1. Drugs Used for Parkinson’s Disease
Chapter 15
Drugs Used for Parkinson’s Disease
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2. Chapter 15
Lesson 15.1
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3. Objectives
Prepare a list of signs and symptoms of Parkinson’s disease and accurately define the vocabulary used for the pharmacologic agents prescribed and the disease state
Name the neurotransmitter that is found in excess and the neurotransmitter that is deficient in people with parkinsonism
Develop a health teaching plan for an individual being treated with levodopa
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4. Objectives (cont’d)
Describe reasonable expectations of medications prescribed for treatment of Parkinson’s disease
Identify the period necessary for a therapeutic response to be observable when drugs used to treat parkinsonism are initiated
Name the action of carbidopa, levodopa, and apomorphine on neurotransmitters involved in Parkinson’s disease
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5. Parkinson’s Disease
Normally there is balance between neurotransmitters
Dopamine – inhibitory effect
Acetylcholine – excitatory effect
Symptoms caused by the deterioration of dopaminergic neurons with resulting deficiency in dopamine
Two types of parkinsonism
Primary – idiopathic (unknown cause)
Secondary – induced by head trauma, infection, tumors, drug exposure
Chronic progressive disorder of the CNS.
Named after James Parkinson, the English physician who described the “shaking palsy” in 1817.
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6. Parkinson’s Disease Key terms
Tremors – occur at rest, start in hand, face
Dyskinesia – loss of voluntary movement, slow and jerky
Propulsive uncontrolled movement – occurs when mobility had deteriorated to cause patient to have quickened and shortened steps; leads to falls
Akinesia – loss of movement
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7. Drug Therapy for Parkinson’s Disease
Goal is to minimize symptoms, not cure
Restore dopaminergic activity
Restore neurotransmitter function
Slow deterioration of dopaminergic nerve cells
Inhibit excess cholinergic activity (which cause tremors)
All symptoms cannot be eliminated because of adverse drug effects
Effectiveness of therapy may take several weeks
Parkinson’s is individualized and uses a combination of agents because symptoms and disease progression vary greatly among individuals.
Therapy begins when symptoms interfere with the ability to function in daily life.
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8. Management of Parkinson’s Disease
Nonpharmacologic
Education, nutrition, exercise, support services
Pharmacologic
Start neuroprotection drugs (selegiline [Eldepryl, Zelapar])
When function impaired, use dopamine agonists
Add levodopa (Larodopa) and/or COMT inhibitor
Surgery is last resort if symptoms do not improve
Stem cell research is ongoing for treatment of Parkinson’s.
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9. Carbidopa and Levodopa Therapy
Carbidopa and levodopa given in combination
Actions:
Carbidopa reduces the metabolism of levodopa so more of administered levodopa reaches receptor sites
Uses:
Levodopa is used to replace dopamine deficiency in Parkinson’s
Brand names: Sinemet, Parcopa
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10. Carbidopa and Levodopa Therapy (cont’d)
Common adverse effects:
Nausea and vomiting, orthostatic hypotension
Serious adverse effects:
Chewing motions, bobbing, facial grimacing, rocking movements (extrapyramidal symptoms), sudden sleep events, nightmares, depression, confusion, hallucinations, tachycardia, palpitations
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11. Drug Class: Dopamine Agonist
Drug: apomorphine (Apokyn)
Actions
Stimulate dopamine receptors, temporarily restore motor function
Uses
Treat hypomobility associated with the wearing off of dopamine agonists near end of dosage cycle
Administered subcutaneously
Common adverse effects
Nausea, vomiting; orthostatic hypotension
Chemically related to morphine but has no opioid effect.
Serious adverse effects: extrapyramidal symptoms; sudden sleep events, depression, confusion, hallucinations; tachycardia, palpitations, others.
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12. Chapter 15
Lesson 15.2
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13. Objectives
Name the action of entacapone and the monoamine oxidase inhibitors, selegiline and rasagiline, as it relates to treatment of Parkinson’s disease
List symptoms that can be attributed to the cholinergic activity of pharmacologic agents
Cite the specific symptoms that should show improvement when anticholinergic agents are administered to the patient with Parkinson’s disease
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14. Drug Class: COMT Inhibitor
Drugs: entacapone (Comtan, Stalevo)
Action
Reduce destruction of dopamine in peripheral tissues, allowing more to reach the brain
Uses
Added to treatment when carbidopa-levodopa become less effective and adverse effects develop
Common adverse effects
Diarrhea; sedative effects; urine discoloration (brownish orange)
Stalevo is a combination drug containing carbidopa, levodopa, and entacapone.
Serious adverse effects: neurologic effects (chorea, confusion, hallucinations; orthostatic hypotension).
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15. Drug Class: Monoamine Oxidase-B Inhibitors
Drugs: selegiline (Eldepryl), rasagiline (Azilect)
Actions
Reduce metabolism of dopamine in the brain, allow greater dopaminergic activity, considered neuroprotective, which slows the destruction of dopamine neurons
Uses
Added when carbidopa-levodopa loses effectiveness
Common adverse effects
Constipation, stomach upset
Used to improve memory, motor speed, and may increase life expectancy.
Serious adverse effects: neurologic effects (chorea, confusion, hallucinations; orthostatic hypotension).
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16. Drug Class: Anticholinergic Agents
Action
Reduce hyperstimulation caused by excessive acetylcholine
Uses
Reduce the severity of the tremor and drooling associated with parkinsonism
Common adverse effects
Constipation; dryness of mucosa of the mouth, throat and nose; urinary retention; blurred vision
For specific drugs, see Table 15-2.
Less effective for rigidity, bradykinesia, or postural abnormalities.
More useful for patients with minimal symptoms and no cognitive impairment.
Serious adverse effects: nightmares, depression, confusion, hallucinations; orthostatic hypotension, palpitations, dysrhythmias.
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17. Patient Education for Levodopa
Discuss expected therapeutic outcomes
Explain the many adverse effects – most dose-related and reversible
Expect orthostatic hypotension
Rise slowly from supine position or sitting position
If feeling faint, sit or lie down
Monitor blood pressure daily
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