Off extended release tablets work over 4 6 hours but

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

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: