Parkinson's/MS/Epilepsy Drug Info Cards
- Goldfarb School of Nursing
- Nursing Pharmacology
- Parkinson's/MS/Epilepsy Drug Info Cards
Last Modified: 2012-07-16
Related Textbooks:Pharmacology and the Nursing Process
What is the Therapeutic goal for Parkinson’s Disease?
To improve the activities of daily living
b/c we can’t cure, can only decease symptoms
What are the symptoms of Parkinson’s Disease?
Motor symptoms resulting from damage to extrapryamidal sys EPS (brain)
Dyskineasia (rest tremors & rigidity)
Bradykineasia (slow shuffle & stooped)
Akinesia (Absence of movement – no expression)
What is the most and 2nd most common neurodegenerative disorder?
What are some Nursing Implications in Administration of drugs for Parkinson’s disease?
What types of drugs are given for Parkinson’s Disease & what is the best drug?
Dopaminergic – promote activ dop receptors (levadopa)
Anticholinergic – prevent activ cholinergic receptors (benztropine). Don’t use b/c poor Pt adherence b/c of SE’s.
BEST – Sinemet (combo levadopa & carbidopa)
Why is the combo of levadopa & carbidopa better than levadopa alone?
B/c carbidopa prevents peripheral metabolism of levadopa & allows it to cross the BBB. Carbidopa has no benefits of its own.
How are drug selection and dosages determined in Parkinson’s patients?
By activities of daily living performance
Inflammation & myeline sheath destruction in the CNS
- Primary progressive (Symp progressively ↑ intense, no clear remissions)
- Secondary progressive (Relap/Remit, ↓ func)
- Progressive-relapsing (rare, acute exacerbat on Prim Prog)
- Relapsing-remitting (def episodes separated by periods partial/full recovery)
- Interferons (possible)
- High-dose glucocorticoids (methylprednisolone)
- Depression - Antidepressants
- Fatigue - Methylphenidate (Ritalin) & Modafinil (Provigil)
- Neuropathic pain (Burning, numbness & tingling) - AED drugs (tegretol, gabapentin)
*Absence (Petit Mal) *Atonic (Drop Attack)
*Myclonic (Sud isolated musc contrac)
*Status epilepticus (more than 30 mins; in ER)
- Motor - Thumb twitch
- Sensory - numbness/olfactory hallucination
- Autonomic - nausea, flushing, salivation
Does NOT put them at high risk for developing epilepsy later on
Nurse Implications - Explain its frightening, but not hi risk, protect when happens
- ↓ seizures to an extent that enables normal or near-normal life
- Ideal - eliminate seizures, but might not be possible b/c of drug SEs
*Promote Pt adherence *Spontaneous remission could occur
*Potential for suicidal ideations - contact nurse to adjust dosage
*Withdrawal AEDs see separate slide w info
- Must be done slowly (over 6-36 weeks)
- If on more than 1 agent, withdrawal individually
- Must keep a seizure diary
- Phenytoin (Dilantin, Phenytek)
- Target Serum levels are 10-20 mcg/mL
- Most widely used AED
- Few - Phenytoin is relatively selective
- Sedation - higher doses
- Gengival Hyperplasia (Gums grow big & fat)
- Teratogenic effects of Cleft Palate & Heart Malformations
- Carbamazepine (Tegretol) - similar to Phenytoin
- Valproic Acid (Depakote) - Bipolar/Migraine. Gen well tolerated. Teratogenic=neural tube defects
- Phenobarbital - Oldest AED. Cheap,effective,1/day dosing. Maj SE=CNS depression (drowsiness/sedation) Terat
Seizure more harmful to baby than teratogenic effects. To ↓ AED teratogenic effects: *↓ to 1 AED med *Use lowest effective dose *Sup folic acid (2mg/day; 5x usual dose)
What are major SE’s for Sinimet (Parkinson’s)?
Dyskineasia (Head bob, tick)
Nausea & Vomitting
Dysrhythmias (not rate, but rhythm)
Psych disturbances (Depression/Hallucinations)
List the major drug interactions for Sinemet (Parkinson’s)?
MAOI – cause hypertensive crisis (MI/stroke)
Anticholinergics – decrease effectiveness of Sinemet
Antipsychotics – decrease effectiveness of Sinemet
What is the major contraindication for Sinemet?
Malignant Melanoma – activates the neoplasm
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