Deg Neuro Pharmacological Therapy Flashcards
Riluzole
ALS
Glutamate blocker; prolong survival 3-6 months
Baclofen
ALS, MS
Treat muscle spasms, spasticity
SE: dizziness, weakness, confusion, nausea
Diazepam
ALS, Huntingtons
Treats anxiety, muscle spasms, seizures; chorea tx
SE: dizziness, weakness, confusion, nausea
Dantrolene sodium
ALS
Treat muscle spasms; treat/prevent malignant hyperthermia
SE: dizziness, weakness, confusion, nausea
Glycopyrrolate
ALS
Treats severe drooling
SE: constipation
IVIG
Guillain-Barre
Stops the antibodies, decreases circulating antibodies; given during first couple weeks of dz
Tx HTN, tachy
Treat hypotension with fluids
Tetrabenazine (xenazine)
Huntington
Tx chorea
Levodopa
Huntington
treat patients with rigidity; may give Parkinson’s disease drugs
Amantadine HCl
MS, P
Reduces rigidity, tremor, bradykinesia, postural changes
SE: mood changes, confusion, depression, hallucinations, LE edema, nausea, epigastric distress, urinary retention, HA, visual impairment
Mitoxantrone (Novantrone)
MS
Reduce clinical relapses (risk of cardiac toxicity)
Gabapentin (Neurontin)
MS
anticonvulsant, nerve pain medication
Oxybutynin
MS
Tx bladder urgency; bladder relaxant
Baclofen (lioresal)
MS
Muscle relaxant, decrease spasticity
Methylprednisolone
MS
Shortens duration of relapse (no LT benefit); anti-inflammatory effect on T-cells and cytokines
Glatiramer
MS
Reduces frequency of relapses, but not progression of disability
Dimethyl fumarate
MS
Decreases number of episodes of worsening MS
Interferon 1A (Avonex, Rebif)
MS
Slows disease worsening, decrease flare ups; immunomodulator medications
SE: flu-like symptoms
Interferon 1B (Betaseron, Extavia)
MS
Reduce flare ups; immunomodulator
SE: flu-like symptoms
IVIG (MG)
Myasthenia gravis
Tx exacerbations;
Consists of immune globulins and acts to destroy and neutralize autoantibodies in the blood stream and block the production of new autoantibodies
AE: HA, migraine, flu-like symptoms
Pyridostigmine bromide (mesitonin)
Myasthenia gravis
Anti-cholinesterase; inhibits breakdown of ach; usually given QID
SE: take with food/milk, diarrhea, abdominal cramps, excessive saliva
Prednisone
Myasthenia gravis
Second line; most common long term; susceptible to oral infections
Azathioprine
Myasthenia gravis
3rd line; inhibits T-lymphocytes and b-cell proliferation and reduce ach receptor antibody levels; therapeutic effects may take 3-12 months
AE: leukopenia, hepatotoxicity
Carbidopa-levodopa
Parkinson’s disease
Increases presence of dopamine in brain
*carbidopa added to avoid metabolism of levodopa before it reaches brain
SE: NV, appetite loss, decreased BP, dystopia, dyskinesia, confusion
Amantadine HCl
Parkinson’s disease
Reduces rigidity, tremor, bradykinesia, postural changes
SE: mood changes, confusion, depression, hallucinations, LE edema, nausea, epigastric distress, urinary retention, HA, visual impairment
Trihexyphenidyl HCl
Parkinson’s disease
Improves muscle control, decreases stiffness; counteract ACh action, control tremors
SE: blurry vision, flushing, rash ,constipation, urinary retention, acute confusion
Which of the following clinical manifestations would alert the nurse caring for a patient with Guillain-Barré syndrome that his status is deteriorating?
A. Tidal volume of 500 mL
B. Residual lung volume of 1200 mL
C. Vital capacity of 11 mL/kg
D. Oxygen saturation of 97%
C. Vital capacity of 11 mL/kg
When developing a plan of care for a patient with Guillain-Barré syndrome, the nurse knows that which of the following nursing interventions would receive priority?
A. Using the IS as prescribed
B. Maintain the patient on bed rest
C. Assisting the patient with ADLs
D. Determining abnormalities of cognitive function
A. Using the IS as prescribed
The physician has ordered a Tensilon test to rule out myasthenia gravis. The nurse knows that which of the following medications would be used to counteract the SE of the Tensilon?
A. Baclofen (Lioresal)
B. Atropine (AtroPen)
C. Epinephrine (Adrenaline)
D. Narcan (Naloxone)
B. Atropine (AtroPen)
The nurse is caring for a patient recently diagnosed with myasthenia gravis whose CT scan reveals an enlarged thymus gland. Which additional assessment data would be consistent with the diagnosis of myasthenia gravis?
A. Decreased sensations in the hands and feet
B. Incoordination of gait
C. Facial numbness causing slurred speech
D. Generalized weakness of extremities
D. Generalized weakness of extremities
The nurse is caring for a recently diagnosed patient with myasthenia gravis whose CT scan reveals an enlarged thymus gland. Which additional assessment parameter should the nurse complete to confirm the diagnosis of myasthenia gravis?
A. Passive ROM of the neck
B. Check of DTRs
C. Applications of painful stimuli to legs
D. Visual screening using the Snellen chart
D. Visual screening using the Snellen chart
It is important to frequently monitor the patient with Guillain-Barré syndrome when ascending paralysis is occurring. When assessing the patient for bulbar muscle weakness, the nurse should be alert to which of the following clinical manifestations?
A. Decreased LOC
B. Inability to clear secretions
C. Hypersensitivity of hands and feet
D. Increased ICP
B. Inability to clear secretions
The nurse knows that plasmapharesis is being utilized in the treatment of the patient with Guillain-Barré syndrome for which of the following reasons?
A. Removal of anti-ACh receptor antibodies
B. Reduction in the number of bacteria in the bloodstream
C. Decrease in antibodies attacking peripheral nerve myelin
D. Removal of potassium and fluid
C. Decrease in antibodies attacking peripheral nerve myelin
When assessing a patient with myasthenia gravis, the nurses would be correct in questioning the patient regarding which of the following clinical manifestations?
A. Weakness associated with fatigue
B. Headache that worsens at night
C. Projectile vomiting without nausea
D. Diaphoresis
A. Weakness associated with fatigue
The nurse recognizes that corticosteroid therapy, when used in the treatment of Guillain-Barré syndrome, reduces the inflammation and edema associated with this neuromuscular disorder. It is most important for the nurse to monitor which of the following lab values for the patient on corticosteroid therapy?
A. pH of urine
B. Hemoglobin
C. Serum potassium
D. Serum glucose
D. Serum glucose
The nurse would expect to document which of the following in a patient with myasthenia gravis undergoing a Tensilon test?
A. Positive Tensilon test
B. Negative Tensilon test
C. Positive sweat test
D. Negative sweat test
A. Positive Tensilon test
When examining a patient with Guillain-Barré syndrome, the nurse would expect to assess which of the following clinical manifestations?
A. Paresthesias of the hands and feet
B. Hyperactive DTRs
C. Hypotension
D. Descending weakness
A. Paresthesias of the hands and feet
A patient with Guillain-Barre has had ABGs drawn. Which of the following ABG values indicates that the patient’s status is deteriorating?
A. pH 7.37
B. PaCO2 60
C. HCO3 24
D. Oxygen saturation of 94%
B. PaCO2 60
Which of the following is a clinical manifestation associated with Guillain-Barré syndrome?
A. Vertigo
B. Ptosis of the eyelid
C. Diminished taste for food
D. Vocal paralysis
D. Vocal paralysis
The nurse teaching a patient recently diagnosed with myasthenia gravis should tell him that it is caused by:
A. Genetic dysfunction
B. Upper and lower motor neuron lesions
C. Decreased conduction of impulses in an upper motor neuron lesion
D. A lower motor neuron lesion
D. A lower motor neuron lesion
Which of the following schedules would be most appropriate for the care of a 28-year-old female hospitalized with a diagnosis of myasthenia gravis?
A. All at one time, to provide a longer rest period
B. Before meals, to stimulate her appetite
C. In the morning, with frequent rest periods
D. Before bedtime, to promote rest
C. In the morning, with frequent rest periods
