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NURS 320 > Exam 1: Degenerative Diseases of the Nervous System > Flashcards

Exam 1: Degenerative Diseases of the Nervous System Flashcards

1
Q

Alzheimer’s Disease

A

Most common degenerative disease of CNS.

Responsible for 70% of all dementia.

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2
Q

What is Alzheimer’s Disease?

A

Progressive loss of brain function: Memory loss, confusion, dementia

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3
Q

Causes of Alzheimer’s Disease

A 
Causes unknown
Possible causes include: 
   -genetic defects
   -chronic inflammation
   -excess free radicals
   -environmental factors
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4
Q

Symptoms of Alzheimer’s Disease

A
  • Impaired memory and judgment
  • Confusion and disorientation
  • Inability to recognize family and friends
  • Aggressive behavior
  • Depression
  • Psychoses, including paranoia and delusions
  • Anxiety
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5
Q

Goals of Pharmacotherapy for Alzheimer’s Disease

A 
Slow memory loss
Slow dementia symptoms
Improve activities of daily living
Improve behavior
Improve cognition
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6
Q

Treating AD with Acetylcholinesterase Inhibitors

A

Prevent breakdown of acetylcholine (Enhances transmission in cholinergic neurons)
Only slows progression

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7
Q

Nursing Considerations with ACHE inhibitors

A

Assess baseline vitals.
Monitor for hypotension.
Monitor for change in mental status or mood.
Monitor for dizziness, insomnia, anorexia.
Clients with narrow-angle glaucoma should not take revastigmine (Exelon).

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8
Q

ACHE Inhibitors Client Teaching

A

Take with food or milk to avoid GI upset.
Take as prescribed.
Teach signs and symptoms of overdose

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9
Q

Signs and Symptoms of an overdose can include

A
  • Severe N/V, sweating, salivation, hypotension

- Bradycardia, convulsions, increased muscle weakness (including respiratory muscles)

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10
Q

Acetylcholinesterase Inhibitors: Prototype Drug

A

donepezil hydrochloride (aricept)

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11
Q

Acetylcholinesterase Inhibitors: MOA

A

to prevent breakdown of acetylcholine; enhance transmission of neurons

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12
Q

Acetylcholinesterase Inhibitors: Adverse Effects

A

N/V
Dizziness and headache
Bronchoconstriction
Liver injury (tacrine)

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13
Q

Parkinson’s Disease

A
  • Second most common CNS disease.
  • Progressive loss of dopamine.
  • Tremor, muscle rigidity, abnormal movement and posture.
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14
Q

What causes symptoms of Parkinson’s Disease?

A

-Degeneration and destruction of dopamine-producing neurons
(Substantia nigra portion of brain)
-Corpus striatum (Normally controls unconscious muscle movement)

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15
Q

Symptoms of Parkinson’s Disease

A 
Tremors
Muscle rigidity
Bradykinesia (slowness in execution of movement)
Postural instability
Affective flattening
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16
Q

What health problems do patients with Parkinson’s often experience?

A
  • Primarily affects muscle movement.
  • Anxiety, depression
  • Sleep Disturbances
  • Dementia
  • ANS disturbances
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17
Q

Drug Therapy for Parkinosonism

A

Restores dopamine function
Blocks acetylcholine
Extrapyramidal side effects

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18
Q

Extrapyramidal side effects can include

A 
Tremors
Slurred speech
Akathisia (unpleasant sensations of inner restlessness)
Dystonia (sustained muscle contractions; repetitive movements or abnormal posture)
Anxiety
Distress
Paranoia
Bradyphrenia (slowness of thought)
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19
Q

Antiparkinsonism Agents

A

restores balance of dopamine and acetylcholine in brain

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20
Q

Antiparkinsonism Agents include

A 
dopaminergic drugs (dopaminergic adjunct agents)
anticholinergics (cholinergic blockers)
21
Q

Dopaminergics

A

restores balance of dopamine and acetylcholine

22
Q

Dopaminergic examples include

A

levodopa (larodopa)

levodopa and carbidopa (sinemet)

23
Q

Levodopa: MOA

A

Increases biosynthesis of dopamine within nerve terminals

24
Q

Levodopa: primary use

A

to restore dopamine function or stimulate dopamine receptors within the brain

25
Q

Dopaminergic Agents: Adverse Effects

A

dizziness, light-headedness, sleep dysfunction, fatigue, nausea, vomiting, constipation, orthostatic hypotension, dystonia, dyskinesia

26
Q

Dopaminergic Adjunct Agents

A 
Inhibits enzymes (ex. tolcapone)
Activates dopamine receptors (dopamine agonists) (ex. ropinirole)
Causes dopamine release from nerve terminals (ex. amantadine)
27
Q

Role of the Nurse: Dopaminergic Drug Therapy

A

Monitor for hypotension and tachycardia.

Look for symptoms of drug toxicity.

28
Q

Dopaminergic therapy is contraindicated in

A

narrow-angle glaucoma

29
Q

Dopaminergic Client Teaching

A
  • Increase fiber and fluids.
  • Avoid food and drugs high in pyridoxine (Vitamin B6).
  • May take several months for full effect.
  • Abruptly stopping the drug may cause Parkinsonism crisis.
30
Q

Anticholinergic Agents

A

-Centrally acting
-Block acetylcholine
(Inhibits overactivity in brain)
-Used in early stages

31
Q

Examples of anticholinergic agents

A 
Benztropine mesylate (Cogentin)
Triexyphenidyl hydrochloride (Artane)
32
Q

Benzotropine Mesylate: MOA

A

blocks acetylcholine; inhibits overactivity in brain

33
Q

Benzotropine Mesylate: Primary use

A

early stages of disease

34
Q

Benzotropine Mesylate: Adverse Effects

A

dry mouth, blurred vision, photophobia, urinary retention, constipation, tachycardia, glaucoma

35
Q

Anticholinergic Client Teaching

A

Relieve dry mouth with frequent drinks or sugarless hard candy.
Take with food or milk to prevent GI upset.
Avoid alcohol.
Wear dark glasses; avoid bright sunlight.
Do not stop taking abruptly

36
Q

Multiple Sclerosis

A

Demyelination of neurons in CNS.
Progressive weakness, visual disturbances, mood alterations, cognitive deficits.
Destruction of axons impairs ability of nerves to conduct electrical impulses.
Inflammation; plaque (scleroses).

37
Q

Causes of Multiple Sclerosis

A

Etiology unknown

Possible causes: genetic or microbial factors (climate: heat or humidity) or microscopic pathogens

38
Q

Signs and Symptoms of MS

A 
Fatigue
Heat sensitivity
Neuropathic pain; spasticity
Impaired cognitive ability
Disruption of balance and coordination
Visual disturbances; slurred speech
Bowel and bladder symptoms
Dizziness; vertigo
39
Q

Immunomodulators include

A
  • Interferon beta (Avonex, Rebif, Betaseron)

- glatiramer acetate (Copaxone)

40
Q

Immunomodulators: Primary Use

A

for MS patients to reduce severity of symptoms; decrease lesions

41
Q

Immunomodulators: Adverse Effects

A

flushing, chest pain, weakness, infection, pain, nausea, joint pain, anxiety, muscle stiffness

42
Q

Immunosuppressants include

A

mitoxantrone (novantrone)

43
Q

Mitoxantrone: Primary Use

A

for MS patients who have not responded to immune-modulating therapy

44
Q

Mitoxantrone: Adverse Effects

A

toxicity; hair loss; GI discomfort; allergic symptoms; blue-green tint to urine

45
Q

Amyotrophic lateral sclerosis (ALS)

A

Diffusely affects upper and lower motor neurons of the cerebral cortex, brain stem, and spinal cord (corticospinal tracts and anterior roots)

46
Q

ALS disease leads to

A

progressive weakness leading to respiratory failure and death
patient has normal intellectual and sensory function until death

47
Q

Guillain-Barre syndrome

A
  • Acquired inflammatory disease causing demyelination of the peripheral nerves with relative sparing of axons
  • Acute onset, ascending motor paralysis
  • Humoral and cellular immunologic reaction
48
Q

Myasthenia Gravis

A
  • Chronic autoimmune disease
  • An IgG antibody is produced against acetylcholine receptors (antiacetylcholine receptor antibodies)
  • Weakness and fatigue of muscles of the eyes and the throat causing diplopia, difficulty chewing, talking, swallowing

NURS 320 (28 decks)

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