CNS Stimulants
Baseline testing that should be completed before starting a pt on Amphetamines
-Baseline ECG and BP: these drugs carry of risk of cardiac arrest, arrhythmias
-Baseline Psych evaluation: these drugs are associated with psychoses, aggression, and mania
What patients should not take drugs to help with weight loss?
Eating disorder
How are Triptans most frequently administered?
-Intranasal
Why do the benefits of these drugs decline after 2 years?
Medications can relieve the symptoms of Parkinson's but they become less effective as the disease progresses, and their side effects get worse. Meds are very individualized and have to be adjusted frequently. Tx with Parkinson's meds aims to balance out the lack of dopamine in the brain in order to relieve the symptoms, but the drugs cannot cure the disease.
What is the goal of tx for Anti Parkinson's drugs (bonus question)!
-Increase levels of dopamine
-Drug-free maintains sensitivity to drug and reduces adverse effects.
-Taking a break during the summer or weekends
Class of drugs that are used to treat Migraines
-Triptans (Serotonin Receptor Agonist)
Onset of Triptans (oral, intranasal, SQ)
-Oral: 0.5 to 1 hr
-Intranasal: Rapid
-SQ: Varies
What is Parkinson's disease?
-Chronic, progressive, Degeneration of Neurons
-Effects Neurons that produce Dopamine
- Dopamine deficit in: Motor Function Nerves
- Most often diagnosed between 45-65 years of age
- Diagnosis is based on symptoms and physical exam
-Symptoms: TRAP
What is the mechanism of Action of Anti-Parkinson's drugs?
- Increase the amount of Dopamine in the brain
- Different drug classes have different mechanisms
What should be monitored when a patient is taking Amphetamines?
-Monitor diet and weight loss
-Monitor HR and BP
- Baseline ECG, BP, psych evaluation
When is the most appropriate time to take a Triptan for migraines?
Used as abortive therapy (Tx headaches that already started).
What drugs interact with Triptans?
- MAOI
- SSRI
- St. John's Wort (herb)
What is an anti-cholinergic drug used to help pts with Parkinson's Disease and why is this drug used for the disease?
-Benztropine
-Used as a secondary drug for tremors
Interactions the nurse should be aware of in patients taking Levodopa-Carbidopa
-Vitamin B6
- High protein meals
-Non-selective MAOIs, Benzos
Educational points to share with a parent of a child receiving Amphetamines
--Take a "drug holiday"
- Tell your provider if you (or child) experience nervousness, insomnia, heart palpations,vomiting, fever, skin rash, or weight loss
- Children with ADHD, take after breakfast to minimize appetite suppression
- Take before meals if weight is an issue
Name 3 drugs used for weight loss
- Benzphetamine
- Methamphetamine
- Orlistat (used for weight loss but is not a stimulant)!
Potential adverse effects that should be monitored when taking a Triptan?
- Vasoconstrictive effects (coronary arteries)
- Irritation at injection site
- Tingling and flushing
- Congestion in head or chest
Name some drugs used to increase Dopamine levels in patients with Parkinson's disease.
Dopamine replacement
-Levodopa-carbidopa
Anticholinergic drugs
- Benztropine
Dopamine modulator
- Amantadine
Indirect-acting dopaminergic
-MAO-B inhibitors
Catechol-O-methyltransferase inhibitors (COMT)
-Tolcapone
Potential adverse effects seen in patients taking Levodopa-Carbidopa
-Cardio: dysrhythmias, hypotension
- Muscular: Chorea, muscle cramps
- GI: Distress
How do migraine medications work?
- Bind to Serotonin receptors in the brain (stimulate serotonin receptors).
- Cause Vasoconstriction of the cranial arteries, which painfully dilate during migraine attack
Name 4 migraine medications
- Sumatriptan (Imitrex)
- Alomotriptan (Axert)
- Eletriptan (Relpax)
- Naratriptan (Amerge)
- Rizatriptan (Maxalt)
- Zolmitriptan (Zomig)
- Frovatriptan (Frova)
Patient education to share with patients taking Triptans
- Administer at the onset of migraine symptoms
- can give a second dose 2 hours after the first dose
- Should not exceed 200 mg/day
- Oral doses with plenty of fluid
- Intranasel, one spray in each nostril
- SubQ right below the skin as soon as symptoms start. Total of 2 injections in 24 hrs.
- Do not use if pregnant
- Do not operate machinery after taking Triptans
- Report to provider hypersensitivity symptoms: heat, flushing, tiredness
Nursing considerations that are important to think about when administering drugs for Parkinson's disease.
-Continuing physical activity is just as important as taking the meds
- It may take several weeks to see a therapeutic response to these meds
- Pts. may experience dizziness and possible syncope...be safe
- Give drugs several hours before bedtime to reduce risk of insomnia
- Avoid taking drugs with high protein meals
- Understand the psychological and emotional effects of this disease
- Get a baseline assessment of movements to help with evaluation of meds
-Nursing interventions will vary depending on the drug classes they are receiving
- Pts can experience postural hypotension related to drug therapy
Important patient education points to share with patients taking drugs for Parkinson's Disease
- Help the pt understand what is happening to their body
- Physical activity is very important for you
- It takes weeks for the drugs to work....give it time
- Do not switch to a genric form of your med until you consult with your provider
- If taking an MAOI, be care full with tyramine-containing foods
- If taking an MAOI you should not take Meperidine
- Do not take multivitamins with Pyridoxine
- Change positions slowly
- Avoid alcohol
- Do not take medication with a high-protein meal
- Drink plenty of water
- Report to the provider an increase in symptoms such as lightheadedness, irregular heartbeat, uncontrolled facial movements, and urinary retention.