Exam 1: Degenerative Diseases of the Nervous System

Question 1

Alzheimer’s Disease

Answer 1

Most common degenerative disease of CNS.

Responsible for 70% of all dementia.

Question 2

What is Alzheimer’s Disease?

Answer 2

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

Question 3

Causes of Alzheimer’s Disease

Answer 3

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

Question 4

Symptoms of Alzheimer’s Disease

Answer 4

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

Question 5

Goals of Pharmacotherapy for Alzheimer’s Disease

Answer 5

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

Question 6

Treating AD with Acetylcholinesterase Inhibitors

Answer 6

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

Question 7

Nursing Considerations with ACHE inhibitors

Answer 7

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).

Question 8

ACHE Inhibitors Client Teaching

Answer 8

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

Question 9

Signs and Symptoms of an overdose can include

Answer 9

• Severe N/V, sweating, salivation, hypotension

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

Question 10

Acetylcholinesterase Inhibitors: Prototype Drug

Answer 10

donepezil hydrochloride (aricept)

Question 11

Acetylcholinesterase Inhibitors: MOA

Answer 11

to prevent breakdown of acetylcholine; enhance transmission of neurons

Question 12

Acetylcholinesterase Inhibitors: Adverse Effects

Answer 12

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

Question 13

Parkinson’s Disease

Answer 13

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

Question 14

What causes symptoms of Parkinson’s Disease?

Answer 14

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

Question 15

Symptoms of Parkinson’s Disease

Answer 15

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

Question 16

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

Answer 16

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

Question 17

Drug Therapy for Parkinosonism

Answer 17

Restores dopamine function
Blocks acetylcholine
Extrapyramidal side effects

Question 18

Extrapyramidal side effects can include

Answer 18

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)

Question 19

Antiparkinsonism Agents

Answer 19

restores balance of dopamine and acetylcholine in brain

Question 20

Antiparkinsonism Agents include

Answer 20

dopaminergic drugs (dopaminergic adjunct agents)
anticholinergics (cholinergic blockers)

Question 21

Dopaminergics

Answer 21

restores balance of dopamine and acetylcholine

Question 22

Dopaminergic examples include

Answer 22

levodopa (larodopa)

levodopa and carbidopa (sinemet)

Question 23

Levodopa: MOA

Answer 23

Increases biosynthesis of dopamine within nerve terminals

Question 24

Levodopa: primary use

Answer 24

to restore dopamine function or stimulate dopamine receptors within the brain

Question 25

Dopaminergic Agents: Adverse Effects

Answer 25

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

Question 26

Dopaminergic Adjunct Agents

Answer 26

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

Question 27

Role of the Nurse: Dopaminergic Drug Therapy

Answer 27

Monitor for hypotension and tachycardia. | Look for symptoms of drug toxicity.

Question 28

Dopaminergic therapy is contraindicated in

Answer 28

narrow-angle glaucoma

Question 29

Dopaminergic Client Teaching

Answer 29

- 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.

Question 30

Anticholinergic Agents

Answer 30

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

Question 31

Examples of anticholinergic agents

Answer 31

``` Benztropine mesylate (Cogentin) Triexyphenidyl hydrochloride (Artane) ```

Question 32

Benzotropine Mesylate: MOA

Answer 32

blocks acetylcholine; inhibits overactivity in brain

Question 33

Benzotropine Mesylate: Primary use

Answer 33

early stages of disease

Question 34

Benzotropine Mesylate: Adverse Effects

Answer 34

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

Question 35

Anticholinergic Client Teaching

Answer 35

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

Question 36

Multiple Sclerosis

Answer 36

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).

Question 37

Causes of Multiple Sclerosis

Answer 37

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

Question 38

Signs and Symptoms of MS

Answer 38

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

Question 39

Immunomodulators include

Answer 39

- Interferon beta (Avonex, Rebif, Betaseron) | - glatiramer acetate (Copaxone)

Question 40

Immunomodulators: Primary Use

Answer 40

for MS patients to reduce severity of symptoms; decrease lesions

Question 41

Immunomodulators: Adverse Effects

Answer 41

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

Question 42

Immunosuppressants include

Answer 42

mitoxantrone (novantrone)

Question 43

Mitoxantrone: Primary Use

Answer 43

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

Question 44

Mitoxantrone: Adverse Effects

Answer 44

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

Question 45

Amyotrophic lateral sclerosis (ALS)

Answer 45

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

Question 46

ALS disease leads to

Answer 46

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

Question 47

Guillain-Barre syndrome

Answer 47

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

Question 48

Myasthenia Gravis

Answer 48

- 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