Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Nearly one million people in the US are living with Parkinson’s disease. The cause is unknown, and although there is presently no cure, there are treatment options such as medication and surgery to manage its symptoms.
Parkinson’s Disease Foundation, 2016
Parkinson’s Disease:
- Idiopathic degenerative disorder of CNS from loss of dopamine-secreting neurons in the substantia nigra
- – Clinical presentation: resting tremor, rigidity, bradykinesia, postural disturbances
- Therapeutic goals: Improve ADL’s
Dopaminergic Drugs:
- Activates dopamine receptors, increase dopamine levels, inhibit actions of ACH
- LEVODOPA: metabolic precursor of dopamine that crosses the BBB, converted to dopamine once in the brain. Disappointing long term effects such as “wearing-off” and “on-off” phenomenon. 2% reaches the brain
- CARBIDOPA-LEVODOPA: carbidopa prevents levodopa from getting destroyed by decarboxylase enzymes in the peripheral blood. Allows for lower dose of levodopa and less side effects
- Major side effects: N/V, dyskinesias, orthostatic hypotension
Anticholinergic Drugs:
- Decreases effects of ACH
- Can reduce tremor, possibly rigidity, but not bradykinesia
- Less effective than dopaminergic drugs
- Most used: BENZOTROPINE (COGENTIN) and TRIHEXYPHENIDYL (ARTANE)
- Major side effects: dry mouth, blurred vision, tachycardia, constipation, urinary retention, decreased sweating, increased body temp
COMT Inhibitors
- inhibit metabolism of levodopa in the periphery
- have no therapeutic effects of their own
- ENTACAPONE and TOLCAPONE
MAO-B Inhibitors
- inhibit inactivation of dopamine in the brain
- when combined with levodopa, can reduce “wearing off” effect
- SELEGILLINE (ELDEPRYL)
Source: Lehne’s Pharmacology for Nursing Care, 9th Edition. Burchum and Rosenthal, Chapter 21. | Medical-Surgical Nursing : Assessment and Management of Clinical Problems, 10th Ed (Lewis)
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