Question

A 63-year-old woman returns with a 4-year history of advanced Parkinson's disease. Currently her medication is only effective for 4 hours, after which her tremors become more severe, handwriting "cramped", and walking is worse. She denies involuntary movements with her medication (dyskinesias), falls, or "freezing" of gait. Her neuropsychiatric review demonstrates no history of depressed mood, anxiety, hallucinations, or significant cognitive impairment. She continues to work part-time, is driving, and has no sleep impairment or daytime somnolence from her medication. Presently she is taking carbidopa-levodopa 25/100 mg po tid.

Is carbidopa-levodopa therapy an effective treatment for significantly reducing symptoms of motor dysfunction such as tremors and difficulty walking?

For a patient diagnosed with Parkinson's disease, is levodopa therapy the best therapy?

How is the medication tolcapone different from carbidopa-levodopa?

Explain actions, assessment, side effects, teaching, and nursing interventions for carbidopa-levodopa.

Explain actions, assessment, side effects, teaching, and nursing interventions for tolcapone.

Answer 1

1. Levodopa is the mainstay treatment for Parkinson disease. Levodopa is a dopaminergic agonist ,after it gets absorbed in the gastrointestinal tract it is transfEerred to brain cells through peripheral circulation where it gets converted to dopamine. Some blood enzymes like amino acid decarboxylase would break down the levodopa before it reaches the brain and decrease the effect of the medicine . To hinder the break down process , levodopa is given in combination with carbidopa (enzyme inhibitor). Yes carbidopa-levodopa is an effective treatment for reducing motor symptoms in Parkinson disease, although it has a side effect of motor fluctuation causing dyskinesia on long term use,it is the most common and effective treatment for Parkinson disease.

2. For a patient diagnosed with Parkinson's disease Levodopa is the best therapy. It is the most commonly used and effective treatment given by the physicians as it significantly causes relief in the motor symptoms of Parkinson disease that are tremors,postural instability etc. It has less side effects as compared to other drugs used in Parkinson disease.

3.Tolcapone is a drug which comes under COMT inhibitor( that is chatechol- O methyltransferase inhibitors). It is used in patients who poorly respond to carbidopa-levodopa. It's action is by blocking the degradation of catecholamines and increases the dopamine levels in the brain cells. The action of levodopa is after getting absorbed in the gastrointestinal tract it is transferred to brain by peripheral circulation,where it is converted to dopamine. Levodopa is a dopaminergic agonist and talcopane is a chatechol-O methyltransferase inhibitor.

4. Carbidopa-levodopa :-

Action - dopaminergic agonist, once it gets absorbed in gastrointestinal tract,it is transferred to brain cells through peripheral circulation where it is converted to dopamine.

Side effects- nuasea, vomiting ,dry mouth, confusion, dizziness, motor fluctuations like dyskinesia , glaucoma mostly closed angle glucose, gastrointestinal bleeding.

Nursing assessment - Nurse must assess the therapeutic response to the drug .Assess for the side effects like nausea , vomiting, hallucinations, dizziness, confusion, dyskinesia etc. Assess whether patient is having any other diseases which will interact with the drug like antidepressants will interact with levodopa ,patients with glaucoma because levodopa causes closed angle glaucoma etc.

Nursing interventions- Monitor the vital signs for hypotension due to dose adjustment . Ask the patient to inform any signs of hypotension like dizziness etc . Monitor for safety as the patient might have confusion , dizziness due the side effects of drug ,it may lead to fall. Monitor hourly glucose level in diabetes patient because levodopa causes fluctuations in glucose . Monitor diet of the patient because high protein and pyridoxine will decrease the absorption of levodopa . Inform the patient that due the drug the colour of urine and sweat will be dark noe need to alar,monitor for overdose symptoms like insomnia ,motor fluctuations. Monitor for behavior changes as it might be related to psychosis.In older patient monitor for cardiovascular changes like heart rate ,look for edema , palpitations.

5. Tolcapone :-

Action - It is a chatechol -O methyltransferase inhibitor ,it inhibits the degradation of catecholamine ,hence increases the level of dopamine.

Side effect- urine discoloration, dyskinesia, anxiety, dyspepsia, dizziness, orthostatic hypotension,liver failure,GI irritation.

Nursing assessment- Nurse just the response of the patient to the drugs ,monitor for the side effects , monitor whether the patient is taking any medications or a diet which hinder it's absorption.

Nursing intervention- Monitor the vitals ,to check for hypotension ,teach the patient to inform if he feels dizziness , palpitations etc. Ensure safety by preventing falls as this drug causes orthostatic hypotension ,hence inform patient to change the position slowly and to get of bed slowly.Monitor for liver and kidney function ,do the route assessment tests.inform the patient about urine discolouration but no need to get panic,monitor for dyskinesia and prevent from falling.