(pharm) Ch 48: Drug Therapy for Parkinson's Disease, Urinary Spasticity, and Disorders Requiring Anticholinergic Therapy

D (Contraindications to therapy include narrow-angle glaucoma; severe cardiac, renal, hepatic disease; and suspicious skin lesions (activates malignant melanoma))

Before administering carbidopa-levodopa for the treatment of Parkinson's disease, it is most important for the nurse to assess the patient for a history of A. pulmonary disease. B. diabetes mellitus. C. allergy to penicillin. D. glaucoma.

Parkinson's disease

Chronic, progressive, degenerative disorder of the CNS characterized by resting tremor, bradykinesia, rigidity, and postural instability. -people with this disease have not enough dopamine and too much acetylcholine -treatment includes: anticholinergics, dopamine replacement & agonists, MAO-B inhibitors, and COMT inhibitors.

carbidopa. tolcapone.

Levodopa is metabolized extensively by the enzyme aromatic amino acid decarboxylase (AADC) and to a lesser extent by catechol-O-methyltransferase (COMT) -_____________ is a AADC inhibitor that prevents breakdown of levodopa and therefore makes more of it available (more dopamine available) -______________ is a COMT inhibitor that also prevents levodopa breakdown and makes more dopamine available.

benztropine mesylate (Cogentin)

Older anticholinergic drugs (like atropine) are rarely used to treat PD because of undesirable peripheral effects (dry mouth, blurred vision, photophobia, constipation, urinary retention, tachycardia). Instead, newer, centrally acting anticholinergic drugs are used. The prototype centrally acting anticholinergic agent is __________________. (contraindications include: glaucoma, GI obstruction, prostatic hypertrophy, urinary black neck obstruction and myasthenia gravis)

A

The 56-year-old man is taking levodopa/carbidopa for Parkinson's disease. During the therapy, he becomes light-headed and dizzy. Which of the following is a potentially serious adverse effect of the drug treatment? A. orthostatic hypotension B. diminished fluid volume C. hematuria D. jaundice

A, C, D (Anticholinergic drugs are used in idiopathic parkinsonism to decrease salivation, spasticity, and tremors. The therapy would cause dry mouth and urinary retention.)

The therapeutic goals for use of anticholinergic drugs in the treatment for parkinsonism is to decrease what symptomology? Select all that apply. A) fine tremors B) dry mouth C) salivation D) muscle spasticity E) urinary retention

A (A statement from the patient such as "I know I need to take this drug once a day" indicates that more teaching is needed because carbidopa/levodopa has a short half-life and must be taken three or four times per day. The other answers are true.)

Which comment to the nurse indicates more teaching is needed for a patient taking carbidopa/levodopa? A."I know I need to take this drug once a day." B."I know I shouldn't stop taking this drug abruptly." C."I understand my urine may become dark and discolored." D."I know it may take a few weeks or months to control my symptoms."

C (It is most important for the nurse to monitor the patient taking carbidopa/levodopa for agranulocytosis (decreased white blood cells), which is life-threatening. Dysphagia, increased libido, and urinary retention are not life-threatening.)

Which side effect/adverse effect of carbidopa/levodopa does the nurse realize is most important to monitor? A. Dysphagia B. Increased libido C. Agranulocytosis D. Urinary retention

Tolcapone (Tasmar)

______________ is the prototype COMT inhibitor. -increases levels of dopamine in the brain -only administered in conjunction with levodopa-carbidopa, and a reduction in levodopa is required. -contraindication for liver disease (check liver enzymes!) -taper to prevent withdrawal -take BP lying down, sitting, and standing up

atropine sulfate

______________ is the protoype of the anticholinergic drugs, a naturally occurring belladonna alkaloid. -also classified as a muscarinic antagonist. -depresses salivary and bronchial secretions, dilates bronchi, increases cardiac output. -antidote for mushroom poisoning and parasympathomimetic drugs

Ropinorole (Requip)

_______________ is a dopamine agonist (mimics action of dopamine) -For both early and late PD -Can increase incidence of dyskinesias and hallucinations

Oxybutynin (Ditropan)

_______________ is the prototype anticholinergic urinary antispasmodic drug. -Use in combination with phenothiazines results in increased anticholinergic effects. -The phenothiazines inhibit the cytochrome 450 enzyme CYP3A4 in the liver.

Levodopa/Carbidopa (Sinemet)

_______________ is well established as the most effective drug for symptomatic treatment of Parkinson's Disease. -"The Gold Standard"

anticholinergic

_________________ drugs inhibit the action of acetylcholine and decrease parasympathetic effects. -also called antimuscarinic drugs -when given in high doses, can block nicotinic receptors. -can be used for antispasmodic effects in GI disorders and overactive urinary bladder. -not as effective as dopaminergic for PD

anticholinergic

__________________ effects related to the eyes: -mydriasis (dilation of pupils) -cycloplegia (accommodation paralysis) -normally this drug doesn't change intraocular pressure (IOP), but with narrow angle glaucoma, they may increase IOP and precipitate an episode of acute glaucoma.

Anticholinergic

_____________________ drugs are the drugs of choice for their antispasmodic effects on smooth muscle to relieve the symptoms of urinary incontinence and frequency that accompany an overactive bladder. oxybutynin (Ditropan) is the prototype for this use.

Anticholinergic

______________________ drugs are contraindicated for clients with BPH, myasthenia gravis, hyperthyroidism, narrow-angle glaucoma, tachydysrhythmias, myocardial infarction, heart failure, or conditions associated with esophageal reflux.

Levodopa/Carbidopa (Sinemet)

because of the adverse effects and recurrence of parkinsonism symptoms after a few years of ______________ therapy, it is usually reserved for pts with significant symptoms. Side effects include: -orthostatic hypotension -head bobbing indicates on-off effect -fatigue, insomnia -dry mouth -heat intolerance

Levodopa/Carbidopa (Sinemet)

contraindications to _________________: -glaucoma -history of melanoma -use of MAO inhibitors -not given with iron preparations or multivitamin-mineral preparations that contain iron. -not taken with a high protein meal -adequate hydration is necessary

anticholinergic

side effects of ______________ drugs: -Blurred vision -Increases IOP -Dizziness; drowsiness -Decrease saliva -Flushing -Tachycardia -Urinary retention/constipation -Anhidrosis

anticholinergic

the ______________ overdose syndrome is characterized by: -hyperthermia -hot, dry, flushed skin -dry mouth -mydriasis -delirium -tachycardia -paralytic ileus -urinary retention -seizures, coma, cardiac arrest -use activated charcoal to absorb ingested drug or use physostigmine as the antidote.

A

A 46-year-old woman is taking benztropine mesylate (Cogentin). The nurse teaches her which of the following? A. avoid overheating and stay well hydrated B. double the dose with excess secretions C. report diarrhea to the prescriber D. administer benztropine with phenothiazines

C

A 65 year old woman has been taking levodopa for several weeks for symptoms of Parkinson's disease. Which of the following symptoms indicate she is not receiving an adequate dose for the treatment of her symptoms? A. edema of the feet and ankles B. widened QRS complex C. static gait D. increased intraocular pressure

A

A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa? A) Pyridoxine (vitamin B6) B) Cyanocobalamin (vitamin B12) C) Phylloquinone (vitamin K1) D) Ascorbic acid (vitamin C)

B (Anticholinergic drugs are given preoperatively to prevent anesthesia-associated complications such as bradycardia, excessive respiratory secretions, and hypotension.)

A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication? A) Tachycardia B) Bradycardia C) Hypertension D) Dehydration

A, B, C

A nurse is making a care plan for a client with Parkinson's disease and has started on an antiparkinson medication. Which nursing diagnosis would be appropriate for this client's care plan? (Select all that apply.) A) Imbalanced Nutrition: Less than Body Requirements B) Altered Bowel Movements: Constipation C) Risk for Injury D) Altered Bowel Movements: Diarrhea E) Imbalanced Nutrition: More than Body Requirements

C

A patient is taking benztropine mesylate (Cogentin) and reports GI upset following administration of the medication. The nurse teaches the patient to do what? A. take the medication prior to eating B. take the medication before bed C. take the medication with food D. take the medication with Maalox