NURS 761PharmacotherapeuticsCentral Nervous System DrugsDrugs for Chronic Neurologic Conditions – Part 3Parkinson’s, Alzheimer’s, Multiple Sclerosis, Seizure DisordersFall 2018Faculty: Dr. Cheryl OetjenDr. Carol Urban
Learning Objectives1.Identify the action and pharmacologic action of drugs used for chronic neurologic conditions.2.Describe the clinical indications for drugs used for chronic neurologic conditions. 3.Identify patients who are at increased risk for negative outcomes of pharmacotherapeutics with drugs used for chronic neurologic conditions.4.Develop a teaching plan to ensure optimal patient outcomes.
Drugs to Know•Drugs for Parkinson’s•Dopamine replacement: levodopa, levodopa-carbidopa•Dopamine agonists: pramipexole, apomorphine, ropinirole, bromocriptine•Miscellaneous: amantadine, selegiline, entacapone•Anticholinergics: benztropine, trihexyphenidyl•Drugs for Seizure Disorders•phenytoin, fosphenytoin, carbamazepine, oxcarbazepine, ethosuximide, valproic acid, levetiracetam, gabapentin, pregabalin
•Drugs for Alzheimer’s•donepezil, galantamine, rivastigmine•Drugs for Multiple Sclerosis•interferon beta 1-b, glatiramer
Parkinson’s: MOA & Clinical Use•Parkinson’s disease occurs as dopamine is no longer produced in substantia nigra; symptoms don’t usually occur until 80% or more of dopamine is lost
•Dopamine and ACh held in “balance” and loss of dopamine allows ACh to predominate; symptoms of Parkinson’s are often due to this imbalance: dopamine-related motor difficulty (bradykinesia, “pill-rolling” tremors, “cogwheel rigidity”) and cholinergic S/S (SLUDGE)
•Goal of treatment is to slow progression of disease and limit effect on ADLs; dopamine enhancers (agonists), replacement and anticholinergic main drugs used•All patients will eventually need replacement therapy. Levodopa combined with carbidopa used•