McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 2 4 Antiparkinsonism agents

Drug therapy across the lifespan

BOX 24.1

Antiparkinsonism agents CHILDREN

PREGNANCY AND BREASTFEEDING Women of childbearing age should be advised to use contraception when they are on these drugs. If a pregnancy does occur, or is desired, they need counselling about the potential for adverse effects. Women who are breastfeeding should be encouraged to find another method of feeding the baby because of the potential for adverse drug effects on the baby. OLDER ADULTS Although Parkinson’s disease may affect individuals of any age, gender or nationality, the frequency of the disease increases with age.This debilitating condition, which affects more men than women, may be one of many chronic problems associated with ageing. The drugs that are used to manage Parkinson’s disease are associated with more adverse effects in older people with long-term problems. Both anticholinergic and dopaminergic drugs aggravate glaucoma, benign prostatic hypertrophy, constipation, cardiac problems and chronic obstructive pulmonary diseases. Special precautions and frequent follow-up visits are necessary for older people with Parkinson’s disease, and their drug dosages may need to be adjusted frequently to avoid serious problems. In many cases, other agents are given to counteract the effects of these drugs, and people then have complicated drug regimens with many associated adverse effects and problems. Consequently, it is essential for these people to have extensive written drug-teaching protocols.

The safety and effectiveness of most of these drugs has not been established in children.The incidence of Parkin­ son’s disease in children is very small. Children do, however, experience parkinsonian symptoms as a result of drug effects. ADULTS The eventual dependence and lack of control that accompany Parkinson’s disease are devastating to all people and their families but may be particularly overwhelming to individuals in their prime of life who value high degrees of autonomy, self-determination and independence. Although these characteristics are not associated with any particular ethnic group, they are valued more highly among certain cultures than others. It is important for the healthcare professional to assess all families with sensitivity to determine what convictions they hold and plan care accordingly. Adults diagnosed with Parkinson’s disease require extensive teaching, support and help coping with the disease as well as with the effects of the drugs. With the increasing interest in herbal and alternative therapies, it is important to stress the need to inform the healthcare provider about any other treatment being used. Vitamin B 6 can pose a serious problem for people who are taking some of these drugs.

TABLE 24.1

DRUGS IN FOCUS Dopaminergic agents

Drug name

Dosage/route

Usual indications

amantadine (Symmetrel)

100 mg PO b.d.; up to 400 mg/day has been used

Antiviral; treatment of idiopathic and drug- induced parkinsonism in adults Intermittent treatment of hypomobility “off” episodes of advanced Parkinson’s disease Treatment of idiopathic Parkinson’s disease; may be beneficial in later stages when response to levodopa decreases

apomorphine (Apomine)

2–6 mg SC t.d.s.

bromocriptine (Parlodel)

1.25 mg PO b.d.; titrate up to 10–40 mg/day

cabergoline (Bergoline) carbidopa–levodopa (Sinemet) levodopa-benserazide (Madopar) levodopa-carbidopa- entacapone (Stalevo)

2–3 mg/day PO as adjunct to levodopa 100 mg levodopa with 25 mg carbidopa PO t.d.s. 125 mg PO t.d.s. increased to 500–1000 mg/day t.d.s. or q.i.d. Individualised up to maximum levodopa 1500 mg/day Initially, 50 mcg PO/day for 2 days; titrated by 100–150 mcg/day every third day for 12 days; increased by 250 mcg/day every third day as needed until optimal dose reached 0.125 mg PO t.d.s., titrate up to 1.5 mg PO t.d.s. 0.25 mg PO t.d.s.; titrate up to maximum dose of 24 mg/day

Treatment of Parkinson’s disease

Treatment of idiopathic Parkinson’s disease

Treatment of idiopathic Parkinson’s disease

Treatment of idiopathic Parkinson’s disease with fluctuating motor status Adjunct treatment of Parkinson’s disease

pergolide (Permax)

pramipexole (Sifrol)

Treatment of idiopathic Parkinson’s disease

ropinirole (Appese, Repreve)

Treatment of idiopathic Parkinson’s disease in early stages and in later stages when combined with levodopa; treatment of restless legs syndrome Treatment of idiopathic Parkinson’s disease

rotigotine (Neupro)

Patch applied once daily