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Nursing Pharmacology > Module 14a - Part 2 > Flashcards

Module 14a - Part 2 Flashcards

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1
Q

Most common form of dementia

A

Alzheimer’s disease

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2
Q

Symptoms of Alzheimer’s disease

A

Memory loss, problems with language, judgement and behaviour

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3
Q

Early symptoms are centered around confusion and problems with routine tasks, but as the disease progresses, patients have difficulty with ______ activities.

A

daily

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4
Q

The pathophysiology of AD is characterized by a degeneration of neurons in the _______ ______.
AD is linked to decreased ________ nerve function.
Patients with advanced AD have only __% of the ________ function of healthy subjects.

A

cerebral cortex
cholinergic
10%
cholinergic

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5
Q

How is a definitive AD diagnosis given?

A

After death, during brain autopsy

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6
Q

These are the hallmark structures of AD.

A

Neurofibrillary tangles

neuritic plaques

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7
Q

Form inside neurons when MT arrangement is disrupted.

Caused by abnormal production of ____ protein.

A

Neurofibrillary tangles

tau

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8
Q

Protein responsible for forming cross-bridges between MTs, keeping their structure

A

Tau protein

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9
Q

Found outside of neurons, and are composed of a core protein fragment called beta amyloid

A

neuritic plaques

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10
Q

Shown to kill hippocampal cells and cause Alzheimer’s-like symptoms when injected into monkeys

A

Beta amyloid

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11
Q

Patients with two copies of this gene are at increased risk for developing AD.

A

apoE4

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12
Q

How is apoE4 involved in the development of AD?

A

ApoE4 is involved in the production of beta-amyloid, a component of neuritic plaques

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13
Q

______ injury is also a risk factor for developing AD.

A

head injury

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14
Q

There are currently only two classes of drugs used to treat AD. What are they?

A

Cholinesterase inhibitors

NMDA receptor antagonists

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15
Q

Block NMDA mediated increases in intracellular calcium

A

NMDA receptor antagonists

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16
Q

Inhibit the metabolism of ACh by acetylcholinesterase

A

Cholinesterase inhibitors

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17
Q

Why do cholinesterase inhibitors only show modest improvement on memory?

A

They only work on the remaining, healthy neurons

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18
Q

What are the common adverse effects of cholinesterase inhibitors?

A

Nausea and vomiting
diarrhea
insomnia

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19
Q

The NMDA receptor is a _______ channel that is blocked by __________ at rest.
When _______ binds to the NMDA receptor, ________ dissociates, allowing calcium to enter the post-synaptic neuron

A

calcium
magnesium
glutamate
magnesium

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20
Q

In AD, there is excess _________ release so the NMDA receptor remains _____, allowing excess ______ to enter the cell

A

glutamate
open
calcium

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21
Q

How is excess calcium detrimental in AD?

A

1 - detrimental to learning and memory (overpowers the normal calcium signal)
2 - causes degradation of neurons (too much calcium is toxic)

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22
Q

What are the adverse effects of NMDA antagonists?

A

Very well tolerated; side effect profile identical to those taking placebos

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23
Q

Disease in which it becomes difficult to distinguish between real and false experiences, to think logically, to have normal emotional responses, and to behave normally in social settings.

A

Schizophrenia

24
Q

Schizophrenia usually begins in _________ or _______ ________.
The prevalence is roughly __%.

A

adolescence
early adulthood
1%

25
Q

Symptoms that exaggerate or distort normal neurological function

A

positive symptoms

26
Q

Symptoms where there is loss of normal neurological function

A

negative symptoms

27
Q 
For the following, indicate if positive or negative:
1 - disorganized speech/thinking
2 - Paranoia
3 - Poverty of speech
4 - Emotional withdrawal
5 - Poor insight/judgement
6 - Combativeness
7 - Social withdrawal
8 - Agitation
A 
1 - positive
2 - positive
3 - negative
4 - negative
5 - negative 
6 - positive
7 - negative
8 - positive
28
Q

What are some factors that predispose a person to schizophrenia?

A

Family history
Drug abuse - crystal meth, PCP, LSD
low birth weight
Low IQ

29
Q

Involved in movement and emotions

In schizophrenia, thought to play a role in paranoia and hallucinations

A

basal ganglia

30
Q

Involved in problem solving and insight

Thought to be involved in disorganized thoughts and difficulty planning actions in schizophrenia

A

Frontal lobe

31
Q

Involved with emotions

Contributes to agitation in schizophrenia

A

limbic system

32
Q

Overactive in hallucinations in schizophrenia (voices)

A

Auditory system

33
Q

Schizophrenia is thought of as a disorder with increased ________ nerve transmission (i.e. the opposite of ____)

A

dopaminergic

PD

34
Q

Drugs that block dopamingeric nerve function decrease some of the _______ symptoms of schizophrenia.

A

Positive

35
Q

What other NTs play a role in schizophrenia?

A

5-HT (serotonin), glutamate

36
Q

Patients with schizophrenia have a decreased number of ______ and an increased number of ________ receptors in the _______ cortex.

A

5HT2A (less)
5HT1A (more)
frontal

37
Q

How do we know glutamate is involved in schizophrenia?

A

PCP is a strong antagonists of the NMDA receptor, can cause similar symptoms to schizophrenia
Additionally, patients with schizophrenia have less NMDA receptors in certain brain regions (recall that glutamate binds to, and activates the NMDA receptor)

38
Q

What is the definitive test for schizophrenia?

A

There is none

39
Q

The basis for treatment of schizophrenia is blocking ______, ______ and/or _______ neurotransmission in the brain.

A

dopamine, serotonin, glutamate

40
Q

Act primarily by blocking dopanine 2 (D2) receptors primarily in the mesolimbic area of the brain.

A

conventional antipsychotics

41
Q

To a lesser degree, conventional antipsychotics also block receptors for these signalling molecules.

A

NE, ACh, histamine

42
Q

The potency of conventional antipsychotics is directly proportional to what?

A

Ability to inhibit the D2 receptors

43
Q

Conventional antipsychotics are more effective at treating the ______ symptoms of schizophrenia, than the _______ symptoms.

A

positive (should be intuitive as the positive symptoms are due to excess dopamine, which this blocks)
negative

44
Q

The initial effect of conventional antipsychotics is seen in as few as __ or ___ days, but substantial improvement usually takes between __ and __ weeks.

A

1-2 days

2-4 weeks

45
Q

What are the side effects of conventional antipsychotics?

Vent = smell

A 
ESO ASS
Extrapyrimidal symptoms
Sudden high fever
Orthostatic hypotension
Anticholinergic effects
Sedation
Skin reactions
46
Q

Extrapyrimidal symptoms (EPS) are due to blockade of ____ receptors.

A

D2

47
Q

Involuntary spasm of the muscles in the face, tongue, neck or back. Typically occurs EARLY in therapy.

A

Acute dystonia

48
Q

Bradykinesia, mask-like faces, rigidity, and stooped posture are common.

A

Parkinsonism

49
Q

How is parkinsonism treated?

What must be avoided?

A

Anti-cholinergics

Avoid use of L-DOPA

50
Q

pacing, squirming and a desire to continually be in motion. Typically occurs EARLY in treatment

A

Akathesia

51
Q

occurs in about 20% of patients on long-term therapy. Is irreversible so early detection is essential. Symptoms include involuntary twisting and writing of the face and tongue along with lip-smacking.

A

tardive dyskinesia

52
Q

Patients developing tardive dyskinesia should be switched to what?

A

Atypical antipsychotic

53
Q

Block both D2 receptors and the 5-HT1a and 5HTa receptors.

A

Atypical antipsychotics

easy to remember since A - atypical - HT1/2a

54
Q

The therapeutic action of Atypical antipsychotics is mostly attributed to what?

A

Blockade of 5-HT receptors, as it has poor ability to block D2 receptors

55
Q

What are the benefits of atypical antipsychotics?

A

No EPS! (since D2 receptors aren’t blocked as much)
As efficacious against positive symptoms
More efficacious against negative symptoms

56
Q

What are the AEs of atypical antipsychotics?

A 
WORSA
Weight gain (sometimes severe)
Orthostatic hypotension
Risk of developing type II diabetes (think of it related to weight gain)
Sedation
Anticholinergic effects

Nursing Pharmacology (30 decks)

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