Anticholinergics
What is benztropine indicated for?
Tremors and rigidity in Parkinson's disease
Why would a patient be prescribed levodopa-carbidopa?
Parkinson's disease to decrease tremors and muscle rigidity
What is donepezil indicated for?
Alzheimer's disease
What drug is the first-line symptomatic treatment for myasthenia gravis?
Neostigmine, pyridostigmine
Why are immunomodulators in multiple sclerosis prescribed?
To reduce the frequency and severity of MS relapses, slow disease progression
What are the contraindications for benztropine?
Glaucoma
Urinary retention
GI obstruction
BPH
Elderly patients (increased risk of confusion, falls)
What are the contraindications for levodopa-carbidopa?
Narrow-angle glaucoma
Psychosis or hallucinations
Melanoma history
Use caution with cardiac or renal/hepatic impairment
What is the mechanism of action for donepezil?
Increases ACh (by inhibiting cholinesterase), which may improve memory and cognition
What is the mechanism of action for neostigmine?
Increases ACh at receptor sites by inhibiting cholinesterase
What do we monitor for when a patient is taking an immunomodulator?
CBC (leukopenia, lymphopenia)
LFTs (hepatotoxicity risk)
ECG (baseline for fingolimod)
Pregnancy test
What are the side effects of benztropine?
Dry mouth
Blurred vision
Constipation
Urinary retention
Confusion, hallucinations
Tachycardia
Heat intolerance
What are the side effects of levodopa-carbidopa?
Dark urine and sweat
Nausea and vomiting
Orthostatic hypotension
Dyskinesia (involuntary movements)
What are the side effects of donepezil?
Headache, diarrhea, nausea
What are the side effects of neostigmine and pyridostigmine?
Excess ACh, causing increased salifation, diarrhea, nausea, vomiting, sweating, bradycardia
What are the adverse effects for taking immmunomodulary agents?
Increase infection risk
Nausea/diarrhea
Headache, depression, dizziness
Injection site reactions, flushing
Elevated liver enzymes
Anticholinergic toxicity: delirium, hyperthermia, mydriasis
Hydration and fiber
Sugar-free gum or lozenges
Assess mental status
What patient teaching should occur for a patient taking levodopa-carbidopa?
Avoid high protein meals as they decrease the effectiveness of the drug
What patient teaching should occur with a patient taking donepezil?
Take at bedtime.
Know that this drug doesn't CURE Alzheimer's
What are cholinergic side effects?
SLUDGE: Salivation, Lacrimation, Urination, Defecation, GI distress, Emesis
What is a drug-specific risk of fingolomid?
Bradycardia
What do we teach a patient on benztropine?
Rise slowly to prevent orthostatic hypotension
Report urinary retention or confusion
Avoid alcohol
Use sunglasses
Maintain hydration
What is the mechanism of action for levodopa-carbidopa?
Increases dopamine in the CNS
What are the contraindications for a patient taking donepezil?
Bradycardia, heart block
Asthma or COPD
GI bleeding history
Use with caution in hepatic or renal impairment
What is the antidote for neostigmine or pyridostigmine overdose?
Atropine
What is a drug-specific risk for natalizumab?
Progressive multifocal leukoencephalopathy (PML) is a viral infection of the brain that damages white matter