11.5: Chapter Summary
This chapter discussed the disease processes and drug classifications used in managing two progressive neurodegenerative conditions: Parkinson’s disease and multiple sclerosis. There are similarities and differences among these conditions. Both cause motor and autonomic system manifestations, and neither has an identified cure. Both diseases are diagnosed mainly by clinical presentation. Medications are essentially beneficial in reducing symptoms of these conditions. In addition, medications are helpful in preventing relapses in MS and delaying the progression of PD.
The medications for each condition are distinct based on the etiologies. In PD, the medications are focused on increasing dopamine levels in the CNS by using dopamine replacement/dopamine agonist agents. Also, drugs that inhibit enzymes that metabolize the levodopa in the periphery—MAO and COMT inhibitors—are used so more dopamine reaches the CNS. Anticholinergic agents can be used as a second-line therapy in PD to decrease the unopposed ACh levels that cause many symptoms. In contrast, the overall purpose of medication in MS is to alter the immune system components to prevent further attack and damage. Generally, these are considered immunomodulators or have immunosuppressant properties. Drugs such as glucocorticoids or immunoglobulins are used in acute episodes to reduce severity and duration of the relapse. Importantly, varied classifications are necessary to treat nonmotor symptoms, such as spasticity and seizures. Overall, the main outcome for both conditions is for the client to continue to be independent as long as possible.