Open Access

Understanding Parkinson's Disease: A Basic Overview

Rachael L Anderson
Rachael L Anderson
, 
Adelene Choo
Adelene Choo
, 
Sue Sharrad
Sue Sharrad
 and 
Ruth Withey
Ruth Withey
   | Oct 11, 2023
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Published Online: Oct 11, 2023
Page range: 9 - 23
DOI: https://doi.org/10.21307/ajon-2023-012
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© 2023 Rachael L Anderson et al., published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Figure 1:

A multidisciplinary team and their role in the management of Parkinson's disease.
A multidisciplinary team and their role in the management of Parkinson's disease.

Parkinson's disease medications, classes, examples, indications, side effects and nursing considerations.

Class Examples Indication(s) Side effects Nursing considerations
Levodopa Therapy Levodopa/carbidopa – KinsonÒ, SinemetÒ, Sinemet CRÒ, SindopaÒ, DuodopaÒ. Levodopa/benserazide - MadoparÒ, Madopar RapidÒ, Madopar HBSÒ Remains the gold standard treatment for PD and the most effective at treating motor symptoms of bradykinesia, rigidity and at times tremor.As dopamine does not cross the blood-brain barrier, levodopa acts as the precursor to dopamine replacement, directly converting to dopamine in the brain and peripheral tissues to replace depleted striatal dopamine (Australian Medicines, 1998),Levodopa is given with a peripheral dopa decarboxylase inhibitor (carbidopa or benserazide) to help reduce peripheral dopamine production and reduce side effects of nausea, vomiting and hypotension (Levodopa benserazide/carbidopa, (Australian Medicines, 1998)) May include nausea, vomiting, drowsiness, mood changes, hallucinations, confusion, postural hypotension, dyskinesia and motor fluctuations, libido alterations, sudden sleep onset (Levodopa benserazide/carbidopa (Australian Medicines, 1998),Dopamine dysregulation syndrome is estimated to occur in 3–4% of advanced stage PD, and can be characterised by a compulsive overuse of levodopa causing dyskinesia's, psychosis, and impulse control disorders (Levodopa benserazide/carbidopa (Australian Medicines, 1998)). Timely administration is crucial. Strict adherence to PD medication timing is vital to obtain optimal symptom management with minimal side effects, and regime is tailored to each PwP.Nurses must be vigilant when administering PD medications, as PD medications exist in a range of formulations and preparations including rapid acting, slow release, and regular release form. Recognise that protein-based foods may interact with medication.Ideally, administer 30 minutes before food or two hours after food to minimise protein/medication interactions.Never cease medications abruptly, as this can lead to life threatening neuroleptic malignant-like syndrome which may present as hyperpyrexia, diaphoresis, muscular rigidity, and life threating autonomic dysfunctions.Medications should continue even if a patient is fasting for a surgical procedure.Contraindicated medications include Haloperidol, Metoclopramide and Prochlorperazine.Avoid the use of contraindicated antidepressants, antipsychotics and some anaesthetic agents and pain medications.Use alerts and warning stickers when available.
Dopamine Agonists Pramipexole - SifrolÒ (immediate release, extended release), Apomorphine – Movapo, ApomineRotigotine transdermal patches - NeuproÒ). Mimic the action of levodopa by acting as dopamine receptor activators, which in turn results in increased dopamine activity Dopamine Agonists (DA), can be used as monotherapy or in combination with medications from other classes. Impulse control disorder (ICD) is a common side effect of DA, and can occur at any stage of PD. Features of ICD may include gambling, over-spending, hypersexuality, binge eating and inappropriate internet use (Australian Medicines, 1998),Postural hypotension, nausea, vomiting, hallucinations, and confusion can be common in Apomorphine.Those with a personal or family history of bipolar disorder, substance misuse or obsessive-compulsive disorders are at higher risk of developing ICD disorders (Australian Medicines, 1998),Dopamine Agonist Withdrawal Syndrome (DAWS) has been reported in up to 20% of PwP.Symptoms can be severe and may include agitation, mood disturbance, fatigue, insomnia, sweating, orthostatic hypotension, and drug craving (Australian Medicines, 1998).Other side effects might include sudden sleep onset, abdominal pain, headache, dizziness, weakness, fatigue, nasal congestion, peripheral oedema, dyskinesia, and digital vasospasm (Australian Medicines, 1998). weakness, fatigue, nasal congestion, peripheral oedema, dyskinesia, and digital vasospasm (Australian Medicines, 1998). Education to PwP and their caregivers is crucial in avoiding adverse outcomes and nurses should remain vigilant in monitoring for DA side effects to ensure timely review and management.DA should never be abruptly ceased; and cessation should occur over a tapering phase with close monitoring for withdrawals (Australian Medicines, 1998).Rotigotine patches should be applied to dry, non-irritated skin. Rotate patch sites daily.Firmly hold patches on skin with the palm of hand for 30 seconds to ensure the adhesive sticks to the skin.
Catechol-O-methyl Transferase (COMT) Inhibitors Entacapone – ComtanÒ, Entacapone combinations - StalevoÒ CarleventÒ LectevaÒ TridopaÒ, Serves as an adjunct to Levodopa.Inhibits the enzyme COMT from metabolising levodopa, prolonging the clinical response to levodopa (Australian Medicines, 1998).COMT inhibitors aim to improve the duration of ‘on’ time by increasing levodopa plasma levels by 10 – 30% and often the dose of levodopa may need to be reduced (Grünig, et al., 2018). May include dizziness, dyskinesia, gastrointestinal upset, hepatoxicity (from Tolcapone), discoloured urine (reddish/brown) and may worsen confusion, hallucinations, paranoia, dyskinesia constipation (Australian Medicines, 1998). Entacapone should not be stopped abruptly, due to the risk of withdrawal syndrome and neuroleptic malignant syndrome.
Monoamine Oxidase Type B (MAO-B) Inhibitors Selegiline (SelgeneÒ, EldeprylÒ), Rasagiline (AzilectÒ) and Safinamide (XadagoÒ) Reduce the breakdown of dopamine and block dopamine reuptake in the brain, working to mildly enhance dopaminergic effects and lessen the degree of “wearing off.” Serves as an adjunct to levodopa or might also be used as monotherapy in early PD to protect the endogenous dopamine (Australian Medicines, 1998). Insomnia, orthostatic hypotension, headache, nausea, vomiting and confusion. Dyskinesia, vomiting, rash, arthralgia (Australian Medicines, 1998). When used with Levodopa, MAO-B inhibiters may increase dopaminergic effects such as dyskinesia, hallucinations, nausea, and vomiting – Levodopa doses may require reduction (Australian Medicines, 1998).
Anticholinergics Benzhexol - ArtaneÒ Benztropine - BenztropÒ, Biperidine - AkinetonÒ Aim to achieve a balance between acetylcholine and dopamine.Mostly used for tremor dominant PD.Generally used infrequently given their side effect profile. Confusion, hallucinations, blurred vision, constipation, urine retention, dry mouth, nausea, vomiting, insomnia, worsening dyskinesia, sweating. Bradyarrhythmia's, mydriasis, extrapyramidal disorders. Adverse effects may depend on dosages as well as patient factors (age, comorbidities) (Australian Medicines, 1998). Can be used in the management of some NMS of PD, however extreme care must be taken when prescribing to the elderly as they can increase the risk of falls, delirium, cognitive impairment and worsening of some PD symptoms.
Amantadine SymmetrelÒ An antiviral drug with N-methyl-D-aspartate (NMDA) receptor blocker properties and is commonly used as an anti-dyskinetic agent in PD. (Australian Medicines, 1998). Sleep disturbance, confusion, postural hypotension, dizziness, and blurred vision, nervousness, depression, nightmares, peripheral oedema, dry mouth, vomiting, constipation, livedo reticularis (Australian Medicines, 1998). As Amantadine causes insomnia, it is suggested to administer no later than 4pm in the afternoon (Sawada et el., 2010). Sudden withdrawal may cause severe delirium, anxiety, and agitation.
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