Lecture 7 and 8 Nursing 100 Flashcards
Parkinsonism (Pathophysiology)
Chronic neurologic disorder Degeneration of dopaminergic neurons Imbalance of the neurotransmitters Less dopamine Need to be a balance of ACh and dopamine on and off periods long term once developed
Parkinsonism (Characteristics)
Tremors of head and neck and knees Rigidity (increased muscle tone) Bradykinesia (slow movement) Postural changes Head and chest thrown forward Shuffling walk Lack of facial expression Pill-rolling motion of hands
Parkinsonism (Treatment)
MAO-B inhibitor- increases dopamine
Par. Treatment- Anticholinergic
Dry the person out Confusion Block cholinergic receptors Parasympatholytic- Benztropine (Cogentin) Action: inhibit release of acetylcholine Decrease tremors and rigidity
Par. Treatment- Dopaminergics
Convert to Dopamine
Carbidopa-levodopa (Sinemet)
Action: converted to dopamine
Increases mobility
Side effects
Fatigue, insomnia, dry mouth, blurred vision
Orthostatic hypotension- increased risk of falls
palpitations, dysrhythmias
Urinary retention, nausea, vomiting
Dyskinesia, psychosis (hallucinations, etc.),
severe depression- older white male (> 55yrs) predictable suicide
Carbidopa-Levodopa (Interactions)
Inhibit MAO-B enzyme that interferes with dopamine Decrease levodopa effect with: Anticholinergics Phenytoin- used for seizures Tricyclic antidepressants MAO inhibitors- interacts with food Benzodiazepines Phenothiazines Vitamin B6
Antiparkinosism Drugs (Interventions)
orthostatic hypotension- drink fluids; let feet dangle before standing
administer drug with low-protein foods
avoid vit B6, alcohol, and other depressants
mixed with alcohol increases effects
taper med off
suicidal- plan, where, how, etc < phenomenom
Monitor blood cell counts, liver and kidney (f)
Amantadine (Symmetrel)- Dopamine Agonist
Stimulate dopamine receptors Action: Stimulates dopamine receptors Use: Early treatment as drug tolerance develops Improvement of symptoms
Parkinsonism Treatments- COMT inhibitors
Inhibit COMT enzyme that inactivates dopamine
Parkinsonism Treatments- Dopamine agonists
Stimulate dopamine receptors
Alzheimer’s disease (Pathophysiology)
Progressive, degenerative disease
Neuritic plaques form- make transmission of signals more difficult
Neurofibrillary tangles are in neurons
Cholinergic neurotransmitter abnormality- ACh protects memory
Alzheimer’s disease (Characteristics)
Loss of memory, logical thinking, judgment Time disorientation Personality changes Hyperactivity Tendency to wander Inability to express oneself
Acetylcholinesterase Inhibitors (2 ex’s, action, and use)
Donepril (Aricept), Rivatstigmine (Exelon)
Action
Allow more acetylcholine in neuron receptors
Increase cognitive function
Use
Mild to moderate Alzheimer’s disease
Acetylcholinesterase Inhibitors (Side effects)
Headache, dizziness Depression GI distress Dehydration, dry mouth Blurred vision Insomnia Hypertension, hypotension, dysrhythmias Hepatotoxicity Orthostatic hypotension
Acetylcholinesterase Inhibitors (Interventions)
Monitor vital signs Maintain consistency in care Monitor behavioral changes Provide safety when wandering Arise slowly to avoid dizziness Monitor for GI bleeding
Stages of sleep
Rapid eye movement (REM)
Non–rapid eye movement (NREM)- 4 stages
Insomnia
More common in females
Treatment: sedative-hypnotics
Nonpharmacologic management (Insomnia)
No daytime naps, drink warm fluids
Avoid caffeine 6 hrs before bedtime
Avoid heavy meals/exercise before bedtime
Warm bath, read, listen to music
Sedative- Hypnotics
Sedatives: mildest form of CNS depression Sedative hypnotics: Barbiturates Benzodiazepiness Nonbenzodiazepines Piperidinediones OTC: Nytol, Sleep-Eze, Tylenol PM Diphenhydramine (Benadryl)
Barbiturates
Ultrashort-acting
Used as a general anesthetic
Example: thiopental sodium (Pentothal)
Short-acting
Induce sleep
No residual drowsiness
Examples: pentobarbital (Nembutal), secobarbital (Seconal)
Intermediate-acting
Induce and sustain sleep
Residual drowsiness (hangover effect)
Examples: amobarbital (Amytal), butabarbital (Butisol)
Long-acting
Used to control seizures
Example: phenobarbital
Benzodiazepines
Ex, Action, Use
GABA= calming «targeted in antianxiety and insomnia meds
Temazepam (Restoril)
Action: Interacts with neurotransmitter GABA to reduce neuron excitability
Use: reduce anxiety, treat insomnia
Non benzo’s
Ex, Action
Zolpidem (Ambien), Eszopiclone (Lunesta)
Action: neurotransmitter inhibition
Zolpidem (Ambien)
gets people to sleep; crazy time before sleep- no memory
Eszopiclone (Lunesta)
not as problematic; metallic taste- makes things taste weird
