Parkinson and Alzheimer disease
pathophysiology of Parkinson disease
- chronic neurologic disorder
- imbalance of neurotransmitters dopamine and acetylcholine
- degeneration of dopaminergic neurons leading to lack of dopamine
what frequently occurs as an adverse reaction to various drugs, carbon monoxide, manganese, or disorders?
what is the main function of Parkinson and Alzheimer disease drugs
main function is to replace Ache and dopamine
what are some characteristics you would see in a patient with Parkinson disease
- involuntary tremors of limbs
- rigidity of muscles
- postural changes
benztropine mesylate inhibits the release of what? what is the drug used for
- it is a parasympatholytic that inhibits the release of acetylcholine
- used for drug-induced Parkinsonism
after your client was administered benztropine mesylate, she experienced an adverse effect. what are the signs?
- blurred vision
- ocular hypertension
- dry mouth
- urinary retention
should you give carbidopa-levodopa to a patient with narrow angled glaucoma?
no, because if the ocular hypertension SE
can carbidopa or levodopa be taken alone?
no. they need to be taken together for an effect to happen
MOA of carbidopa-levodopa. what's the use?
- carbidopa drives levodopa to its destination before it breaks down.
- it is used to treat Parkinson's and relieve tremors and rigidity
the SE of carbidopa-levodopa are dry mouth, blurred vision, dysrhythmia, urinary retention, agranulocytosis. also known as_____
how many times should carbidopa-levodopa be taken for a therapeutic effect?
3-4 times a day because it has a fast half life
should tolcapone (tasmar) be taken alone? what should you check before administering? what is it in conjunction with?
- should never be taken in isolation.
- check LFT before taking and every 2 weeks
- only administer in conjunction with levodopa
- it's a last resort drug due to AE
MOA of tolcapone and use
- it carries levodopa to it's receptor site and increases duration of drug in the body
- it is used for idiopathic PD
tolcapone has severe AE that affect majority of the body system. what are they?
- fulminant liver failure
tolcapone is contraindicated in______
liver disease due to it's severe AE
- incurable dementia illness
- marked cognitive dysfunction
- onset between 45-65
pathophysiology of alzheimer disease
- not enough acetylcholine
- tangle in neurons
what are some symptoms of alzheimer disease?
- memory loss, confusion
- inability to communicate
- aggressive behavior, depression, psychoses
what is the goal of therapy for Alzheimer's disease
- slow memory and cognition loss
- bring about slight improvement in cognition and function
- rivastigmine MOA
- allow more acetylcholine in neuron receptors
- improves memory loss in alzheimer disease
what should the nurse monitor for in a client taking rivastigmine?
- dry mouth
- orthostatic hypotension
- suicidal ideation
you're teaching your patient about how rivastigmine is taken. you know the teaching has being effective when your patient states_____
"I should take my medication without food"
your patient's daughter asks you why they can't take rivastigmine with food. how should you respond?
if you take it with food, food competes with binding site and slows the action of the drug
which side effect of carbidopa-levodopa Does the nurse realize is most important to monitor?
pathophysiology of Myasthenia graves
- antibodies attach to acetylcholine receptor sites and destroy it
- lack of acetylcholine impairs transmission of messages
- remission and exacerbation
lack of transmission of messages at neuromuscular junctions in MG leads to____
- ineffective muscle contraction and muscle weakness
- weakness of respiratory, facial, extremity muscles
characteristics of myasthenia graves
- skeletal muscle weakness
- fatigue, ptosis
- respiratory muscle weakness, paralysis and arrest
what test is done to diagnose myasthenia gravis? what will happen If the patient has MG? what will happen if the patient does not have MG?
edrophonium or tensilon test. their function will temporarily improve. their condition will worsen
myasthenia crisis is caused by what? what are s/s?
- severe generalized muscle weakness
what can trigger a myasthenic crisis
- inadequate dosing
- emotional stress
- menses, pregnancy
what do you use to treat a myasthenic crisis?
a cholinergic crisis within 30-60 minutes after taking what? what triggers it
- anticholinergic medications
what are some S/S of a cholinergic crisis?
- severe muscle weakness
- possible respiratory paralysis and arrest
- excess salivation
what makes a cholinergic crisis worse. what is the antidote?
- administration of edrophonium or tensilon test
the MOA of pyridostigmine is to
prevents the destruction of acetylcholine
what is pyridostigmine used for
MG, neuromuscular blockage, nerve gas exposure prophylaxis
when pyridostigmine is taken, the AE is everything slows down. what are the AE?
- increased salivation and tearing
- miosis, blurred vision
- bradycardia, hypotension
- GI distress
what drugs/procedures can be given if the patient is unresponsive to acetylcholinesterase inhibitors
- plasma exchange
- immunosuppressive drugs
- IV immune globulin
pathophysiology of multiple sclerosis
- autoimmune disorder
- causes lesions
- attacks myelin sheath in brain and spinal cord
characteristics of multiple sclerosis
- remissions and exacerbations
- weakness or paralysis of extremities, fatigue
- blurred vision, vertigo, tinnitus
what is the diagnostic test for MS
there is no specific diagnostic test.
what are the indicators of diagnosis for MS
- medical history
- neurologic exam
- multiple lesions observable through MRI
- visual evoked potential
- elevated immunoglobulin G in cerebrospinal fluid
what is the MOA of beta-interferon
interacts with specific receptor sites on cell surfaces
what is beta-interferon used for
decrease number and severity of MS attacks, slows progression of disability
should patients with liver conditions take beta-interferon?
no, but monitor liver enzymes while on this medication
what are the AE of beta-interferon
myelosuppresion, hepatitis, neutropenia, myalgia anaphylaxis, flulike symptoms