12.1 The Impact of Nutrition on Cardiovascular Wellness Across the Lifespan

Parkinson's disease disrupts movement due to dopamine loss in the brain. Anti-Parkinsonian medications aim to restore dopamine function or balance neurotransmitters, alleviating motor symptoms like tremors and rigidity.

Various drug classes target different aspects of the disease. Dopaminergic drugs replenish dopamine, while anticholinergics restore neurotransmitter balance. Understanding these medications is crucial for effective symptom management and improved quality of life.

Overview of Anti-Parkinsonian Medications

Introduction to Parkinson's Disease

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Parkinson's disease, first described by James Parkinson in 1817, is a progressive neurodegenerative disorder affecting movement, balance, and coordination. It primarily results from the loss of dopamine-producing neurons in the substantia nigra, disrupting the nigrostriatal pathway and leading to motor symptoms.

Classes of anti-Parkinsonian medications

• Dopaminergic drugs enhance dopamine activity in the brain to alleviate Parkinson's symptoms
  • Levodopa crosses the blood-brain barrier and converts to dopamine in the brain, replenishing depleted levels
    • Often combined with carbidopa to reduce peripheral side effects and increase central nervous system availability
  • Dopamine agonists (ropinirole, pramipexole) directly stimulate dopamine receptors, mimicking dopamine's effects
  • Monoamine oxidase B (MAO-B) inhibitors (selegiline, rasagiline) block dopamine breakdown by MAO-B enzyme, prolonging its action
• Anticholinergic drugs (benztropine, trihexyphenidyl) block acetylcholine action in the brain, helping restore dopamine-acetylcholine balance
• Catechol-O-methyltransferase (COMT) inhibitors (entacapone, tolcapone) prevent levodopa and dopamine breakdown by COMT enzyme, prolonging levodopa's effects and increasing its bioavailability

Dopaminergic vs anticholinergic drugs

• Dopaminergic drugs provide effective improvement in motor symptoms (tremor, rigidity, bradykinesia) and are considered first-line treatment
  • Risks include dyskinesias (involuntary movements) with long-term use, "on-off" fluctuations in symptom control, nausea, vomiting, and orthostatic hypotension
• Anticholinergic drugs help control tremor and rigidity, particularly useful for younger patients with predominant tremor
  • Risks include cognitive impairment and confusion (especially in older patients), dry mouth, constipation, urinary retention, and blurred vision
  • Limited efficacy compared to dopaminergic drugs

Neurotransmitters in Parkinson's Disease

• Dopamine: Primary neurotransmitter affected in Parkinson's disease, with decreased levels leading to motor symptoms
• Acetylcholine: Imbalance between dopamine and acetylcholine contributes to Parkinson's symptoms
• Glutamate: Excessive glutamate activity may contribute to disease progression
• GABA: Reduced GABA activity in the basal ganglia is associated with motor symptoms

Nursing considerations for Parkinson's medications

• Assess for contraindications and drug interactions before administration
• Monitor for common side effects
  • Dopaminergic drugs: nausea, vomiting, orthostatic hypotension, dyskinesias
  • Anticholinergic drugs: cognitive impairment, dry mouth, constipation, urinary retention
• Administer medications on time to maintain consistent dopamine levels
• Encourage patients to take medications with food to minimize gastrointestinal side effects
• Monitor for signs of impulse control disorders (compulsive gambling, hypersexuality)
• Assess for wearing-off and on-off phenomena, reporting to the physician for dose adjustments
• Be aware of potential drug interactions
  • Levodopa: protein-rich foods, iron supplements, antacids
  • MAO-B inhibitors: tyramine-rich foods (aged cheeses, cured meats), sympathomimetic drugs, antidepressants

Patient education for Parkinson's treatment

• Emphasize the importance of taking medications as prescribed
  • Maintain consistent timing of doses to prevent wearing-off and on-off phenomena
  • Do not stop medications abruptly, as this can worsen symptoms
• Provide strategies for managing side effects
  • Take medications with food to minimize gastrointestinal issues
  • Change positions slowly to prevent orthostatic hypotension
  • Practice good oral hygiene to combat dry mouth
• Encourage lifestyle modifications
  • Regular exercise (tai chi, yoga) to improve mobility and balance
  • Healthy diet with adequate hydration
  • Stress management and relaxation techniques (meditation, deep breathing)
• Educate about potential drug interactions and the need to inform all healthcare providers about Parkinson's medications
• Discuss the importance of regular follow-up with the neurologist for medication adjustments
• Provide resources for support groups (Parkinson's Foundation, Michael J. Fox Foundation) and Parkinson's disease organizations