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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
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: