Antiepileptic and Antiparkinsonian Treatment: Patient Care and Safety

Antiepileptic Treatment: Mouth Care

There is a risk of bleeding and gingival hyperplasia with antiepileptic treatment. It is recommended to use a soft toothbrush, avoid mouthwashes with alcohol, and have regular dental checkups.

Specific Mouth Care

• Use a soft toothbrush
• Avoid alcohol-containing mouthwashes
• Regular dental checkups

Vitamin K and Folic Acid Supplementation

A diet rich in vitamin K and folic acid is recommended to help prevent excessive bleeding in patients undergoing antiepileptic treatment.

Risks of Injury in Antiepileptic Treatment

Patients should avoid activities that pose a physical risk. It's important to understand the effects of medications on daily life.

Antiparkinsonian Treatment Goals

The overall goal of antiparkinsonian pharmacology is to improve the patient's ability to perform activities of daily living, such as eating, dressing, and personal hygiene.

Levodopa: Toxicity Risks

Levodopa carries a high risk of toxicity because only 1% crosses the blood-brain barrier (BBB), leading to numerous side effects. High doses increase this risk.

Recognizing Levodopa Toxicity

• Involuntary movements (finger flexion-extension, shoulder shrugging)
• Muscle tremors or jerky eye movements
• Loss of appetite, nausea, vomiting
• Constipation
• Orthostatic hypotension

Note: Elderly patients, neonates, and those with renal, cardiac, or liver failure are at increased risk.

Levodopa Interactions

Levodopa interacts with several substances:

• Tricyclic antidepressants: Decreased levodopa action
• MAOIs: Risk of hypertensive crisis
• Haloperidol: Antagonistic effect
• Antihypertensives: May cause hypotension
• Anticonvulsants: May decrease levodopa's therapeutic effects
• Antacids (magnesium, calcium, bicarbonate): Increased levodopa absorption and toxicity

Antiparkinsonian Treatment Problems and Interventions

Drug Toxicity

Monitor for and instruct patients on detecting early symptoms of poisoning.

Hypertension

Patients should have bi-monthly blood pressure checks.

Arrhythmias/Tachycardia

Patients should report palpitations, dizziness, or chest tightness to their healthcare provider.

Dose Inefficiency

This can occur at treatment initiation or adjustment.

Confusion/Hallucinations

Patients or caregivers should report mood changes or confusion. The medication may increase suicidal thoughts.

Safe Environment for Antiparkinsonian Treatment

To ensure patient safety:

• Change positions slowly to prevent orthostatic hypotension and dizziness.
• Increase fluid intake.
• Adapt the home to prevent falls.
• Use canes or walkers as needed.
• Encourage physical activity to maintain muscle mass.