Description: a slow degenerative disease

caused by the depletion of dopamine and

ACh, which
Interferes with the inhibition of excitatory
impulses resulting in the dysfunction of
Psychological and physical
the
support is crucial!
Extrapyramidal system (crippling

Falls
Depression and emotional
disability)

Assessment/Observation
Parkinsons Disease
Pill-rolling
Drooling
Antiparkinsonism Agents

Self-care deficits
Failure of body systems
depression

Drug Therapy
Aimed at achieving a balance
between the stimulating
cholinergic effects and the
inhibitory effects of dopamine in
the basal ganglia.
Type 1 drugs affect dopamine
and are inhibitory. Type 2 drugs
block cholinergic effects
preventing
stimulation
Drug Choice:

Carpidopa/Levodopa
(Sinemet)
Amantadine (Dopaminergic)
Tolcapone, Entacapone
(COMT inhibitors) causes
severe liver failure. REQUIRES
MONITORING LIVER ENZYMES. NOT
USED UNLESS OTHER DRUGS DONT
WORK

Drug-Drug Interactions:
MAOI(should be stopped 14 days
before beginning therapy
Vitamin B6 or phenytoin
Tyramine-containing foods
St. Johns Worts

upset

Anticholinergics are
used to treat
Parkinsons disease- it
blocks the
neurotransmitter ACh
activity that regulates
movement.
Adverse Effects:
Dry mouth
Blurred vision
Constipation
Urinary retention
Confusion
Hallucination
Agitation
Nausea and
vomiting
Intestinal
obstruction
Hypotension
Palpitations
Response to Drug
Muscle twitching
Therapy:
Improved sense of
Sweat increase
well-being
Increased appetite
Increased ability to
perform ADL,
Increased ability to
concentrate &Think
clearly
Less intense

Mask-like Expressions
Difficulty walking
Loss of coordination and
Balance
Stooped position
Contraindications
Any known allergy to the
drug(hypersensitivity
prevention)
Breastfeeding(dopamergics
enter breast milk)
Skin lesions(melanoma)
Cardiovascular
Hypertension
Asthma
Ulcers
Urinary tract obstruction
Psychic disorders
Intervention

Renal/hepatic disease
Promote independence along
w/safety measures
Instruct patients not to stop taking
abruptly
Administer medications to increase
the level of dopamine in the system
Oral doses w/ food to minimize GI
upset
Encourage fluids to at least 3000
mL/day
Entacapone may darken urine and
sweat
Effects may be noticed within a few
days or weeks with other drugs
Instruct client to avoid MOAIs

and cautions:
Muscle RelaxantsContraindications
Known allergies to the drug(hypersensitivi
Neuromuscular Abnormalities:
Muscle Spasm Often results from injury to the
musculoskeletal system . Caused by the flood of
sensory impulses coming to the spinal cord from
the injured area
Muscle Spasticity Result of damage to
neurons within the CNS May result from an
increase in excitatory influences or a decrease in
Action
ofinfluences
Skeletal Muscle
inhibitory
within the CNS
Relaxants:
Most Relaxants
Work in the brain and spinal cord
Interfere with cycle of muscle spasm
and pain
Botulinum Toxins and Dantrolene
Enter muscle fibers directly
Action of Centrally Acting Skeletal
Muscle Relaxants
Work in the upper levels of the CNS to
interfere with the reflexes
causing the spasm
*possible depression anticipated with
their use
Lyses or Destroy Spasm
*often referred to as spasmolytics
Mechanism of Action
Relief of painful musculoskeletal conditions
Muscle spasms
Management of spasticity of severe chronic
disorders (multiple sclerosis, cerebral palsy)
Works best when used along with physical
therapy

Rheumatic disorders
History of epilepsy
Cardiac dysfunction
Pregnancy/lactation)
Nursing Implications:
Allergy history
Use of other medications
Adverse Reactions:
Obtain baseline vital signs including
Euphoria
Supine and erect blood pressure
Lightheadedness
Input/output
Dizziness
Assess for potential disorders or
Drowsiness
conditions that may be
Fatigue
contraindications for potential drug
Muscle weakness
interactions
Confusion
Monitor for decreased spasticity,
Insomnia
decreased ridgidy
Hypotension
Safety (side rails, bed alarm,
GI disturbances
smoking, assist ambulation
Urinary frequency/urges
Call light in reach
Monitor for adverse effects
Common Muscle
Relaxants:
baclofen (Lioresal)
cyclobenzaprine (Flexeril)
dantrolene (Dantrium) (at
risk for +35)
metaxalone (Skelaxin)
tizanidine (Zanaflex)(liver
toxicity)
carisoprodol (Soma)
chlorzoxazone (Paraflex)
(urine discolor)

Patient Response to Drug Therapy:

Improvement in muscle spasm
Relief of pain
Improvement in muscle spasticity
Comfort measures

Drug-to-Drug Interactions:
Other CNS depressants or alcohol may
increase depression