NUR354- EXAM 1 REVIEW
Module 1 & 2
Parkinson’s neurodegenerative disease: LOW dopamine and HIGH ach
**Anti-Parkinson drugs are given to restore the balance of dopamine and Ach in specific
regions of the brain--
**Achieved by either increasing the levels of dopamine (dopamine agonists and MOA-
B inhibitors) or by inhibiting the excitatory actions of ach (cholinergic blockers)
1. BENZTROPINE (COGENTIN):
Anticholinergic side effects: “Can’t pee, can’t see, can’t spit, can’t shit”
Therapeutic Class:
oAnticholinergic Drug to treat Parkinson’s Disease (Anti-Parkinson drug)
Pharmacologic Class:
oCentrally acting cholinergic receptor blocker
Indications:
oParkinson’s Disease—DECREASE tremors, muscle rigidity (extrapyramidal
symptoms)
MOA:
oDECREASES ach in the CNS
oblocking cholinergic activity—causing fight or flight= CONSTIPATION
S/S:
oAnticholinergic effects: “dry you up”
dry mouth, blurry vision, urinary retention, low BP, tachycardia &
CONSTIPATION – paralytic ileus (nursing intervention= increase fiber
and fluids in patients)
AE:
osedation, hallucinations, drowsiness, restlessness, irritability, nervousness,
and insomnia
Contraindications:
oNarrow-angle glaucoma (BLACK BOX WARNING), MG, liver disease, enlarged
prostate, blockage of urinary tract, severe dry mouth, hiatal hernia, severe
constipation.
Nursing:
oTake as directed, avoid driving until response is known, rinse mouth, good
oral hygiene to decrease dry mouth, change positions slowly.
KEY POINTS:
oTo counteract anticholinergic side effects—chew gum, wear sunglasses,
increase fiber and fluid intake
, 2. LEVADOPA-CARBIDOPA (SINEMET):
“CARbidopa and LevoDOPA drive in their car to the park to increase dopamine in Parkinson’s
patients”
Therapeutic Class:
oDopamine agonist to treat Parkinson’s disease (ant-Parkinson’s agent)
Pharmacological Class:
oDopamine precursor; dopamine-enhancing drug combination
MOA:
oINCREASES dopamine in CNS (levodopa converted to dopamine in CNS, and
carbidopa prevents breakdown of levodopa)
Indications:
oParkinson’s disease (decrease tremors and muscle rigidity—DOES NOT
ELIMINATE)
S/S:
oN/V, drowsiness, dyskinesias (tics, tremors) orthostatic HTN, darkening of
urine and sweat, psychosis, diarrhea, sweating, bradycardia
AE:
oHallucinations with higher doses, syncope (fainting—loss of consciousness),
Suicidal ideations, MI, shock, liver failure, sleep attacks, neuroleptic
malignant syndrome
Contraindications:
oPatients with narrow angle glaucoma, suspicious pigmented skin lesions, or a
hx of melanoma (activates malignant melanoma), MAOI antidepressants
Nursing:
oTake with food
oSLOW onset (2-6 weeks for effectiveness)
oNOT elimination of tremors or muscle rigidity—ONLY DECREASES
oNEVER stop abruptly—taper off!
oAvoid with skin lesions that have not been diagnosed— do a full skin
assessment
activates malignant melanoma
oDark (red or brown) urine, sweat, and saliva is normal
KEY POINTS:
oNO high protein meals—they DECREASE the effectiveness of L/C
oImprovement in spontaneous movement (effective for bradykinesia)
** Entacapone will inhibit enzymes that normally destroy levodopa
Alzheimer’s Damage to the brain:
**Alzheimer’s drugs work by intensifying the effect of Ach at central receptors in the brain
**Happens in the CNS (Brain and spinal cord)—Parkinson’s, M.S., & Alzheimer’s
, 3. DONEPEZIL (ARICEPT):
“Don’t FORGET things (like your Pez dispenser) when you take donepezil”
Therapeutic Class:
oAlzheimer’s disease drug
Pharmacological Class:
oCholinesterase inhibitor
MOA:
oinhibits the cholinesterase making more ach available
which may improve memory, cognition, and ability to perform ADL’s
S/S:
oHeadache, diarrhea, N/V, syncope, depression
AE:
oCHOLINERGIC CRISIS: “Too much Rest and digest—cause”
(paRasympathetic)
Increased peristalsis, increased saliva (hypersalivation—drooling),
lowered BP, bronchial constriction, excessive pupil constriction
(miosis), pale, muscle weakness/ twitching, bradycardia, sweating
(diaphoresis)
oBLACK BOX WARNING: hypersensitivity
Contraindications:
oGI bleeding and jaundice patients
Nursing:
oAirway, HR, BP, Neuro, Salivation, bowel sounds, urinary output
KEYPOINTS:
oTake at bedtime
oDonepezil does NOT cure Alzheimer’s disease
oANTIDOTE= ATROPINE
4. GINGKO BILOBA (herb):
oHelps to improve memory restoration, brain function, and enhance
circulation to the brain, hear, limbs, and eyes
oCAM THERAPY for memory
Seizures disturbance of electrical activity in brain:
**Goal of antiseizure pharmacotherapy is to suppress neuronal activity enough to prevent an
abnormal focus from forming or spreading across the cerebrum
Module 1 & 2
Parkinson’s neurodegenerative disease: LOW dopamine and HIGH ach
**Anti-Parkinson drugs are given to restore the balance of dopamine and Ach in specific
regions of the brain--
**Achieved by either increasing the levels of dopamine (dopamine agonists and MOA-
B inhibitors) or by inhibiting the excitatory actions of ach (cholinergic blockers)
1. BENZTROPINE (COGENTIN):
Anticholinergic side effects: “Can’t pee, can’t see, can’t spit, can’t shit”
Therapeutic Class:
oAnticholinergic Drug to treat Parkinson’s Disease (Anti-Parkinson drug)
Pharmacologic Class:
oCentrally acting cholinergic receptor blocker
Indications:
oParkinson’s Disease—DECREASE tremors, muscle rigidity (extrapyramidal
symptoms)
MOA:
oDECREASES ach in the CNS
oblocking cholinergic activity—causing fight or flight= CONSTIPATION
S/S:
oAnticholinergic effects: “dry you up”
dry mouth, blurry vision, urinary retention, low BP, tachycardia &
CONSTIPATION – paralytic ileus (nursing intervention= increase fiber
and fluids in patients)
AE:
osedation, hallucinations, drowsiness, restlessness, irritability, nervousness,
and insomnia
Contraindications:
oNarrow-angle glaucoma (BLACK BOX WARNING), MG, liver disease, enlarged
prostate, blockage of urinary tract, severe dry mouth, hiatal hernia, severe
constipation.
Nursing:
oTake as directed, avoid driving until response is known, rinse mouth, good
oral hygiene to decrease dry mouth, change positions slowly.
KEY POINTS:
oTo counteract anticholinergic side effects—chew gum, wear sunglasses,
increase fiber and fluid intake
, 2. LEVADOPA-CARBIDOPA (SINEMET):
“CARbidopa and LevoDOPA drive in their car to the park to increase dopamine in Parkinson’s
patients”
Therapeutic Class:
oDopamine agonist to treat Parkinson’s disease (ant-Parkinson’s agent)
Pharmacological Class:
oDopamine precursor; dopamine-enhancing drug combination
MOA:
oINCREASES dopamine in CNS (levodopa converted to dopamine in CNS, and
carbidopa prevents breakdown of levodopa)
Indications:
oParkinson’s disease (decrease tremors and muscle rigidity—DOES NOT
ELIMINATE)
S/S:
oN/V, drowsiness, dyskinesias (tics, tremors) orthostatic HTN, darkening of
urine and sweat, psychosis, diarrhea, sweating, bradycardia
AE:
oHallucinations with higher doses, syncope (fainting—loss of consciousness),
Suicidal ideations, MI, shock, liver failure, sleep attacks, neuroleptic
malignant syndrome
Contraindications:
oPatients with narrow angle glaucoma, suspicious pigmented skin lesions, or a
hx of melanoma (activates malignant melanoma), MAOI antidepressants
Nursing:
oTake with food
oSLOW onset (2-6 weeks for effectiveness)
oNOT elimination of tremors or muscle rigidity—ONLY DECREASES
oNEVER stop abruptly—taper off!
oAvoid with skin lesions that have not been diagnosed— do a full skin
assessment
activates malignant melanoma
oDark (red or brown) urine, sweat, and saliva is normal
KEY POINTS:
oNO high protein meals—they DECREASE the effectiveness of L/C
oImprovement in spontaneous movement (effective for bradykinesia)
** Entacapone will inhibit enzymes that normally destroy levodopa
Alzheimer’s Damage to the brain:
**Alzheimer’s drugs work by intensifying the effect of Ach at central receptors in the brain
**Happens in the CNS (Brain and spinal cord)—Parkinson’s, M.S., & Alzheimer’s
, 3. DONEPEZIL (ARICEPT):
“Don’t FORGET things (like your Pez dispenser) when you take donepezil”
Therapeutic Class:
oAlzheimer’s disease drug
Pharmacological Class:
oCholinesterase inhibitor
MOA:
oinhibits the cholinesterase making more ach available
which may improve memory, cognition, and ability to perform ADL’s
S/S:
oHeadache, diarrhea, N/V, syncope, depression
AE:
oCHOLINERGIC CRISIS: “Too much Rest and digest—cause”
(paRasympathetic)
Increased peristalsis, increased saliva (hypersalivation—drooling),
lowered BP, bronchial constriction, excessive pupil constriction
(miosis), pale, muscle weakness/ twitching, bradycardia, sweating
(diaphoresis)
oBLACK BOX WARNING: hypersensitivity
Contraindications:
oGI bleeding and jaundice patients
Nursing:
oAirway, HR, BP, Neuro, Salivation, bowel sounds, urinary output
KEYPOINTS:
oTake at bedtime
oDonepezil does NOT cure Alzheimer’s disease
oANTIDOTE= ATROPINE
4. GINGKO BILOBA (herb):
oHelps to improve memory restoration, brain function, and enhance
circulation to the brain, hear, limbs, and eyes
oCAM THERAPY for memory
Seizures disturbance of electrical activity in brain:
**Goal of antiseizure pharmacotherapy is to suppress neuronal activity enough to prevent an
abnormal focus from forming or spreading across the cerebrum
