PD/MG

• Parkinson's Disease

  Chronic Progressive neurological disorder that affects the motor tract of the brain
• Parkinson's Disease


  • Imbalance between dopamine and acetylcholine
  • Degeneration of dopaminergic neurons leading to lack of dopamine
• Priorities of care for a patient with Parkinson's Disease


  • Emphasize Safety
  • Improve ADL's
  • Fall risk (all drugs side effect) → orthostatic hypotension
• Mechanism of Action (MOA) of dopaminergics

  1. Carbidopa stops levodopa from metabolizing meaning carbidopa helps reach the brain

  2. Stimulates dopamine receptors

  3. Inhibit MAO-B enzyme that interferes w/ dopamine → prolonging the action of levodopa

  4. Reversibly inhibits COMT when given w/ levo carbidopa, increase levodopa bioavailability
• Side Effects of dopaminergics

  • CNS: D/HA, dizziness, insomnia, ataxia, hallucination, depression
  • CV: orthostatic hypotension, palpitations
  • RESP: rhinitis/sinusitis
  • GI: bleeding, nausea, constipation, abdominal pain
  • Other: agranulocytosis, Angioedema, hypoglycemia, dyskinesia, fatal hepatoxicity
• Carbidopa-levodopa is the first drug of treatment for Parkinson's Disease
• Dopamine Agonists can be taken alone or in combination with carbidopa-levodopa
• MAO-B Inhibitors are used in combination with levo-carbidopa
• COMT Inhibitors like Tolcapone are the first drug to be given with levodopa for advanced Parkinson's Disease
• COMT Inhibitors and Tolcapone have a Black Box Warning
• Myasthenia Gravis


  Antibodies attach ACH receptors resulting in decreased amount of receptors sites at the neuromuscular junction, this prevents ACH molecules from attaching to the receptor and stimulates normal muscular contraction
• Most Frequent Affected Sites in Myasthenia Gravis

  • Eye & eyelids movement
  • Facial Expression
  • Chewing & swallowing
  • Respiratory paralysis
• Priority Assessment for Myasthenia Gravis

  • Respiratory assessment (ABC's)
  • Safety
  • Monitor drug effectiveness
  • Observe pt for s/s of cholinergic crisis
  • Administer does on time
  • Take drugs before meals
• Myasthenic Crisis


  Muscle Weakness involving diaphragm & intercostal muscles resulting in respiratory failure, triggered by inadequate/underdosing, emotional stress, infection, surgery, trauma
• Cholinergic Crisis


  Overdosing with acetylcholinesterase inhibitors may trigger a cholinergic crisis
• Neostigmine is used to treat Myasthenic Crisis as it is a fast-acting drug
• Atropine is the antidote used to treat Cholinergic Crisis