...that can be used with your levodopa to help control Parkinson's symptoms and all that. They can use it initially to delay the need for levodopa and it can be used concurrently. Your others, your MAOIs, there's a slight difference and all that, cannot. Those are the ones you want to be very cautiously with.
Those are the things you're going to need to like, if you're giving it, whatever you like, look and be sure that those three MAO-B inhibitors, those three drugs can be given. Does that make sense? We talked about amantadine.
Okay, don't put that. We want to be cautious if our patient has history of seizures, liver problems, psychosis, or congestive heart failure. Okay. Common adverse effects.
Confusion, disorientation, hallucinations, depression. You know, they said, you know, we're going to, like, Of course, you know, do assessment before and during therapy of their meditation, their orientation, their mood, stuff like that. It can cause dizziness and lightheadedness, so of course we just need to consider patient safety with that. Lack of appetite, nausea, abdominal discomfort, these side effects usually are not, like, distressing, and they tend to, like, kind of resolve or go away with continued treatment.
We want to again make sure that we educate the patient not to just stop therapy like if it does become bothersome they need to let them know and not just stop taking the medication. Skin modeling is a dermatologic condition that can with amantadine is that rose-colored modeling of the skin, usually like in the extremities, and you may also see some ankle edema. It tends to be more noticeable when the patient is upright or exposed to the cold.
It is reversible and will usually go away within two to six weeks after the amantadine is stopped. But usually it's not harmful. So like the amantadine is usually a shorter term therapy anyhow. So it's not life threatening.
It's not like necessary to like stop treatment for this. It'll go away once the amantadine has been discontinued. More serious side effects are hepatotoxicity.
which can be manifested as like anorexia, nausea, vomiting, jaundice, enlarged liver, enlarged spleen, abnormal liver function tests, stuff like that. It can, seizures, psychosis, which is why you want to kind of be aware they already have those disorders and all that because, you know, it can worsen those. It can also, cause dyspnea or edema if it's used in patients who have a history of heart failure. And so we, you know, we're going to want to monitor those lung sounds, edema, weight gain, stuff like that to monitor for those.
Drug interactions. If It's given with like an anticholinergic, like your Clogentin or Diphenhydramine. It can actually worsen those adverse effects of such as confusion and hallucinations. So usually like reducing the dosage of either or both drugs can like help with that. Apomorphine.
This is a non-ergo dopamine agonist that stimulates the dopamine receptors. which helps temporarily restore motor function. It's chemically related to morphine, but it does not have any opioid activity.
I said, as we discussed, as the disease progresses, the levodopa is not as effective. So the patients will have like, periods of hypermobility or like freezing where they just they can't get up, they can't speak, they can't walk. So they'll give the apomorphine will be given to treat these acute episodes of the hypermobility. Usually like if they're at the end of a dosage cycle or sometimes it's like when they know they're going to have like an off time, they'll get the apomorphine.
Same thing, pre-medication assessment, same with all those. We need to know those baseline assessments with the Parkinson's symptoms, cardiovascular history, their degree of mobility, degree of disability. We need to inquire whether or not they're taking any sedating medications, watch their vital signs, monitor for orthostatic hypertension, teach safety. it can, the apomorphine can like induce vomiting. So it needs usually the anti-emetic trimethobenzanide should be given like prior to administration of this drug.
So don't, it's not, not Zofran, not Prochlorazine. It needs to be that trimethobenzanide. It also, apomorphine should not ever be given IV. because it can crystallize in the veins and cause a thrombus or embolism.
Common adverse effects, nausea, vomiting, like I said, that's why we're gonna get that anti-emetic. Orthostatic hypotension, monitor the blood pressure, heart rate, and provide for safety. More serious effects is the choreo, the chewing motions, the head bobbing, facial grimacing, rocking movements, usually reducing the dosage kind of like helps with that. It can also cause sudden sleep events or sleep attacks.
So if the patient by chance is still driving, they need to be very cautious and all that because it just causes sudden sleep. It can cause nightmares, depression, confusion, and hallucinations, tachycardia, palpitations. It can also cause pre-opism, a penile like erection, but you know, like I said, it can be like, you know, an emergency if it's not treated.
It's also prone because of that, the effects of the erection or whatever, it is prone to being abused too, so you have to monitor to make sure it's not being abused. Drug interactions. Your serotonin antagonist, they said your Zofran, stuff like that, can cause profound hypotension to the point of like loss of consciousness. You do not get them together. Your phenothiazines, they block the dopaminergic effects of apomorphine, so basically it makes it ineffective.
ethanol, which is your alcohol, your vasodilators, antihypertensives can increase the episodes of orthostatic hypertension. Of course, we're going to avoid alcohol with it and with the vasodilators and antihypertensives, you're going to like adjust dosages if needed. Your Meropex is also a non-ergo dopamine agonist. Used to treat the early signs and symptoms of Parkinson's to help improve motor function and AVLs and help reduce the required dosage of the levodopa. It can be used alone too or in combination with levodopa.
Getting baseline assessment, you know, the Parkinson's systems, gastrointestinal symptoms, cardiovascular symptoms, baseline vital signs, Mental health, you know, if they have like a history or experienced elucidations, nightmares, dementia, anxiety. If they happen to have like kidney dysfunction to where their creatinine clearance is less than 30 mLs a minute or 30 or lower, we need to, they're going to need like a dosage adjustment because they're not going to be able to excrete it. may need to be given with food or milk because of gastric irritation or stomach upset. If it is to be discontinued, it needs to be gradually reduced over at least a week. Got those, like I said, also with the nausea, vomiting, given food, like I said, they can also like make sure they do dosage adjustments slowly or divide the total daily dose into smaller doses throughout the day.
Same thing as serious, the chorea, the sudden sleep events, nightmares, depression, hallucinations. This one said that what can cause impulsiveness or compulsive behavior, which might be like some of the things like Ashley saw with her patient and all that, tachycardia, palpitations. With that, like I said, set them to sleep a bit.
So we need to make sure that they're not doing anything where suddenly falling asleep could be a safety issue. If they develop any pulse control or compulsive behaviors, it needs to be reported. The patient themselves may not even realize they're doing it. So this is where we would need to educate family or caregivers about the potential side effect and to report that. It can cause tachycardia, palpitations, orthostatic hypotension.
Your merapex drug interactions, diltiazem, verapamil, quinidine all like inhibit like the excretion of the merapex so which means it can build up the levels can build up so we they are probably going to need like a decrease in dosage. The dopamine antagonist actually decrease the effectiveness of it. So kind of like either you're not going to give it concurrently or you're going to have to adjust those just because again, it defeats the entire point of giving it. And with your all the high to higher intensives, you may need to reduce their dosage to like prevent that or minimize orthostatic hypertension.
Requip, you see this one, is also a non or no dopamine agonist used early in Parkinson's to help improve motherfucking ADLs and to help reduce that amount of levodopa that's needed. That's why you'll see a lot of these Parkinson's people, they'll be on multiple, they'll be on the Cinemat with the levodopa and carbidopa, but then they'll be on Requip or this or that too. Let's see.
With all the medications like cardiovascular, gastrointestinal, history, because of those, the side effects and stuff like that, we gotta know where they are at baseline. It can also be given with food or milk to reduce upset stomach. And it's another one that needs to be gradually reduced if it is going to be discontinued.
Common side effects, the other one, nausea, vomiting, lack of appetite, orthostatic hypertension. Again, they can either like, you know, go up on the dose slowly, take it with food or like, you know, the dose, divide the dosages, the total daily dosage over, you know, the day. With the orthostatic hypertension, this effect actually diminishes over time. So it, you know, just need to be patient safety with it.
The chorea, the chin vision, the head something like that usually needs like levodopa a dosage decreased can also cause sudden sleep events nightmares depression hallucinations confusion impulse control compulsive behavior so just like the urethra and mirapax can both cause those tachycardia palpitations all right We want to be aware, like the Cipro is there again. It inhibits the metabolism of Requip, which would build up the serum blood levels, so we would need to reduce the dosage of Requip. Estrogens inhibits the excretion of it, so again, we would need to decrease the dosage because it's going to build up.
The dopamine antagonists, Basically, it diminishes the effectiveness of the requip so, you know, it defeats the entire point and then your anti-hypertensives. Every single one of them. I'm telling you, every one of them. NuPro, number I see. This one's also non-ergogelumin agonist.
It's used both in early and late stages of Parkinson's. With this one, we're gonna, of course, the baseline assessment, the UPDRS. assessment, see where they are with baseline with disability, their vital signs, GI and cardiovascular, any symptoms that hallucinations, nightmares, dementia, anxiety. This is like a patch so we need to be aware that if they're going to go have an MRI or a cardioversion it needs to be removed first because there's a foil backing on a motor it can actually cause a burn.
We also need to educate them or make sure they know they need to avoid sources of direct heat. You know, heating pads, electric blankets, heat lamps, saunas, your heated water beds, direct sunlight because that heat increase the absorption through the skin. Okay, that's one too.
And if it's discontinued, we want to gradually reduce that dosage. Anybody want to guess the adverse effects of Nucro? At least most of them are consistent, okay?
All right, nausea, vomiting, lack of appetite, orthostatic hypotension. This one does have one different one, skin reactions like erythema, edema, or like itching to the patch area, because remember, it's a patch, okay? For the nausea, vomiting, and like lack of appetite, you're gonna slowly increase the dosage, divide the total daily dosage, administer food if it's by mouth. If it's orthostatic hypotension, you're gonna keep them safe.
Usually that kind of decreases over time. they're having a skin reaction usually it's localized to the area where the patch is on so just rotating sites can help but if it does happen to start worsening or starts extending past the area of the patch then we need to let the health care provider know. For the two acid, the patient can also develop the chewing motion, bobbing, facial grimacing, rocking movements, stuff like that usually needs the levodopa decreased.
sudden sleep events, safety considerations, nightmares, depression, confusion, hallucinations. We're just, we're going to monitor and, you know, make sure they stay safe because, you know, depending on what they're hallucinating or what's, how depressed they are, it could be safety concerns. All right, this one can also cause problems with impulse control and compulsive behavior. So, So it's something that we would want to let the healthcare provider know immediately.
And of course tachycardia and palpitation. So we're gonna keep an eye on that heart rate. All right, drug interactions. Your dopamine antagonists, they diminish the effectiveness of the Nupro.
And then your antihypertensives. Guess what it causes? It's aesthetic hypertension.
The COMT inhibitors. This is your tassocapone. There's actually a drug called Stilivo that actually combines carbidopa, levodopa, and entecapone into one drug. Again, it's the same thing with a nursing function. With this one, we're going to assess.
You get a baseline assessment of the Parkinson's symptoms. We're going to assess their bowel patterns, any gastrointestinal symptoms, cardiovascular symptoms. mentation. We're going to check and see if they're on any like antihypertensive drugs.
We're going to monitor their blood pressure and heart rate. With this one we're going to actually look at their liver function. Not only before but like during therapy.
Common adverse effects this one can actually cause diarrhea and it has a negative effect and it can cause like a brownish orange color to the urine. It can also increase the adverse dopaminergic effects of the levodopa. Your hallucinations, psychosis, dyskinesia, impulse control disorder. Like if they start, like I said, this is the one, like actually the impulse control, it can cause hypersexuality, like gambling, stuff like that. So it's more likely a side effect of the medications, one of the medications.
sleep attacks, stuff like that. So like I said, the COMT inhibitor can actually increase. It can also cause a, like this symptom complex that kind of resembles something called neuroleptin malignant syndrome. You ever know if you've had anesthesia, now they ask you if you've ever had any problems with anesthesia, they're screaming for this. and all that because there's like certain people there's like genetic component that causes you to react to certain like anesthesia agents it's like um in fact i forget because i have to constantly get do health stream education for this little hospital it's like um It's like there was a guy that had this extreme fear of undergoing surgery because he had had a lot of family members who died during surgery.
It turned out they had a mutation that caused them to react. to the thing. It causes like an extremely high temperature, we're talking 104, 105, 106, muscular rigidity, altered consciousness, like just very like automatic instability and it can result in death if it's not caught early.
But I said this is not neuroleptic malignant syndrome, but the complex, it resembles that. It has like the same manifestations. Of course, we're gonna like keep an eye on their mental status, their mentation, their mood. If they do start developing any of those effects, like I said, they're probably gonna need that levodopa decreased. We're gonna, of course, keep the patient safe, support them emotionally.
Usually if they do have some of those more common side effects, they usually kind of like go away as they become tolerant of the drug. Like I said, it can be given with levodopa. It does have additive neurologic effects and allows for a lower dosage of levodopa, but it can also increase those adverse effects, which again, the solution to that is to decrease the levodopa. Antihypertensive agents, your apomorphine, epinephrine, norepinephrine can...
the COMT inhibitors can like prolong their duration of action. So you've got to keep an eye on that BP and heart rate because most of them can cause palpitations and tachycardia and stuff like that. So you want to kind of keep an eye on that.
Anticholinergics. So remember this is your Cogent and your Benadryl, stuff like that. It helps like reduce the hyperstimulation that's caused by the excessive acetylcholine. It can help reduce the tremor and drooling that you see with Parkinson's.
Nursing assessment, we're going to get baseline assessment of the Parkinson's systems, the UPDRS. We're going to monitor their bowel system, their cardiovascular system. With this one, you're going to monitor their urinary system. You're going to assess their mentation, their orientation, their alertness. You're going to vital signs.
You're going to get orthostatic vital signs. You're going to monitor their pulse. You're going to look at the rhythm regularly.
They're going to be assessed for glaucoma. all that because they said this is another anticholinergic remember can cause an acute attack if it's given to somebody with closed-angle glaucoma you know at all the open-angle glaucoma is generally safe but we need to routinely watch those and assess the intraocular pressures. Anticholinergic so it can cause constipation Dry mouth, dry throat, dry nose.
It can cause urinary retention, which is why you're going to do a urinary assessment with the anticholinergics. Blurry vision. Then it can cause nightmares, depression, confusion, hallucinations, orthostatic hypotension, palpitations, dysrhythmias, all things.
For the milder adverse effects, like the dry mouth, usually it kind of subsides as they kind of adjust to the medication. We can teach them to suck on hard candy or ice chips, maybe chew gum to help relieve the symptoms. We can have them take stool softeners, make sure that they're drinking adequate amounts of fluid, getting sufficient bulk, exercising as much as they can tolerate.
We need to monitor them for urinary hesitancy or any signs of urinary retention, as well as bladder distension because urinary retention would need to be reported immediately so that it could be evaluated. Lowry vision is another one that can subside with continued treatment because that comes with just the dry eyes and stuff. Alright, drug interactions. your amantadine, tricyclic antidepressants, pentothiazines, like I said, it can like worsen those anticholinergic adverse effects like your confusion and hallucinations.
So, but they may need to adjust the dosages. And then with the levodopa, it can slow the gastric emptying, which like slows down the absorption of levodopa. So they might actually need to increase the dosage of levodopa, which is generally what they don't want to do, is increase the levodopa. Because then you get more of the other dopaminergic effects like the chorea. And we're finally off of Parkinson's.
I said it should have been like drug therapy for Parkinson's and a few others. Um, alright. Just like with other Alzheimer's disease, there's no drugs that slows down the process.
There's no drugs that cures it. Basically, it's just focused on improving their cognitive function. There's two classes of medications. Your acetylcholine esterase inhibitors and your NMDA inhibitors.
Going to concentrate a lot is like on like educating the caregiver on like what to expect, how to manage the, you know, declining cognitive abilities because you know it could progress slowly, progress rapidly. It could like, it could fluctuate, you know, that. Other ones, Aricept and Exelon are ones I've seen quite a bit. They're given to try to help improve the cognitive function. Common adverse effects with them is like your nausea, vomiting, dyspepsia, diarrhea, can cause bradycardia.
So you got to be careful with that. We're going to like watch those vital signs. We're going to routinely assess that blood pressure, heart rate, respirations.
We're gonna assess for the presence of any gastrointestinal symptoms before we start therapy so we know what's because of medication and what's not. Then your NMDA receptor inhibitors. This is your NMDA, which you guys have probably seen.
Again, it's just trying to help include that mental functioning as much as possible. It can cause neurologic adverse effects like headache, dizziness, a case of athesia, insomnia, restlessness, increased motor activity, excitement, agitation. there are some drug interactions.
Your sodium bicarbonate, acetazolamide, and also some conditions like your renal tubular acidosis and like a severe UTI can actually cause, with this drug can cause the urine to alkalize, which will basically it can reduce the excretion of the menda, which means that the blood levels will go up. So you just need to be careful. Now again, side effects, I'm like, I feel like that's a problem with 90% of Alzheimer's patients.
Insomnia, restlessness, agitation. Now, so it makes you wonder how much is that? And now I want to go back to the, were they on the menda? Right? You think about it because you go, like, how many times did we assume that it's part of the Alzheimer's whereas it could be a, you know, it's in the disease process.
It could be a medication side effect or interaction, right? So this is something to kind of be aware of. We have two hours left.