CNS drugs 3

Question 1

Parkinson’s

Answer 1

• most common mvmt dx
• affects extrapyramidal motor tract (posture, balance, & locomotion)
• depletion of dopamine (shuffling)
• increaes of ach (tremors)
• no cure
• drug tx is based on easing the s/s & to assist in maintaining the pt’s mobility & function as long as possible

Question 2

s/s of Parkinson’s

Answer 2

• tremors
• rigidity
• akinesia & bradykinesia
• postural instability
• affect is flat

Question 3

drugs used to tx Parkinson’s

Answer 3

• anticholinergics
• dopaminergics
• adjunctive

Question 4

s/e of anticholinergics

Answer 4

• dry mouth
• blurred vision
• dizziness
• urinary retention
• dysuria
• tachycardia
• muscle weakness
• confusion

Question 5

dopaminergics

Answer 5

• act on sympathetic NS

- affect the dopamine content of the brain

Question 6

Levodopa

Answer 6

• cannot give alone in the US
• it is converted to dopamine before it enters the brain=large doses needed=too many s/e
• reduces muscle rigidity & tremors
• takes 2-4 months to achieve max benefit

Question 7

Carbidopa

Answer 7

inhibits the enzyme so that more levodopa can reach the brain

Question 8

s/e of levodopa

Answer 8

• n/v
• dyskinesia
• hypoTN
• cardiac dysrhythmias
• psychosis
• usually seen with high doses

Question 9

early s/s of levodopa toxicity

Answer 9

• spasmodic eye winking

- muscle twitching

Question 10

Sinemet

Answer 10

• carbidopa-levodopa
• most effective for Parkinson’s, not pseudoparkinsonism
• levodopa crosses the blood brain barrier
• more dopamine reaches the basal ganglia

Question 11

Sinemet s/e

Answer 11

• levodopa s/e are not prevalent
• cardiac dysrhythmias
• palpitations
• orthostatic hypoTN

Question 12

disadvantages of Sinemet

Answer 12

• using early in the dx may cause s/e to develop more quickly
• pt may stop responding to drug sooner

Question 13

contraindications of dopaminergic drugs

Answer 13

• angle closure glaucoma
• suspicious skin lesions associated with the development of melanoma
• CVD
• bronchial asthma
• urinary obstruction
• peptic ulcer dx

Question 14

adjunctive Parkinson’s meds

Answer 14

• extend Sinemet’s effectiveness
• delay the need for Sinemet
• used in pts who are unable to tolerate the max dose of Sinemet

Question 15

foods to avoid in Parkinson’s

Answer 15

• high in vit B6
• beef, ham, egg yolk, sweet potatoes, oatmeal, fotified cereals
• high protein

Question 16

Alzheimer’s dx

Answer 16

• anomia
• apraxia
• agnosia
• amnesia
• aphasia
• terminal dx of brain tissue

Question 17

Alzheimer’s drugs

Answer 17

• prevent breakdown of Ach
• don’t cure
• help reduce behavioral problems, improve thinking, judgment, & recognition
• aricept
• namenda
• razadyne
• exelon

Question 18

Aricept

Answer 18

• administer qhs
• rifampin=drug/drug interaction
• indication: mild-mod dementia
• caution: dizziness, drowsiness, depression, diarrhea, deep muscle cramps
• elevation in ach
• pt may have bradycardia
• take w/o regard to food

Question 19

Namenda

Answer 19

• not to take with renal impairment
• assess for cognitive function
• must not dilute
• dizziness may occur
• neurotransmitter inhibitor

Question 20

Razadyne

Answer 20

• reversible AchE inhibitor
• for mild to mod dementia
• take with meals
• bradycardia

Question 21

Exelon

Answer 21

• AchE inhibitor
• s/e: GI upset, wt loss
• PO (with meals) & transdermal

Question 22

generalized s/e anti alzheimer’s drugs

Answer 22

• HA
• dizziness
• fatigue
• frequent urination
• wt gain/loss
• cardiac dysrhythmias
• change in BP

Question 23

myasthenia gravis

Answer 23

• autoimmune
• “grave muscle dx”
• fluctuating muscle weakness & fatigue
• ach receptors are blocked
• lack of ach receptor

Question 24

pharm mgmt of MG

Answer 24

• neostigmine (prostigmin)
• pyridostigmine (mestinon)
• endrophonium (tensilon)

Question 25

myasthenic crisis

Answer 25

**severe generalized muscle weakness
triggers:
-inadequate dosing
-infection
-emotional stress
-menses
-pregnancy
-surgery
-trauma
-decreased K+
-temperature extremes
-alcohol
-certain meds

Question 26

neostigmine

Answer 26

• interferes with breakdown of ach
• improves muscle tone in MG
• has greater effect on skeletal muscle than pyridostigmine

Question 27

pyridostigmine

Answer 27

• cholinesterase inhibitor
• prevents breakdown of ach
• OD=atropine sulfate

Question 28

pyridostigmine contraindications

Answer 28

• GI/GU obstruction
• lung disorders
• kidney dx
• slow/irregular HR

Question 29

pyridostigmine s/e

Answer 29

• n/v
• adb cramps
• increased saliva/mucus
• decreased pupil size
• increased urination or sweating
• life threatening
• respiratory depression
• bronchospasm
• cardiac dysrhythmias
• seizures

Question 30

edrophonium

Answer 30

• used as dx for MG only
• used to differentiate between MG and cholinergic crisis
• if s/s are alleviated: cause is myasthenia crisis
• if muscle weakness is more severe: cause is cholinergic crisis d/t drug OD