E2 Concepts Flashcards
Pathophysiology of Myasthenia Gravis
Acetylcholine (ACh) receptor sites destroyed leading to a lack of nerve impulses and muscle responses at the myoneural junction
What special precautions should you take with patients who have myasthenia gravis?
Lack of muscle control leads to decreased ability to breathe. Always access breathing and ability to swallow before giving PO medication.
Cholinergic vs Adrenergic
Both involved with the autonomic nervous system. Cholinergic (constricted pupils, increased saliva, bronchoconstriction, increased GI mucus, bladder contraction) Adrenergic (dry mouth, dilated pupils, increased contractility, increased HR, bronchodilation, bladder relaxation)
Cholinergic NT
Acetylcholine (Ach)
Adrenergic NT
Epinephrine, Norepinephrine and dopamine
Parkinson’s Disease Patho
Chronic disorder with the imbalance of NT. Dopamine normally control acetylcholine to inhibit (ACh’s) excitability.
Parkinson’s disease is the degeneration of dopamine neurons
Three main Parkinson characteristics
Tremors (head, neck and limbs at rest) Rigidity (increased muscle tone) Bradykinesia (slow movements)
Additional: Postural changes (head + chest forward) Shuffling walk, lack of facial expressions
Treatment of parkinson
Many of the dopamine neurons are destroyed before signs show.
Non pharmacologic: Exercise, nutrition (weight loss) and supports
Medications to replace dopamine or block acetylcholine
Anticholinergics
Blocks cholingergic receptors
Dopaminergics
Converts to dopamine
Dopamine agonists
Stimulates dopamine receptors
MOA-B inhibitors
Inhibits the action of the MOA-B enzyme that interferes with dopamine
Alzheimers Disease
Chronic progressive neurodegenerative condition
Beta-amyloid and neuritic plaques form, neurofibrillary tangles and not enough !acetylcholine!`
Acetylcholinsterase (AChE) Inhibitors/Cholinesterase Inhibitor
Inhibit the break down of ACh that is done by AChE
Allows more acetylcholine in the neuron receptors, increases cognitive function, used for mild to moderate dementia
NMDA Receptro Antagonist
Blocks neuronal receptors for N-methyl- D-aspartate
- Normalzies the Ca++ enhancing the use of glutamate
Cholinergic Crisis
Overdosed from cholinesterase inhibitors - see SE within 30-60 minutes
Severe muscle weakness: respiratory paralysis and arrest, abnormal pupil constriction, excess salivation, pallor, sweating, vertigo, Gi distress, bradycardia
Multiple Sclerosis (MS)
Autoimmune disorder - attacks myelin sheath of nerve fivers, causes lesions or plaques
Characteristics: Variable but muscle weakness, cognitive impairment, spasticity, diplopia and dysphagia
No specific diagnosis labs can indicate elevated (IgG) or increased IgG/albumin ratio
Lesions are observable in a brain MRI
Drug therapy used to relieve symptoms, maintain QOL, and prevent permanent damage
Disease modifying therapy (DMT) for MS
Can decrease the number and severity of the MS attacks, slow progression of disability
Do not use with Echinacea + melatonin
Monitor liver function (hepatotoxicity) and signs of infection
Narcolepsy
Falling asleep uncontrollably while driving, talking, eating or standing
Treatment is a stimulant
ADHD
Dysregulation of serotonin, norepinephrine and dopamine
Inattentive, inability to concentrate, restlessness, impulsivity
Herbs nursing considerations
No regulation, pts should look for seals (US Pharmacopeia, consumer lab, natural products association and NSF international)
Do not give herbs to infants or young children, do not take large quantities
Assessment: Obtain all therapies a patient uses (OTC drugs, herbs and vitamins)
Glaucoma
Too much aqueous humor leads to increased intraocular pressure (IOP) which leads to nerve damage
Two classifications: Open angle + Closed/Narrow Angle
Diagnostic studies for eyes
Locate lesions, foreign bodies, objects, eval dry eye
Forurescein stains, rose bengal, lissamnie green
Conjunctivitis
inflammation of conjunctiva membrane (pink eye)
Blepharitis
infection of lids/lashes
Chalazion
blocked meibomian gland, eyelid cyst
Hordelum
stye
Infectious keratitis
cornea infection
infectious uveitis
vascular infection, red + swollen eyes
Eye infections Pt Education
Discard and discontinue contact lenses
Eye decongestants
Vasoconstrictors that narrow blood vessels, reduce eye redness/edema
CAUTION with pt hypertension
Contraindicated in pts with narrow angle glaucoma
Macular degeneration
Central vision affected
Overgrowth of sub retinal blood vessel, fluid leakage and separation of the macula leads to vision loss/distortion
Ear infection (Acute otitis media)
Often starts as congestion and eustachian tube inflammation
PAIN relief + antibiotics
Acute Otitis Externa
Swimmers ear, in the outer ear canal
Anti-infectives can cause burning or stinging and aminoglycosides can cause ototoxicity
Acne Vulgaris
Characterized by comedones, papules, nodules, cycts
Results from keratin plugs and bacteria
Non-pharm: Gentle cleansing, oil free lotions and makeup, healthy diet
iPLEDGE
Risk management program for isotretinoin includes sections for patient, provider, pharmacist and wholesaler
Sections need to be done by each group each month
Verruca Vulgaris
Warts, often benign
Can treat with OTC salicylic acid or cryotherapy
Drug-Induced Dermatitis
Characteristics; Rash, urticaria, papules, vesicles
Erythema multiforme: Steven-Johnson
Toxic Epidermal Necrolysis: detachment of epidermis from underlying layers
Contact dermatitis
Causes by cosmetics, perfume, laundry soaps or poison ivy
Treatment: Burows solution (aluminum acetate) Calamine lotion
Impetigo
Staphylococcus aureus infections
Appears as honey-colored crusts
Contagious - spreads through daycare/school quickly
Treatment: Mupirocin (bactroban) cephalixin (keflex)
1st, 2nd, 3rd degree burn classification
1st: redness, mild to moderate pain
2nd: deep thickness, blistering, painful
3rd: full thickness, nerve damage no pain
miosis
construction of pupils
mydriasis
dilation of pupils
IOP
increased intra ocular pressure
mydriatics
drugs that cause dilation of pupils
cycloplegics
drugs that cause paralysis of ocular muscles
diplopia
double vision
