AntiParkinsonian Drugs
Parkinson Drug Classification to decrease tremors and rigidity (NO CURE)
Parkinson is a disease where dopamine cell in an area called substantia nigra (part of Basal Ganglia-lower cerebrum) begin to die.
Clinical Manifestations is T.R.A.P. (Tremor, Rigidity, Akinesia, Posture)
Walk slow dragging feet (gait), slow movement (bradykinesia), no movement (akinesia), stiff (rigidity), hand tremor (pill rolling) 1 Carbidopa/Levodopa-Sinemet-Antiparkinsonian Drug
Combination drug that brings in dopamine precursor and allows the
use for inside the brain and not in the other tissues
Keeps the ratio of acetylcholine down by being against it so that it is
3 Amantadine-Symmetrel-Antiviral
This antiviral discovered accidently to help increase dopamine
release. It blocks the uptake of catecholamines which dopamine is.
4 Ropinerole-Requip-Dopamine Receptor Agonist
Increase sensitivity and receptors for dopamine. Helps the receptor
5 Selegiline-Eldepryl-MOB Inhibitor
6 Tasmar-Tolcapone-COM Inhibitor
Blue-Generic Red-Brand Green-Class (Table)
1) In order to treat parkinson’s the pharmacological drug generic name carbidopa-levodopa is used. The brand name is Sinemet. This combined therapy drug uses Levodopa (precursor to dopamine) and carbidopa (allows for dopamine use in the brain) Levodopa (dopamine precursor) is good because unlike most drugs it is able to cross the blood brain barrier and insert its effects in brain Carbidopa-Levodopa brings a precursor of dopamine that turns into more dopamine as an external supply for the loss the body is experiencing. More dopamine is available from the drug Sinemet. Sinemet causes constipation, dry mouth, orthostatic hypotension. (1st and 2nd symptom are related 3rd symptom from standing) Avoid vitamins like B6 and cereal because it reduces effect. Provide fluids and candy for 1st and 2nd symptom. Stand slowly for 3rd symptom 2) Anticholinergic is another drug. Means ANTI ACETYLCHOLINE. Because dopamine is lacking you want to bring acetylcholine down as well Acetylcholine is the neurotransmitter that muscles of movement use at the muscle surface Very smart to use both anticholinergics with Sinemet. Anticholinergics DRY you up. Urinary retention, blurred vision. Do not give to benign prostatic hypertrophy or glaucoma. They decrease tremors (unwanted movement) and rigidity (stiffness) 3) Amantadine is an antiviral but it has some neural activity. It blocks uptake of catecholamines (neurotransmitter of fight or flight - epinephrine and norepinephrine and dopamine. Those three types come from amino acid phenylalanine-tyrosine) Only effective for short times. 4) Dopamine receptor agonist. Requip (good for Restless Leg Syndrome). Stimulate dopamine receptors. Side effect of hallucination and other neurological problems Increase compulsive behavior and disorder (i.e. gambling) 5) MOB Inhibitor block dopamine breakdown (Monoamine Oxidase B Inhibitor) Like eldepryl No to many foods, cheese, wine Mention that MOA Inhibitor has tons of side effects and so does the MOB Inhibitor 6) C.O.M. Inhibitor Inhibit C.O.M (Catecol-O-Methyltransferase) COM breaks down dopamine, by using this less dopamine breakdown Tasmar is an example Causes liver failure, jaundice There are surgical procedures and deep brain stimulation to consider (video showed how one man suffers dyskinesia but can stand with it) Thalotomy and Fetal tissue transplant (like stem cell)
Patients may have aspiration from the difficulty of swallowing. Out of bed in chair, avoid loose liquids. Do chin tuck technique when swallowing to prevent aspirations. Speech pathology needed if swallow problem. Coughing, lungs, shortness of breath, maybe aspiration pneumonia (but fever and WBC goes up), altered consciousness from O2 loss Help patients in walking. Remind patient to lift feet when walking. Move arm side to side, put had behind back to straighten posture. Help with tremors by doing an activity such as playing with change in pocket or minor movements. Kinesia problems include bradykinesia or akinesia (no movement). Sometimes help is needed in initiating the movement but don’t push them so that they fall. Things to help and watch for Prevent urinary retention will prevent UTI. Promote self-care for the capable. Voice becomes weak so singing out loud programs will help. Tai chi, yoga, and dance therapy help keep them moving and forming that rigidity. Preventing aspiration Maintaining safety Facilitating communication Promoting elimination Maximizing nutrition Promoting self-care Depression from coping with problems Constipation Orthostatic Hypotension
Clasificación clínica, etiológica, anatómica y fisiopatológica (CEAP) y escalas de gravedad de los trastornos venosos crónicos La necesidad de una clasificación internacional de los trastornos venosos crónicos diolugar a una revisión reciente. Si se le agregan las escalas de gravedad, se convierte enuna herramienta de trabajo en común. La clasificación CEAP consta de cuatroparáme
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