final: chronic neuro drugs Flashcards
parkinson’s is an excess of ….. and a depletion of ….
excess of acetylcholine
depletion of dopamine
in order to treat parkinsons’ drugs must
increase dopamine
decrease acetylcholine
parkinson’s treatment only does what with the disease
delay the progression
levodopa/carbidopia (sinemet) used for
parkinson’s
Levodopa/Carbidopa (Sinemet) …. levodopa becomes
levodopa becomes dopamine in the brain and crosses the BBB
Levodopa/Carbidopa (Sinemet)… carbidopa does what
carbidopa gets the levodopa to the brain but doesnt cross the bbb
if Levodopa/Carbidopa (Sinemet) fails, suspect
a misdiagnosis of parkinson’s
SE of Levodopa/Carbidopa (Sinemet)
- n/v
- cardiovasccular
- hallucinations, CNS effects
- activates meanoma
- dyskinesias
Levodopa/Carbidopa (Sinemet) drug interactions
- MAO-I (hypertensive crisis)
- antipsychotics (block dopamine)
- high protein foods reduce terapeutic effects
instruct pt taking Levodopa/Carbidopa (Sinemet) to do what with meals
spread protein throughout the day
pramipexole (mirapex) uses
used for PRA-kinsons
pramipexole (mirapex) action
non-ergot dopamine agonist= direct activation of dopamine in striatum
pramipexole (mirapex) can be used how
alone or as adjunct to Ldopa/Cdopa
do not give pramipexole (mirapex) to those with impulse control disorder why
because it can cause SE like compulsive gambling (this is because of the direct dopamine activation_
SE of pramipexole (mirapex) when used alone
- nausea, constipation
- dizziness
- sleep disturbances and hallucinations
SE of pramipexole (mirapex) when combined with Ldopa/Cdopa
- orthostatic hypotension
- dyskinesias
- hallucinations
alzheimer’s disease is a depletion of
acetylcholine
to treat alzheimer’s disease, drugs must
increase acetylcholine
inhibiting acetylcholinesterase stops
the break down of acetylcholine
donepexil (aricept) class
acetylcholinesterase inhibitor
donepexil (aricept) action
inhibits metabolism of acetylcholine in brain making it more available
donepexil (aricept) does what with alzheimers
doesnt cure but delays progression by a little more than a year
donepexil (aricept) use
used for alzheimers
donepexil (aricept) SE
- n/d
- bradycardia
- fainting
- falls
- fall related fractures
when to take donepexil (aricept)
at bedtime due to SE thus reducing risk of falls
contraindications for donepexil (aricept)
do not combine with anticholinergic drugs including first gen antihistamines (benadryl)
what is MS
neurological autoimmune disorder where the immune system eats away the myelin sheaths
what can we do with drugs to MS
slowed with treatment
early treatment increases the chances of significantly improving the prognosis
Interferon Beta (Refib) class
immunomodulator
disease modifying drug: naturally occurring cytokine
Interferon Beta (Refib) action
reduces the frequency/severity of MS attacks, number and size of lesions
delays progression f disability
Interferon Beta (Refib) is given
injection
Interferon Beta (Refib) SE
- flu like symptoms
- depression and suicidal thoughts
- extensive liver involvement
Interferon Beta (Refib) nursing implications
obtain baseline CBC and LFT’s
what to check with Interferon Beta (Refib)
check liver function
Interferon Beta (Refib) interactions
dont give with other drugs that affect the liver
do not take with booze
Interferon Beta (Refib) use
MS
what is spasticity
movement disorder of CNS
what is the most common cause of spasticity
MS and cerebral palsy
characteristics of spasticity
- heightened muscle tone
- spasm
- loss of dexterity
drugs for spasticity and what they have in common
- baclofen (CNS)
- dantrolene (directly on muscle)
- Diazepam (CNS)
all have CNS depressing qualities
Baclofen (Lioresal) MOA
- works in CNS
- mimics GABA in spinal (back) neurons to suppress hyper reflexes
Baclofen (Lioresal) use
relief of spasticity related to cerebral palsy, spinal cord injury, and MS
Baclofen (Lioresal) admin
intrathecally (in the back)
Baclofen (Lioresal) SE
- nausea,
- urinary retention
- constipation
- orthostatic hypotension
caution with Baclofen (Lioresal)
dont operate machinery until you know your response to drug
how to stop Baclofen (Lioresal)
gradual taper
abrupt withdrawal= rhabdomyolysis
Dantrolene (Dantrium) MOA
- peripherally acting muscle relaxant
- inhibits muscle contraction by preventing release of calcium in skeletal muscles
Dantrolene (Dantrium) uses
- relief of spasticity due to cerebral palsy or MS
- treatment of malignant hyperthermia
Dantrolene (Dantrium) SE
- CNS depression
- Hepatic tox
Dantrolene (Dantrium) contraindications
- caution with impaired liver function
- CNS depressants additive effects
