Anti-Parkinson’s Medications

Anti-Parkinson’s Medications

Parkinson’s disease A slowly progressive, degenerative neurologic disorder characterized by resting tremor, pill-rolling of the fingers, masklike faces, shuffling gait, forward flexion of the trunk, loss of postural reflexes, and muscle rigidity and weakness.

Select Prototype Medications:

Dopaminergics: levodopa (Dopar, Larodopa) or levodopa plus carbidopa (Sinemet)

Dopamine agonists: pramipexole (Mirapex)

Centrally acting anticholinergics: benztropine (Cogentin)

Dopamine releaser (Antiviral): amantadine (Symmetrel)

Other Medications:

Dopamine agonists: ropinirole (Requip), bromocriptine (Parlodel)

Centrally acting anticholinergics: trihexyphenidyl (Artane)

These medications do not halt the progression of Parkinson’s disease (PD). However, they do offer symptomatic relief from dyskinesias (bradykinesia, resting tremors, and muscle rigidity) and an increase in the ability to perform (Activities of daily living) ADLs by maintaining the balance between dopamine and acetylcholine in the extrapyramidal nervous system.

Expected Pharmacological Action

Levodopa may be used as a first-line medication for PD treatment.

Pramipexole is used as monotherapy in early-stage PD and used in conjunction with levodopa in late-stage PD. It is used more often in younger clients who are better able to tolerate daytime drowsiness and postural hypotension.

Therapeutic Uses

Levodopa

This medication is Pregnancy Risk Category C.

Contraindicated in clients with malignant melanoma.

Do not use within 2 weeks of MAOI use.

Use cautiously in clients who have heart disease, clients who have psychiatric disorders, and older adult clients.

Contraindications/Precautions

Pramipexole

This medication is Pregnancy Risk Category C.

Use cautiously in clients with liver and kidney impairment.

Benztropine

Contraindicated in clients with narrow-angle glaucoma

Use cautiously in older adults, the very young, and in clients who have enlarged prostate glands and a history of urinary retention.

Contraindications/Precautions

Interactions

Instruct family members to assist clients with the medication at home.

Instruct clients about the possible sudden loss of the effects of medication and to notify the provider if symptoms occur.

Inform clients that effects may not be noticeable for several weeks to several months.

Medication “holidays” may be indicated, but must be monitored in a hospital setting.

Advise clients to avoid high-protein meals and snacks.

Nursing Administration

Depending on therapeutic intent, effectiveness may be evidenced by:

Improvement of symptoms as demonstrated by absence of tremors, and reduction of irritability and stiffness.

Increase in ability to perform ADLs.

Nursing Evaluation of Medication Effectiveness