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)
