off Extended release tablets work over 4 6 hours but can take up to 2 hours to

Off extended release tablets work over 4 6 hours but

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off Extended release tablets work over 4-6 hours but can take up to 2 hours to begin working in the morning Complications: Nausea, vomiting, ortho/postural hypotensions, darkening of urine and sweat, dyskinesias, tremors, twitching , other movements, symptoms of psychosis-hallucinations, paranoia serious→ abnormal movement, psychiatric disturbances, cardiac dysrhythmias, on-off effect, neuroleptic malignant syndrome Contraindications and Precautions: Contraindication Narrow angle glaucoma Hx of melanoma Psychosis, suicidal thought Precaution Older adults Existing renal, hepatic, respiratory, or endocrine disorders Wide angle glaucoma Peptic ulcer disease depression Interactions: Traditional (first generation) antipsychotics and supplements with vit B6 decrease levodopa/carbidopa MAOI antidepressants within 2 weeks can cause hypertensive crisis High protein meals decrease levodopa/carbidopa action Anticholinergic drugs increase the response to levodopa/carbidopa Nursing Interventions: GI symptoms → ass carbidopa to levodopa dyskinesias→ decrease levodopa or prescribe amantadine (affects the release of dopamine from nerve endings, so higher level is available in CNS) Hallucinations, paranoia→ second generation antipsychotic Orthostatic hypotension→ precaution measures to prevent falls Evaluation of Medication effectiveness: Client education: Take with food if necessary (avoid high protein foods) Should take on an empty stomach though Dose is titrated, therapy is palliative Urine, sweat may darken (not really a concern though) Move slowly to sitting/standing position, eps when getting out of bed Avoid driving until effects are known Importance of caregiver instructions Additional information: Levodopa is a precursor to dopamine→ when converted to dopamine in the CNS helps balance ACh/Dopamine scale→ need carbidopa to decrease peripheral destruction of levodopa
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Anticholinergics for Parkinson’s Disease: benztropine (Cogentin) These are “adjunct” drugs---why? How do they work and what are the major adverse effects? (Centrally acting anticholinergic) MOA: Block excess cholinergic stimulation of neurons in corpus striatum; inhibit overactivity in brain Expected Pharm Action: Block Ach to restore chemical balance Synthetic drugs that work better in CNS than PNS Decreases salivation Relaxes smooth salivation Therapeutic Uses: Used to treat muscle tremors and muscle rigidity Used in the early stages of parkinson’s Routes of administration/Medication Administration: Dosing schedules vary Parenteral and oral routes Complications: Typical of anticholinergics Dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma Contraindications and Precautions: contraindication→ pts with glaucoma, certain condition of GI tract Interactions: Nursing Interventions: Evaluation of Medication effectiveness: Client education: Additional information:
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