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Parkinsons (Nursing Care (Maintain patient dignity and respecting the…

- - - - 60,000 people in the US are diagnosed each year.
      - Men are 150% more likely to have Parkinson's than women.
    - - Parkinson's only progresses to the substantia nigra and cortex over the years.
      - The medulla and particularly the olfactory bulb #
      - Earliest signs may be found in the enteric nervous system
    - - Dopamine producing neurons in the basal ganglia degenerate.
      - When 60-80% of Dopamine producing neurons are damaged the motor symptoms of Parkinson's appear..
      - Particularly in the substantia nigra, neurons that produce dopamine are very concentrated
      - Dopamine helps relay messages between the Substantia Nigra and other parts of the brain to control body movements.
    - - Primary Unknown, Likely genetic.
      - Secondary Toxins, medications, repetitive trauma,infectious conditions, and metabolic conditions.
- - - - Carbidopa-Levodopa: -levodopa synthesized to dopamine in the brain
        -first line drug for Parkinson's treatment and still most effective comes IR and ER
        -Example: Sinemet
        -Carbidopa is decreases nausea from Levodopa and also assists to enhance effect and lower needed dose (80%)
        -Comes in 16hour intestinal infusion pump Duopa
        -high fat and protein foods interfere with absorption
        
        Side effects: nausea, vomiting, loss of appetite, lightheadedness, hypotension, confusion, dyskinesia
        
        Amantadine: -initially developed to treat flu in 1960's
        
        Used with levodopa to treat dyskinesias
        
        only mild relief, used in later stages
        Side effects: nausea, lightheadedness, insomnia, confusion, hallucinations, ankle edema
        
        COMT Inhibitors- only effective as combination with Levodopa
        -COMT is enzyme that converts Levodopa to useless form
        -Examples: Entacapone given with each dose of Levodopa and Tolcapone given 3 times daily
        -Requires initial and every 6 month liver function studies
        -Side effects: Exaggerated dyskinesia, confusion, hallucinations, discoloration of urine, diarrhea
      - Anticholinergic Drugs: -Oldest class of drugs to treat PD -Examples: Artane, Cogentin
        
        Most helpful to younger patients with chief complaint of tremor
        -Side effects: Confusion, Hallucinations, Decreased STM, Dry mouth, Blurry vision, Urinary retention
      - Dopamine Agonists:
        -mimic effects of dopamine without needing conversion
        -Examples: Mirapex, Requip, Neupro Patch, Apomorphine (used as injectable 'rescue' drug for severe 'off' episodes)
        -also first line treatment can be in conjunction with Carbidopa-Levodopa in later stages
        -effective alone in early motor symptom control
        -Side effects: Sleepiness, Visual Hallucinations, Confusion, Ankle edema, Dyskinesia, Compulsive behavior
      - MAO-B Inhibitors- MAO-B is enzyme that breaks down dopamine in brain.
        -Help block destruction of dopamine in the brain
        -Examples: Selegiline, Rasagaline
        -Used early in therapy alone but may be later used in combination with others
        -Side effects: Mild nausea, dry mouth, lightheadedness, constipation, confusion, hallucinations
- - - - MRI- examines brain stucture
      - DaTscan- detects dopamine function in the brain- helps to differentiate Parkinson's from other tremor disorders
        (May only be available at large hospitals)
        #
      - PET and fMRI- examines brain function, not often used except in research