DRUG STUDY

GENERIC NAME: caribidopa/levodopa

TRADE NAME: Sinemet 25/100

CLASSIFICATION: antiparkinson agents

ACTION: Levodopa is converted to dopamine in the CNS, where it

serves as a neurotransmitter. carbidopa prevents peripheral
destruction of levodopa. Therapeutic effect -Relief of tremor and
rigidity in Parkinson's syndrome.

PHARMACOKENETICS

Absorption: Well absorbed.

Distribution: Widely, distributed. Levodopa-enters the CNS in small

concentrations. Carbidopa-does not cross the blood-brain barrier. Both
enter breast milk.

Metabolism and Excretion: Levodopa-mostly metabolizied by the GI

tract and liver. Carbidopa - 30% excreted unchanged by the kidneys.

Half-life: Levodopa- 1hr. carbidopa- 1-2hr.

CONTRAINDICATION/PRECAUTIONS

Contraindicated in: Hypersensitvity. Norrow-angle glaucoma. MAO

inhibitor therapy. Malignant melanoma. Undiagnosed skin leisons.

Use cautiously in: History of cardiac, psychiatric, or ulcer disease.

ADVERSE REACTIONS/SIDE EFFECTS

CNS: involuntary movements, anxiety, dizziness, hallucinations,

memory loss, psychiatric problems. EENT: blurred vision,mydriasis. GI:
nausea, vomiting, anorexia, dry mouth, hepatotoxicity. Derm:
melanoma. Hemat: hemolytic anemia, leukopenia. Misc: darkening of
urine or sweat.

INTERACTIONS

Drug-drug: MAO may result in hypertensive reactions.

Phenothiazines, haloperidol, papaverine, phenytoin, and
reserpine may decrease effect of levodopa. Methyidopa may alter
the effectivness of levodopa and increase CNS side effects. Concurrent
use Antihypertensives may increase the risk of hypeotension.
Anticholingergics may decrease the absorption of levodopa.
Selegilene or cocaine may increase risk of adverse reactions.

Drug-Natural Products: Kava may decrease levodopa effectivness.

NURSING IMPLICATIONS OF DRUG ADMINISTRATION

Assessment

•assess parkinsonian symptoms (akinesia, rigidity,tremors, pill

rolling, shuffling gait, mask-like face, twisting motions and
drooling) during therapy. `` On off phenomenon`` may cause
symptoms to appear or improve suddenly. To establish a
baseline evaluation to determine medication effectiveness.

•obtain complete health history including allergies, drug history and

possible drug interactions.

obtain baseline vital signs, especially blood pressure and pulse.

•Lab test Considerations: may cause false-positive test results in

Coomb's test,serum and urine uric acid, and urine protein
concentrations.

•Monitor hepatic and renal function and CBC periodically in patient

on long term theraphy.

•assess that patient is able to complete ADL,s.

•Toxicity and Overdose: Muscle twitching and blepharospasm

(eyelid spasms) Overdose is a common phenomenon, particularly
with long term drug use. Recognizable as the patient
experiences a sudden onset of worsening parkinsonian
symptoms.

Potential Nursing Diagnosis

•Impaired physical mobility

•Risk for falls

•Impaired mental ability (understand and commuicate)

•Social isolation (depressed angry and lonely)

Implementation

•Do not confuse levodopa with methyldopa

•Monitor vital signs closely when levodopa dose is being adjusted.

(Hypotension could occur. Dysrhythmias can occur in patients
with cardiac problems.)

•Monitor for behavior changes. ( levodopa increases risk of

depression and could cause other mood changes such as
aggressiveness and confusion)

•Monitor for symtoms of overdose.

•Monitor for improved functional status followed by loss of

theraputic effects. (on-off phenomenon)due to changes in
dopamine levels. Usually occurs in patient on long term
theraphy.

•Evaluate diet (Absorption of levodopa decreases with high protein

meals or high consumption of pyridoxine-containing foods)

•Monitor for decreased kidney or liver function. (Decrease in these

functions may slow metabolism and excretion possibly leading to
an overdose.)

Patient Teaching

•Instruct patient to report signs of hypotension, dizziness, light

headedness, feeling of heart racing, or dyspnea.

•instruct patient to change positions slowly and how to protect self

from falls.

•Instruct patient to watch for and report any signs of changes in

behavior or mood.

•Instruct patient to be aware of newly occuring muscle twitching,

including eyelids and to report.

•Instruct patient to report rapid, unpredictable changes in motor

symptoms.

•Instruct patient to take med. on an empty stomach but food may

be eaten 15 min. later to avoid GI upset. to avoid taking med.
 with high protein meal and avoid foods containing pydoxine
(bananas, wheat germ, green vegetables, liver and legumes).

•Advise patient to have liver and kidney funtion tests periodically.

•Inform patient that urine and sweat may darken, but not to be
alarmed.

Evauation

•Patient has an increased ease of movement and decrease of

symtoms of Parkinson's .

•Patient has and understanding of this drug as he can describe the

drugs action and side effects and to report any changes if they
occur.

•Patient understands the importance of adhering to the drug

regimen.