) -indirect acting dopamine receptor
agonists (MAO-B inhibitor); inhibits the action of the enzyme monoamine oxidase; primary role of
MAO is the breakdown of catecholamines; prevents breakdown of lepadopa
used in early stage ; adjunct drug.
Adverse effect: interaction with tyramine foods;(cheese; wine, beer , yogurt) produces severe
hypertension
MAO (monoamine oxidase) causes ANS the breakdown of catecholamines in the body; the
catecholamines are epi; norepi; and dopamine.
MAO inhibitors ; selegiline and rasagiline causes an increase in the levels of dopaminergic
stimulation in the CNS; both are approved for use in combo with carbidopa-levodopa; do not use
concurrently with meperidine
Dopamine Modulator: ANS amantadine (Symmetrel) - anti viral used in the early stage; nerve
fibers release dopamine in the basal ganglia & blocks the reuptake of dopamine reduces tremor and
rigidity; also used for influenza; effective for 6-8 months.
Adverse effects: dizziness, insomnia and nausea; this med has anticholinergic effects, if used with
other anticholinergic meds will have additive effects
COMT Inhibitor: both drugs block COMT ANS talcapone (Tasmar)- adjunct drug to carbidopa-
levodopa; treats symptoms; levodopa dose-sparing effect. Works both centrally and peripherally
entacapone (Comtan) - adjunct; Works only peripherally, can not cross BBB
Adverse effect: GI upset, urine discoloration; associated with severe liver failure.
Direct acting dopamine receptor agonist
,first line agents; stimulate pre/post synaptic dopamine receptors in the brain stimulate production of
more dopamine; all dopamine agonists ANS
direct acting dopamine receptor agonists (drugs) ANS bromocriptine (Parlodel)..Adverse effects:
ataxia, dizziness, headache, depression, Caution: can produce vasoconstriction in peripheral tissues;
can worsen PVD
Pramipexole (Mirapex)..Adverse Effects: edema, fatigue, syncope, dizziness, drowsiness
Ropinirole (Requip)..Adverse effects: drowsiness; ortho hypotension
Dopamine replacement drugs: ANS carbidopa-levodopa (Sinemet) - drug of choice for elderly
patients; used when patient functionally impaired. Carbidopa prevents breakdown in periphery and
thus prevents s/s of too much levodopa and also requires lesser dose of levodopa
Large doses of levodopa:
involuntary movements, GI distress, hypotension and cardiac arrhythmias
Adverse effects: palpitations, hypotension, urinary retention, depression, dyskinesia
parkinsons adjunct meds Anti-cholinergic Drugs ANS Cogentin (benztropine): secondary drug
for tremor/muscle rigidity; action is to block acetylcholine; does not help bradykinesia; meds can
cross the BBB
parkinson adjunct meds: Antihistamines:
Benadryl (diphenhydramine): secondary drug for tremor/muscle rigidity; decreases dyskinesia;
anticholinergic properties
Adverse effects: urinary retention, confusion, visual blurring, palpitations, and increased intraocular
pressure ANS
Nursing Care ANS Monitor for adverse effects of medications.
, Urinary retention, dry mouth, hypotension, dizziness, orthostatic hypotension, constipation, loss of
appetite, confusion.
Obtain history and physical assessment.
Administer medications on time, even 30 minutes late can result in a decrease in function or being
"off" for hours
Monitor liver function.
Do not allow the elderly patient on anticholinergics (Cogentin benztropine) to become overheated.
Teach patient to avoid alcohol, OTC drugs, and herbal meds unless approved by care provider.
Monitor carefully when dopaminergic medications are begun. ANS Assistance with walking due
to dizziness and syncope SE
Give medication 30 minutes before a high protein meal
Drink 3,000cc/day
Include foods that are natural laxatives
For dry mouth give fluids, hard candy
May take several weeks to become effective
Anticholinergic drugs should be taken after meals and at bedtime.
Take bromocriptine as directed and with a snack
MAO-B inhibitors should be taken exactly as ordered; given in the am before breakfast and without
food or drink .
Change positions slowly to avoid ortho hypotension.
Assistance with walking due to dizziness and syncope SE
Give medication 30 minutes before a high protein meal
Drink 3,000cc/day
