Concept Map for Parkinson Disease Selegiline (Eldepryl) by Anna Forynska Jill Garrett Kyle Geving

Mechanism of Action: Selegiline Inhibits Irreversibly enzyme that breaks down Dopamine, which increases dopaminergic effect, and with levodopa/carbidopa is used in treatment of Parkinson disease. The transdermal version of the medicine is used also in treatment of major depressive disorder (MDD).

Side Effects: Selegiline Nausea and dizziness, light-headedness, Syncope and abdominal discomfort Confusion, hallucination, dry mouth, vivid dreams, dyskinesia Anxiety, diarrhea, insomnia

Adverse Effects: Selegiline Impaired motor coordination- loss of balance, uncontrollable blinking Delusions, sleep disturbance Anger, facial grimace

How does Selegiline impact the body? The MAO enzymes are widely distributed throughout the body, with the highest concentrations found in the liver, kidney, stomach, intestinal wall, and PRIMARILY the brain. The primary role of MAO enzymes is the breakdown of catecholamines, such as dopamine, norepinephrine, and epinephrine, as well as serotonin. Selegiline causes an increase in the levels of dopaminergic stimulation in the CNS.

Different Body Systems Impacted by Selegiline Autonomic Nervous System = dry mouth, blurred vision, and sexual dysfunction. Cardiovascular System = orthostatic hypotension, hypertension, arrhythmia, palpitations, new or increased angina pectoris, hypotension, tachycardia, peripheral edema, sinus bradycardia, syncope. Gastrointestinal System = nausea/vomiting, constipation, weight loss, anorexia, poor appetite, dysphagia, diarrhea, heartburn, rectal bleeding, gastrointestinal bleeding (exacerbation of preexisting ulcer disease).

Different Body Systems Impacted by Selegiline (contd). Endocrine System = slow urination, transient anorgasmia, nocturia, prostatic hypertrophy, urinary hesitancy, urinary retention, decreased penile sensation, urinary frequency. Integumentary System = increased sweating, diaphoresis, facial hair, hair loss, hematoma, rash, photosensitivity.

Nursing Implications ØAkinesia ØBradykinesia ØRigidity ØTremor ˜Classic symptoms include: ØAkinesia ØBradykinesia ØRigidity ØTremor ØPostural instability ØStaggering gait ØDrooling

Therapeutic Responses Improvement in functional ability Decreased severity of symptoms Approximately 50% to 60% of patients show a positive response.

Patient Teaching Tell your doctor about all other prescription and over-the-counter medications you use, including vitamins, minerals, and herbal products. Do not drink alcohol or eat foods that are high in tyramine (aged cheeses and beer). Eating tyramine while you are using selegiline can raise your blood pressure to dangerous levels and cause life-threatening symptoms. Do not stop taking selegiline suddenly or you may have harmful side effects. Keep taking the medicine as prescribed. Talk with your doctor before stopping the medication. You may have increased sexual urges, unusual urges to gamble, or other intense urges while taking this medication.

References Lilley, Linda Lane., Shelly Rainforth. Collins, Julie S. Snyder, and Diane Savoca. Pharmacology and the Nursing Process. 7th ed. St. Louis, MO: Elsevier/Mosby, 2014. Print. Robert J. Kizior., Barbara B. Hodgson. Saunders Nursing Drug Handbook 2015. 1st ed. St. Louis, MO: Elsevier/Saunders, 2015 Truven Health Analytics Inc: Micromedex. (n.d.). Retrieved September 10, 2015, from http://micromedex.com/