Neuro - Myasthenia Gravis + Parkinson's + Alzheimers Flashcards
more ACh means
more cholinergic
-sludge dumbells
cholinesterase
an enzyme that breaks down ACh
-allows cholinergic neuron to return into its resting state
cholinesterase inhibitors drug names (6)
neostigmine donepazil edrophonium pilocarpine physostigmine pyridostigmine (johNE DEPPP)
cholinesterase inhibitors
MOA
extends the actionof ACh
-increase ACh effects
cholinesterase inhibitors
AE
cholinergic crisis
- sludge
- dumbells
cholinesterase inhibitors
CI
- patients receiving succinylcholine
- caution in asthma, bradycardia, low BP
Myasthenia Gravis
low ACh
-immune system attacks ACh receptors
Cholinergic Crisis
high ACh
-greatly increased secretions + RESPIRATORY DEPRESSION
cholinergic crisis treatment
atropine (anti-ACh) + resuscitative equipment (crash cart)
Tensilon Test
-give edrophonium 2 mg Q15-60 seconds until transient improvement
or
-give total dose of 10mg
-given via IV
Tensilon Test
results
[+ MG] strong hand squeeze
[- MG] weak hand squeeze
should monitor ___ + ____ + _____ during the tensilon test
- SpO2
- HR
- BP
if + for MG,
indicates that they got too little ACh medication> myasthenic crisis
administer neostigmine or other cholinesterase inhibitor
if - for MG,
indicates ACh overdose> cholinergic crisis
administer atropine (anti-ACh)
edrophonium
short term acting cholinergic drug
when is tensilon test indicated
patient that is receiving Ach medication has trouble breathing
-sign of either too much or too little Ach
Anti-Parkinson’s
medication types
1 first line 2 COMT inhibitors 3 dopamine agonist 4 dopamine releasers 5 centrally acting anti-ACh
anti-prknsn
first line medication
carbidopa/levodopa
carbidopa
MOA
carbidopa is the car that carries and prevents breakdown of levodopa in the bloodstream
-increases the amt of levodopa that can enter the brain
levodopa
MOA
converts itself into dopamine when it enters the brain
which is the most effective symptomatic therapy for parkinson’s?
carbidopa/levodopa
aka first line medication for parkinsons
carbidopa/levodopa
AE
psychosis
-visual hallucinations, nightmares, paranoia
carbidopa/levodopa
CI
- melanoma
- skin lesions that haven’t been DDX bc can speed up cancer
carbidopa/levodopa
PT teaching
- beneficial effects diminish by the end of year 5
- monitor protein intake
- avoid foods w pyridoxine
- can discolor sweat + urine (red or brown)
is carbidopa/levodopa a cure for parkinsons?
NO,
it only slows the progression
protein + carbidopa/levodopa
delays absorption + reduces med effect
-eat SMALL portions of protein throughout the day
pyridoxine foods + carbidopa/levodopa
B6>interferes w absorption
psych A/E of carbidopa/levodopa
expect 2nd generation antipsychotic meds
-clozapine or quetiapine
COMT inhibitors
catelcholamine-O-methyltransferase inhibitors
COMT inhibitors
drug names
entacalone
entacapone [COMPT inhibit]
MOA
enhances effect of levodopa
-blocks its breakdown in intestines
entacapone [COMPT inhibit]
AE
urine turns yellow orange
entacapone [COMPT inhibit]
RN teaching
monitor for NMS-like s/s
NMS
Neuroleptic malignant syndrome
-life-threatening idiosyncratic reaction to antipsychotic drugs
NMS-like s/s
- hyperpyrexia (+106)
- dystonia (involuntary muscle contractions that cause slow repetitive mvmt)
dopamine agonist
drugs
pramipexole
bromocriptine
pramipexole [dope agonist]
MOA
- activates dopamine receptors
- 1st line supplement to levodopa
- —allows for lower dosages
pramipexole [dope agonist]
AE
- sudden inability to stay awake
- poor impulse control DO
bromocriptine [dope agonist]
AE
-supresses breast milk production/lactation
bromocriptine [dope agonist]
Tx
anti parkinsons
- poorly controlled DM2 to reduce post meal glucose levels
- decr triglycerides
dopamine releaser
drug name
amantadine
amantadine [dope releaser]
Tx
PD motor symptoms
amantadine [dope releaser]
RN
monitor for livedo reticularis
livedo reticularis
netlike pattern of reddish-blue skin discoloration
centrally acting anti-ACh
drug names
benztropine
trihexyphenidyl
benztropine, trihexyphenidyl
Tx
- PD
- drug induced EPS
- sialorrhea
benztropine, trihexyphenidyl
AE
- dry mouth
- blurred vision
- mydriasis
- urinary retention
- constipation
- sedation
Alzheimers Medication Types
- Cholinesterase inhibitors
- NMDA Receptor Antagonist
Cholinesterase inhibitors
drug name + alzheimer stage
donepezil
-early to moderate stage
NMDA Receptor Antagonist
drug name + alzheimer stage
memantine
-moderate to severe stages of alzheimers
NMDA Receptor Antagonist - memantine
AE
- blood clots
- psychosis
- HF (syncope)
is there a cure for alzheimers?
NO,
meds are just to treat cognitive symptoms
-slows progression of disease by like 6 months max
