Levodopa
Cornerstone of Parkinson's Disease treatment
Promotes synthesis of dopamine
Therapeutic effects may take months
Decreased benefits over time
Dyskinesias
Carbidopa
Decreases destruction of dopamine so more can enter the brain
Decreases body's tolerance to levodopa
Dyskinesias occur sooner and may be more intense
,Dopamine Agonists
Directly activate dopamine receptors in striatum
Pramipexole (Mirapex)
Do not require enzymatic conversion, do not convert to toxic metabolites, do not
compete with dietary proteins, decreased dyskinesias
Disadvantages include somnolence, hypotension, syncope, hallucinations, addictive
behavior
COMT inhibitors
Used with levodopa, inhibit the metabolism of levodopa
Entacapone (Comtan)
Increases levels of levodopa avilable
Causes n/v, diarrhea, constipation, yellow-orange urine, dyskinesias, hallucinations,
sleep disturbances, orthostatic hypotension
Mechanism of action TCAs
Inhibits reuptake of norepinephrine and serotonin into presynaptic nerve terminals
Directly blocks histamine, acetylcholine, and norepinephrine receptors
Nursing Care TCAs
Check baseline affect prior to administration
Limit drug access to suicidal patients
Maintain initial dosage for 4-8 weeks
Take with food
Patient Education TCAs
Bedtime dosing
Food w/ drugs
Void prior to dosing
Inform PCP of worsening depression or suicidal thoughts
Avoid alcohol, CNS depressants
Mechanism of action levodopa
Promotes synthesis of dopamine
Decreased benefit over time
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