1. Chapter 31 Anti-Parkinson Agents

2. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 2 Parkinson’s Disease A neurological disorder characterized by:  Muscle tremors  Muscle rigidity  Lack of coordination  Drooling  Shuffling gait  Postural changes (continues)

3. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 3 Parkinson’s Disease Imbalance of dopamine and acetylcholine levels in the brain Levels of other neurological chemical decrease:  Gamma-aminobutyric acid (GABA)  Serotonin  Norepinephrine (continued)

4. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 4 Classes of Anti-Parkinson Agents Dopaminergic agents Anticholinergic agents Catechol-O-methyltransferase inhibitors

5. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 5 Levodopa Dopaminergic agent Most effective drug treatment Acts peripherally Rapidly converts to dopamine Symptoms subside or disappear (continues)

6. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 6 Levodopa Therapeutic effects  Therapeutic intensity varies  Dosage dependent Adverse effects  Nausea and vomiting  Orthostatic hypotension  Cardiac arrhythmias (continued)

7. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 7 Carbidopa/Levodopa (Sinemet) Carbidopa prevents levodopa from being broken down in the peripheral circulation Improves neurological-skeletal muscle activity Combining these agents reduces the required Levodopa dose by 25%  Given in Carbidopa, 10 mg / Levodopa,100 mg dose

8. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 8 Amantadine (Symmetrel) Treats viral disorders such as influenza Acts as an anti-Parkinson agent; it exerts an additive effect on Levodopa  Increases CNS dopamine concentration

9. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 9 Anticholinergic Agents Reduces excessive cholinergic brain activity  Example: trihexyphenidyl (Artane)  Used for clients with minimal symptoms  Adjunct with other agents Caution: narrow-angle glaucoma (continues)

10. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 10 Anticholinergic Agents Apomorphine (Apokyn)  Morphine-like substance  Old, but new  No analgesic or addictive qualities  Increases dopamine activity (continued)

11. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 11 Newest class of anti-Parkinson drug agents Treats clients with history of poor response to levodopa  Sustains dopaminergic levels  Brain remains stimulated (continues) Catechol-O-Methyltransferase Inhibitors

12. Copyright 2007 Thomson Delmar Learning, a division of Thomson Learning Inc. All rights reserved. 31 - 12 Catechol-O-Methyltransferase Inhibitors Adverse effects  Liver failure  Dyskinesia  Orthostatic hypotension  Dystonia  Somnolence  GI irritation (continued)