McKenna's Pharmacology for Nursing, 2e

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C H A P T E R 2 4 Antiparkinsonism agents

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■■ Adjunctive drugs are used to increase the responsiveness of the cells to dopamine. They act to decrease the breakdown of dopamine, leaving it on the receptor for longer periods of time. ■■ Adjunctive drugs are only used in combination with carbidopa–levodopa and are usually reserved for use when the person stops responding adequately to traditional therapy. CHAPTER SUMMARY ■■ Parkinson’s disease is a progressive, chronic neurological disorder for which there is no cure. ■■ Loss of dopamine-secreting neurons in the substantia nigra is characteristic of Parkinson’s disease. Destruction of dopamine-secreting cells leads to an imbalance between excitatory cholinergic cells and inhibitory dopaminergic cells. ■■ Signs and symptoms of Parkinson’s disease include tremor, changes in posture and gait, slow and deliberate movements (bradykinesia) and eventually drooling and changes in speech. ■■ Drug therapy for Parkinson’s disease is aimed at restoring the dopamine–acetylcholine balance. The signs and symptoms of the disease can be managed until the degeneration of neurons is so extensive that a therapeutic response no longer occurs. ■■ Anticholinergic drugs are used to block the excitatory cholinergic receptors and dopaminergic drugs are used to increase dopamine levels or to directly stimulate dopamine receptors. ■■ Many adverse effects are associated with the drugs used for treating Parkinson’s disease, including CNS changes, anticholinergic effects when using the anticholinergics (atropine-like or parasympathetic blocking effects) and dopamine stimulation (sympathetic-type effects) in the peripheral nervous system when using the dopaminergics. Knowing your strengths and weaknesses helps you to study more effectively. Take a PrepU Practice Quiz to find out how you measure up! ONLINE RESOURCES An extensive range of additional resources to enhance teaching and learning and to facilitate understanding of this chapter may be found online at the text’s accompanying website, located on thePoint at http://thepoint.lww.com. These include Watch and Learn videos, Concepts in Action animations, journal articles, review questions, case studies, discussion topics and quizzes.

Healthcare providers and students may want to consult the following Internet sources: www.parkinsons.org.au Home page of Parkinson’s Australia. Information on parkinsonism, ataxia and related disorders, including support groups, research and treatment. www.parkinsons.org.nz Home page of Parkinson’s New Zealand. Information on parkinsonism, ataxia and related disorders, including support groups, research and treatment. Cranwell-Bruce, L. A. (2010). Drugs for Parkinson’s disease. MEDSURG Nursing , 19(6) , 347–355. Daley, D. J., Myint, P. K., Gray, R. J. & Deane, K. H. (2012). Systematic review on factors associated with medication non-adherence in Parkinson’s disease. Parkinsonism & Related Disorders , 18(10) , 1053–1061. Farrell, M. & Dempsey, J. (2014). Smeltzer & Bare’s Textbook of Medical-Surgical Nursing (3rd edn). Sydney: Lippincott Williams & Wilkins. Goodman, L. S., Brunton, L. L., Chabner, B. & Knollmann, B. C. (2011). Goodman and Gilman’s Pharmacological Basis of Therapeutics (12th edn). New York: McGraw-Hill. Hallett, P. F. & Standaert, D. G. (2004). Rationale for and use of NMDA receptor antagonists in Parkinson’s disease. Pharmacology and Therapeutics , 102 , 155–174. McKenna, L. (2012). Pharmacology Made Incredibly Easy (1st Australian and New Zealand edn). Sydney: Lippincott Williams & Wilkins. McKenna, L. & Mirkov, S. (2014). McKenna’s Drug Handbook for Nursing and Midwifery (7th edn). Sydney: Lippincott Williams & Wilkins. Porth, C. M. (2011). Essentials of Pathophysiology: Concepts of Altered Health States (3rd edn). Philadelphia: Lippincott Williams & Wilkins. Porth, C. M. (2009). Pathophysiology: Concepts of Altered Health States (8th edn). Philadelphia: Lippincott Williams & Wilkins. Selbach, A. & Silburn, P. (2012). Management of Parkinson’s disease. Australian Prescriber , 35 , 183–188. Turnbull, G. I. & Millar, J. (2006). A proactive physical management model of Parkinson’s disease. Topics in Geriatric Rehabilitation , 22 , 162–171. Wright, J. & Walker, J. (2013). Medication adherence in Parkinson’s. British Journal of Nursing , 22(12) , 686–699. BIBLIOGRAPHY