REPORTER: Melody B.

Miguel

Degenerative diseases of the central nervous system (CNS)

Parkinson’s Disease
 is a degenerative disorder of the CNS caused by death of neurons that produce the
brain neurotransmitter dopamine. It is the second most common degenerative
disease of the nervous system, affecting more than 1.5 million Americans.
 that causes a person to lose control over some body functions
 other health problems often develop in these patients, including anxiety,
depression, sleep disturbances, dementia, and disturbances of the autonomic
nervous system such as difficulty urinating and performing sexually

Pathophysiology of Parkinson's disease (how it develop)

 Symptoms of parkinsonism develop because of degeneration and destruction of
dopamine-producing neurons found within an area of the brain known as the
substantia nigra.
 Under normal circumstances, neurons in the substantia nigra supply dopamine to
the corpus striatum, a region of the brain that controls unconscious muscle
movement.
 Balance, posture, muscle tone, and involuntary muscle movement depend on the
proper balance of the neurotransmitters dopamine (inhibitory) and acetylcholine
(stimulatory) in the corpus striatum.
 If dopamine is absent, acetylcholine has a more dramatic stimulatory effect in this
area. For this reason, drug therapy for parkinsonism focuses not only on restoring
dopamine function but also on blocking the effect of acetylcholine within the corpus
striatum. Thus, when the brain experiences a loss of dopamine within the substantia
nigra or an overactive cholinergic influence in the corpus striatum, parkinsonism
results.

How far the disease has progresses

 Stage one- Mild symptoms affect only one side of the body.
 Stage two- Symptoms affect both sides of the body, with posture and gait changes.
 Stage three- Body movements are slow, and balance is impaired.
 Stage four- Symptoms are severe and disabling, muscles become rigid, the patient
can't live alone, and walking is limited.
 Stage five- Wheelchair-bound or bedridden, the patient needs constant care.

Characteristics of Parkinson’s Disease

 Tremors - The hands and head develop a palsy-like motion or shakiness when at
rest; “pill rolling” is a common behavior in progressive states, in which patients rub
the thumb and forefinger together.
 Muscle rigidity- also known as muscle tension, rigor, or stiffness, is one of the most
common causes of muscle pain.
 Bradykinesia- is marked by difficulty chewing, swallowing, or speaking. Patients
with Parkinson’s disease have difficulties initiating movement and controlling fine
muscle movements. Walking often becomes difficult.
 Postural instability- Patients may be humped over slightly and easily lose their
balance. Stumbling results in frequent falls with associated injuries.
 Affective flattening- Patients often have a “masked face” where there is little facial
expression or blinking of the eyes.

Factors affecting/contributing to Parkinson’s disease

 Age- It ordinarily begins in middle or late life, and the risk increases with age.
People usually develop the disease around age 60 or older.
 Heredity- Having a close relative with Parkinson's disease increases the chances
that you'll develop the disease.
 Sex- Men are more likely to develop Parkinson's disease than are women.
 Exposure to toxins- Ongoing exposure to herbicides and pesticides may slightly
increase your risk of Parkinson's disease.

Drugs Medication
 The goal of pharmacotherapy for Parkinson’s disease is to increase the ability of the
patient to perform normal activities of daily living (ADLs) such as eating, walking,
dressing, and bathing

Dopaminergic Drugs- either restore dopamine function or stimulate dopamine receptors

located within the brain. Most recent efforts have focused on the use of dopamine
agonists for the initial treatment of Parkinson’s disease.

 Drug: Levodopa- it still remains not only the most effective but also first line of
treatment for these patients. levodopa is a precursor of dopamine
synthesis.
Mechanism of action: Supplying it directly leads to increased biosynthesis of
dopamine within the nerve terminals. Whereas levodopa can cross the blood–brain
barrier, dopamine cannot.
Primary use: to restore dopamine function or stimulate dopamine receptors within
the brain
Adverse Effect: Dizziness, light-headness, sleep dysfunction, fatigue, nausea,
vomiting, constipation, orthostatic hypertension, dystonia, dyskinesia

 Tolcapone, entacapone, rasagiline, and selegiline inhibit enzymes that normally

destroy levodopa and dopamine.
 Apomorphine, bromocriptine, pramipexole, and ropinirole directly activate the
dopamine receptor and are called dopamine agonists.
 Amantadine, an antiviral agent, causes the release of dopamine from nerve
terminals.
 Stalevo restores the neurotransmitter dopamine in extrapyramidal areas of the
brain, thus relieving some Parkinson’s symptoms. To increase its effect, levodopa is
combined with two other drugs, carbidopa and entacapone, which prevent its
enzymatic breakdown. Several months may be needed to achieve maximum
therapeutic effects.
Anticholinergic drugs
 inhibit the action of acetylcholine in the brain. They are used early in the course of
therapy for Parkinson’s disease.
 The centrally acting anticholinergics are not as effective as levodopa at relieving
severe parkinsonism symptoms. They are used early in the course of the disease
when symptoms are less severe, in patients who cannot tolerate levodopa, and in
combination therapy with other antiparkinsonism drugs.

 Drug: Benztropine is used to treat symptoms of Parkinson's disease and helps

decrease muscle stiffness, sweating, and the production of saliva, and helps improve
walking ability in people with Parkinson's disease.
Mechanism of Action: block acetylcholine, inhibit overactivity in brain
Primary use: in early stages of disease
Adverse Effect: dry mouth, blurred vision, photophobia, urinary retention,
constipation, tachycardia, glaucoma

Non pharmacological management of Parkinson’s disease

 Your doctor may also recommend lifestyle changes, especially ongoing aerobic
exercise. In some cases, physical therapy that focuses on balance and stretching also
is important.
 cognitive training and deep brain stimulation as well as noninvasive brain
stimulation strategies.
 A speech-language pathologist may help improve your speech problems.

Alzheimer’s Disease
 affects memory, thinking, and behavior. It is one of the forms of dementia that
gradually gets worse over time. By age 85, as many as 50% of the population may be
affected by AD.
 The early signs of the disease may be forgetting recent events or conversations. As
the disease progresses, a person with Alzheimer's disease will develop severe
memory impairment and lose the ability to carry out everyday tasks.

Characteristics of Alzheimer’s Disease

 Dementia is a degenerative disorder characterized by progressive memory loss,

confusion, and an inability to think or communicate effectively. Consciousness and
perception are usually unaffected. Known causes of dementia include multiple
cerebral infarcts, severe infections, and toxins.
 Inability to recognize family or friends.
 Aggressive behavior
 Depression.
 Psychoses, including paranoia and delusions.
 Anxiety

Alzheimer's disease typically progresses slowly in three general

stages
 Mild Alzheimer's disease (early stage)--a person may function independently. He or
she may still drive, work and be part of social activities. Despite this, the person may
feel as if he or she is having memory lapses, such as forgetting familiar words or the
location of everyday objects.
 Moderate Alzheimer's disease (middle stage)--typically the longest stage and can
last for many years. A person may have greater difficulty performing tasks, such as
paying bills, but they may still remember significant details about their life.getting
frustrated or angry, or acting in unexpected ways, such as refusing to bathe.
 Severe Alzheimer's disease (late stage)--Individuals lose the ability to respond to
their environment, to carry on a conversation and eventually to control movement.
They may still say words or phrases, but communicating pain becomes difficult. As
memory and cognitive skills continue to worsen, significant personality changes may
take place and individuals need extensive help with daily activities.

Factors affecting Alzheimer’s Disease

 Age- According to the Alzheimer’s Association, 1 in 9 people over age 65 and 1 in 3
people over 85 has Alzheimer’s.
 Gender--Women outnumber men when it comes to Alzheimer’s.
 Family history--If you have a parent, sibling, or child with the disease, you’re more
likely to develop it yourself.
 Head trauma--People who’ve had serious head injuries are at higher risk for
Alzheimer’s. Their risk increases if the injury involves losing consciousness or
happens repeatedly, such as in contact sports.
 Limited physical activity- Lack of exercise can make you more prone to Alzheimer’s.
If you exercise at least twiceTrusted Source a week during midlife, you might lower
your chances of getting Alzheimer’s in your senior years

Drug Medication

Treating Alzheimer’s Disease with Acetylcholinesterase Inhibitors

 The goal of pharmacotherapy in the treatment of AD is to improve function in three
domains: ADLs, behavior, and cognition.
 Drugs are used to slow memory loss and other progressive symptoms of dementia.
Some drugs are given to treat associated symptoms such as depression, anxiety, or
psychoses. The acetylcholinesterase inhibitors are the most widely used class of
drugs for treating AD.

 Drug: Donepezil hydrochloride (Aricept)

Mechanism of action: to prevent breakdown of acetylcholine; enhance transmission
in neurons
Primary use: slow progression of the disease
Adverse Effect: nausea/vomiting, dizziness and headache, bronchoconstriction, liver
injury

 Memantine (Namenda) is approved for treatment of moderate to severe AD.

Reduces the abnormally high levels of glutamate. Too much glutamate in the brain
may be responsible for brain cell death. Memantine may have a protective function
in reducing neuronal calcium overload.
 Mood stabilizers such as sertraline, citalopram, or fluoxetine are given when major
depression interferes with daily activities .
 Anxiolytics such as buspirone or some of the benzodiazepines are used to control
unease and excessive apprehension

Non pharmacological management of Alzheimer’s Disease

 memory training, mental and social stimulation, and physical exercise programs.
Some of these strategies could possibly improve people's cognitive performance and
increase their independence.
 nutritional support- aging individuals who consume enough fish (sea fish two to
three times a week) and fish products, omega-3 fatty acids and Ginkgo biloba see an
effect on their cognitive function which can slow down the development of
cognitive deficits.

Patients Receiving Pharmacotherapy

Assessment
*Baseline assessment prior to administration:
 Obtain a complete health history including cardiovascular, musculoskeletal diseases,
or glaucoma. Obtain a drug history including allergies, current prescription and OTC
drugs, and herbal preparations. Be alert to possible drug interactions.
 Obtain a history of the current disease and ability to carry out ADLs, particularly
mobility and eating.
 Obtain baseline vital signs, bowel sounds, urinary output, muscle strength, and
mental status as appropriate.
 Assess the patient’s ability to receive and understand instruction. Include the family
or caregivers as needed.

*Assessment throughout administration:

 Assess for desired therapeutic effects dependent on the reason for the drug
 Continue periodic monitoring of vital signs, mental status, and motor function.
 Assess for and promptly report adverse effects: hypotension, increasing tremors,
dizziness, salivation, anorexia, dysphagia, or changes in mental status, including
agitation or confusion.

Potential Nursing Diagnoses

 Impaired Physical Mobility
 Impaired Verbal Communication
 Self-Care Deficit (feeding, bathing, hygiene, toileting)
 Risk for Injury

Planning: Patient Goals and Expected Outcomes

The patient will:
 Experience therapeutic effects dependent on the reason the drug is being given
 Be free from, or experience minimal, adverse effects.
 Verbalize an understanding of the drug’s use, adverse effects, and required
precautions.
 Demonstrate proper self-administration of the medication
 Interventions
Ensuring therapeutic effects:
 Continue frequent assessments as described earlier for therapeutic effects. Drug
therapy may take several weeks or months to have a full effect. Support the patient
in self-care activities as necessary until improvement is observed.

Minimizing adverse effects:

 Ensure patient safety; monitor motor coordination and/or ambulation, eating, or
other essential motor activities.

Patient understanding of drug therapy:

 Use opportunities during administration of medications and during assessments to
provide patient education.

Patient self-administration of drug therapy:

 When administering the medications, instruct the patient, family, or caregiver in the
proper self-administration of drugs and the need for regular, consistent dosing.

Evaluation of Outcome Criteria

 Evaluate effectiveness of drug therapy by confirming that patient goals and
expected outcomes have been met (see “Planning”).