Module 2 Active Reading Guide: Pharmacotherapy in Parkinson's Disease and Movement Disorders

Instructions: This guide will help you actively engage with your reading by capturing key information, completing concept maps, and applying knowledge to real-world scenarios. Complete each section as you read Chapter 24, 29, 30, 31, 32, and 33.

Chapter 24: Antiparkinsonism Agents

Pre-Reading Reflection

Before reading, reflect on the following:

1. What are the most common signs and symptoms of Parkinson's disease?
2. How do medications help restore neurotransmitter balance in the brain?
3. What patient education topics are important when initiating dopaminergic or anticholinergic medications?

Fill-in-the-Blank Notes & Key Definitions

Complete the following using your reading:

1. Parkinson's Disease: A neurodegenerative disorder caused by the progressive loss of ________-producing neurons.
2. Dopaminergic Agents: Drugs that increase the effects of ________ in the brain.
3. Anticholinergic Agents: Drugs that block the effects of ________ in the central nervous system.
4. Carbidopa-Levodopa: Combination drug used to ________ dopamine levels in the CNS.
5. Extrapyramidal Symptoms (EPS): Motor side effects often caused by dopamine-blocking ________.
6. COMT Inhibitors: Adjunctive drugs that prolong the effects of levodopa by inhibiting its ________.
7. MAO-B Inhibitors: Prevent breakdown of dopamine by inhibiting monoamine ________ enzymes.
8. Benztropine: An anticholinergic used to treat ________ or drug-induced parkinsonism.
9. Entacapone: A COMT inhibitor used in combination with ________ to manage wearing-off symptoms.
10. Iron Salts: Can interfere with the absorption of ________, reducing its effectiveness.

Guided Reading Questions

Use these questions to support your reading:

1. How does dopamine depletion lead to the motor symptoms of Parkinson's disease?
2. What is the role of carbidopa in combination with levodopa?
3. When are anticholinergic agents preferred over dopaminergics?
4. What are the key differences between COMT inhibitors and MAO-B inhibitors?
5. What nursing assessments and labs are important before and during therapy with antiparkinsonism drugs?

Concept Mapping Activity Managing Parkinson's Disease Pharmacologically

Instructions: Use the table to map out the major classes of antiparkinsonism agents and their mechanisms.

Drug Class	Mechanism of Action	Common Medications	Key Nursing Considerations
Dopaminergic Agents	____________________________	________________	_______________________
Anticholinergic Agents	____________________________	________________	_______________________
COMT Inhibitors	___________________________	________________	_______________________
MAO-B Inhibitors	___________________________	________________	_______________________
Adjunctive Therapies	__________________________	________________	_______________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. What is the most important teaching point for a patient starting carbidopa-levodopa?
2. Which side effects would prompt immediate intervention when caring for a client receiving dopaminergic therapy?
3. How does understanding adjunctive agents like entacapone or selegiline change your approach to care planning?

Chapter 29: Introduction to the Autonomic Nervous System

Pre-Reading Reflection

Before reading, reflect on the following:

1. What do you already know about how the sympathetic and parasympathetic systems influence the body?
2. Why might understanding the structure of the ANS help in predicting drug actions and side effects?
3. How does the body's "fight-or-flight" response relate to medications you may encounter in clinical settings?

Fill-in-the-Blank Notes & Key Definitions

Complete the following using your reading:

1. Autonomic Nervous System (ANS): Works with the ________ system to maintain internal homeostasis.
2. Sympathetic Nervous System (SNS): Prepares the body for ________ or ________.
3. Parasympathetic Nervous System (PNS): Supports functions like ________ and ________.
4. Adrenergic Receptors: Receptors that respond to ________ and ________.
5. Alpha Receptors: Found in blood vessels and responsible for ________.
6. Beta-1 Receptors: Primarily affect the ________.
7. Beta-2 Receptors: Cause ________ dilation and affect glucose metabolism.
8. Cholinergic Receptors: Receptors that respond to the neurotransmitter ________.
9. Muscarinic Receptors: Located in the ________, bladder, and heart.
10. Nicotinic Receptors: Found in ganglia and at the ________ junction.

Guided Reading Questions

Use these questions to support your reading:

1. What are the key differences in structure and function between the sympathetic and parasympathetic nervous systems?
2. How do alpha and beta receptors differ in their location and function?
3. What is the role of acetylcholinesterase in cholinergic synapses?
4. How does norepinephrine differ from acetylcholine in terms of termination of effect?
5. How does the ANS contribute to maintaining homeostasis?

Concept Mapping Activity Comparing the SNS and PNS

Instructions: Use the chart to map out the structure, function, and effects of each division of the autonomic nervous system.

Division	Origin in CNS	Neurotransmitters	Physiological Effects
Sympathetic Nervous System	_____________	____________________	_____________________________
Parasympathetic Nervous System	_______________	_____________________	_____________________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. Which aspect of the ANS do you find most difficult to understand?
2. How does this chapter help you understand how certain medications (e.g., beta-blockers or anticholinergics) work?
3. How can understanding receptor subtypes help you provide safer and more effective care?

Chapter 30: Adrenergic Agonists

Pre-Reading Reflection

Before reading, reflect on the following:

1. What effects do you associate with "fight-or-flight" responses?
2. Why might medications that stimulate the sympathetic nervous system be useful in emergencies?
3. What concerns might arise when using drugs that activate alpha and beta receptors?

Fill-in-the-Blank Notes & Key Definitions

Complete the following using your reading:

1. Adrenergic Agonists: Drugs that stimulate ________ receptors of the sympathetic nervous system.
2. Sympathomimetic: A drug that mimics the effects of ________ nervous system activation.
3. Epinephrine: A non-selective adrenergic agonist used to treat ________, cardiac arrest, and asthma.
4. Alpha-Agonists: Drugs that primarily stimulate alpha receptors, causing ________ of blood vessels.
5. Beta-1 Agonists: Increase ________ rate and contractility.
6. Beta-2 Agonists: Are often used in __________ treatment.
7. Isoproterenol: A non-selective beta agonist used for ________ disorders.
8. Dopamine: A dose-dependent adrenergic drug used in shock and ________ failure.
9. Extravasation: The leakage of IV-administered drug into tissues, potentially causing ________ damage.
10. Phentolamine: An antidote used to reverse the effects of local tissue ________ due to extravasation.

Guided Reading Questions

Use these questions to support your reading:

1. What is the difference between selective and non-selective adrenergic agonists?
2. How do the actions of alpha vs. beta adrenergic receptors differ?
3. In what clinical situations are drugs like epinephrine and dopamine used?
4. What precautions must nurses take when administering adrenergic drugs via IV?
5. What teaching is necessary for clients prescribed beta-2 agonists (e.g., albuterol)?

Concept Mapping Activity Adrenergic Agonist Drug Classes

Instructions: Use the table to classify drugs based on receptor activity and nursing responsibilities.

Drug Name	Receptor Type	Clinical Use	Key Nursing Considerations
Epinephrine	____________	_______________________	______________________________
Dobutamine	____________	_______________________	_______________________________
Albuterol	_____________	________________________	_______________________________
Dopamine	_____________	________________________	_______________________________
Isoproterenol	_____________	________________________	_______________________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. What do you find most challenging about administering adrenergic agonists safely?
2. How can understanding receptor selectivity improve your clinical decision-making?
3. What patient education would you emphasize when a client is prescribed an adrenergic inhaler or IV agent?

Dosage Calculation Practice Box: IV Adrenergic Infusion

Use this case-based prompt to apply clinical math reasoning alongside pharmacologic understanding.

Case: A patient weighing 50 kg is prescribed norepinephrine at 0.05 mcg/kg/min for shock. The pharmacy provides a solution of 4 mg in 250 mL of D5W.

Your Task:

• Calculate the total mcg/min dosage for this patient.
• Convert that dose to mcg/hr.
• Using the available concentration, determine the mL/hr rate to set on the IV pump.

Round to the nearest whole number and show your work in the space below:

Work:

Answer (mL/hr): ___________

Chapter 31: Adrenergic Antagonists

Pre-Reading Reflection

Before reading, reflect on the following:

1. What symptoms might you expect to see if the sympathetic nervous system is blocked?
2. In what types of conditions are beta-blockers commonly used?
3. What side effects might occur when using drugs that decrease heart rate and blood pressure?

Fill-in-the-Blank Notes & Key Definitions

Complete the following using your reading:

1. Adrenergic Antagonists: Also called blockers, these drugs inhibit the action of ________ at alpha and beta receptors.
2. Alpha Blockers: Cause ________ by relaxing blood vessels.
3. Beta-Blockers: Decrease ________ rate and myocardial contractility.
4. Non-Selective Beta Blockers: Block both ________ and ________ receptors.
5. Selective Beta-1 Blockers: Primarily act on the ________.
6. Labetalol: Blocks alpha-1 and beta receptors and is used to treat severe ________.
7. Propranolol: A non-selective beta-blocker used to treat hypertension, angina, and ________.
8. Atenolol: A cardioselective beta-blocker often used in clients with ________.
9. Orthostatic Hypotension: A common side effect of adrenergic antagonists due to vasodilation and reduced ________ return.
10. Bronchospasm: A possible adverse effect in clients with asthma taking ________ beta-blockers.

Guided Reading Questions

Use these questions to support your reading:

1. What are the differences between selective and non-selective beta-blockers?
2. Why are some beta-blockers preferred for clients with respiratory conditions?
3. How do adrenergic antagonists lower blood pressure?
4. What side effects are common with alpha blockers?
5. What precautions should nurses take when administering or discontinuing beta-blockers?

Concept Mapping Activity Adrenergic Antagonists and Their Effects

Instructions: Complete the table below to organize information about adrenergic antagonist drugs and their clinical use.

Drug Name	Selectivity (Alpha/Beta)	Clinical Use	Key Nursing Considerations
Propranolol	________________________	___________________	__________________________
Labetalol	__________________	___________________	__________________________
Atenolol	__________________	___________________	__________________________
Prazosin	__________________	____________________	__________________________
Tamsulosin	______________________	____________________	__________________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. When would a selective beta-blocker be preferred over a non-selective one?
2. What teaching points would you emphasize to prevent orthostatic hypotension in clients taking alpha blockers?
3. How can you monitor for and respond to adverse respiratory effects in clients prescribed beta-blockers?

Chapter 32: Cholinergic Agonists

Pre-Reading Reflection

Before reading, reflect on the following:

1. What do you already know about how acetylcholine affects the body?
2. In what conditions might stimulating the parasympathetic nervous system be beneficial?
3. What are your concerns or expectations about the side effects of cholinergic drugs?

Fill-in-the-Blank Notes & Key

Definitions Complete the following using your reading:

1. Cholinergic Agonists: Drugs that mimic the action of ________ in the parasympathetic nervous system.
2. Direct-Acting Agonists: Bind directly to cholinergic receptors and activate ________.
3. Indirect-Acting Agonists: Inhibit the enzyme ________, increasing endogenous acetylcholine levels.
4. Bethanechol: A direct-acting cholinergic drug used to treat urinary ________.
5. Pyridostigmine: An indirect-acting cholinergic drug used to treat ________ ________.
6. Donepezil: A cholinesterase inhibitor used in the management of ________ disease.
7. Cholinergic Crisis: A potentially life-threatening condition characterized by excessive ________ stimulation.
8. SLUDGE: An acronym for cholinergic effects: salivation, lacrimation, urination, diarrhea, GI cramping, and ________.
9. Atropine: An antidote used to treat ________ toxicity.
10. Myasthenic Crisis: An acute exacerbation of ________ ________ due to underdosing.

Guided Reading Questions

Use these questions to support your reading:

1. What are the key differences between direct- and indirect-acting cholinergic agonists?
2. How does inhibiting acetylcholinesterase affect synaptic transmission?
3. What is the clinical use of drugs like bethanechol and pyridostigmine?
4. How can nurses distinguish between myasthenic and cholinergic crisis?
5. What are important teaching points when starting a client on donepezil?

Concept Mapping Activity Cholinergic Agonists and Their Uses

Instructions: Complete the table below to organize medications and nursing implications.

Drug Name	Type (Direct/Indirect)	Indication	Key Nursing Considerations
Bethanechol	______________	_____________________	______________________________
Pyridostigmine	______________	_____________________	______________________________
Donepezil	______________	_____________________	_______________________________
Neostigmine	______________	_____________________	_______________________________
Atropine	______________	_____________________	_______________________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. What signs would alert you to a cholinergic crisis?
2. What nursing actions are critical in managing clients receiving cholinergic medications?
3. What patient education strategies would you use for clients prescribed pyridostigmine or donepezil?

Chapter 33: Anticholinergic Agents

Pre-Reading Reflection

Before reading, reflect on the following:

1. What effects do anticholinergic drugs have on the body?
2. Why might anticholinergic medications be prescribed for clients with Parkinson's disease or GI disorders?
3. What safety concerns should nurses be aware of when administering these medications?

Fill-in-the-Blank Notes & Key Definitions

Complete the following using your reading:

1. Anticholinergic Agents: Drugs that block the action of ________ in the parasympathetic nervous system.
2. Atropine: A prototype anticholinergic used to increase ________ rate and reduce secretions.
3. Benztropine: Used to reduce tremors in clients with ________ disease or drug-induced parkinsonism.
4. Glycopyrrolate: Often used preoperatively to reduce ________ secretions.
5. Scopolamine: Commonly used to prevent motion ________.
6. Oxybutynin: Prescribed for ________ bladder and urinary urgency.
7. Dry Mouth: A common side effect of anticholinergic therapy known as ________.
8. Heat Intolerance: Occurs because anticholinergics suppress ________.
9. Vision Changes: Such as blurred vision or photophobia, may result from ________ pupil dilation.
10. Contraindicated Conditions: Anticholinergics should be used cautiously in clients with ________, GI obstruction, or urinary retention.

Guided Reading Questions

Use these questions to support your reading:

1. How do anticholinergic medications produce therapeutic effects?
2. In what conditions are anticholinergic drugs most commonly used?
3. What side effects should nurses monitor for in clients receiving anticholinergics?
4. What teaching should nurses provide clients about managing dry mouth, constipation, or heat intolerance?
5. How do anticholinergics differ from cholinergic agonists in their mechanism and effects?

Concept Mapping Activity Anticholinergic Agents and Their Uses

Instructions: Complete the table below to map anticholinergic drugs and their nursing implications.

Drug Name	Indication	Mechanism of Action	Key Nursing Considerations
Atropine	____________________	____________________	___________________________
Benztropine	____________________	____________________	___________________________
Oxybutynin	____________________	____________________	___________________________
Scopolamine	____________________	___________________	___________________________
Glycopyrrolate	____________________	___________________	___________________________

Self-Assessment & Reflection

Reflect on what you've learned from this chapter:

1. What patient populations are most at risk for complications from anticholinergic therapy?
2. What are your key nursing priorities when caring for clients prescribed anticholinergic agents?
3. How will this chapter influence the way you assess and educate clients about medication side effects?

Application: Real-World Case-Based Scenarios

Case 1: Parkinson's Disease and COMT Inhibitor Education A client with Parkinson's disease is prescribed entacapone in addition to carbidopa-levodopa. The client expresses confusion about why the new medication was added.

• What education should the nurse provide about the purpose of entacapone?
• How does this combination therapy improve the client's symptom management?

Case 2: Drug-Food Interaction A client with Parkinson's disease who is taking carbidopa-levodopa begins a new health regimen involving iron supplements. They soon report a return of their tremors.

• What is the most likely cause of symptom recurrence?
• What education should the nurse provide to prevent further interaction?

Case 3: Anticholinergic Use in Myasthenia Gravis A client with myasthenia gravis is inadvertently prescribed benztropine. The client reports worsening muscle weakness.

• What is the nurse's best course of action?
• How should the nurse explain the reason for the reaction?

Case 4: Monitoring Beta-Blocker Effects A client is prescribed propranolol for essential tremors. During follow-up, the client reports lightheadedness and a low pulse rate.

• What monitoring steps should the nurse take next?
• How does this reflect the pharmacologic action of propranolol?

Case 5: Adrenergic Response Recognition A client presents with increased heart rate, dilated pupils, and anxiety. These are signs of sympathetic nervous system activation.

• What other findings would the nurse expect?
• What nursing interventions may be necessary in this scenario?