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NURS 2514 > NEUROMUSCULAR MEDS > Flashcards

NEUROMUSCULAR MEDS Flashcards

1
Q

What is the MOA of Levodopa?

A

crosses the BBB and converts to dopamine once it reaches the brain –> restores the balance btwn Ach and dopamine

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2
Q

What is the indication for Levodopa?

A

parkinson’s disease

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3
Q

What is the therapeutic effect of Levodopa?

A

reduction in symptom severity (improvement in carrying out ADL’s) –> does not cure or delay disease

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4
Q

What are the nursing considerations for Levodopa?

A
  • administered orally
  • therapeutic effect can take several months
  • most effective drug for PD
  • effectiveness of Levodopa decreases over time (symptoms controlled in first 2 yrs of treatment –> declines)
  • ALONE: small fraction of med enters the brain –> given in combo
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5
Q

What is the other drug that is used with Levodopa?

A

Carbidopa (SINEMET) –> has no therapeutic effects

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6
Q

How does Carbidopa work with Levodopa?

A

delays the process of peripheral drug metabolism –> allows for more Levodopa to enter the brain

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7
Q

What is the risk of taking Levodopa alone?

A

only a small portion reaches the CNS –> requires high doses = more adverse effects

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8
Q

What are the adverse effects of Levodopa/Carbidopa (SINEMET)?

A
  • N/V (activation of dopamine in CTZ)
  • dyskinesias (tics, head bobbing, grimacing, rapid involuntary jerking, writhing movements)
  • postural hypotension
  • psychosis (visual hallucinations, vivid dreams, paranoia)
  • CNS effects (anxiety, agitation, memory loss, cognitive impairment, issues with impulse control)
  • darken sweat/urine
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9
Q

What are the precautions/CI of Levodopa/Carbidopa (SINEMET)?

A

hypersensitivity

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10
Q

What are the nursing considerations and assessments of Levodopa/Carbidopa (SINEMET)?

A

assess:
- parkinsonian and extrapyramidal symptoms before and during therapy (shuffling gait, bradykinesia, drooling, pill rolling, tremors, twisting motions, masked face, rigidity)
- blood pressure frequently during therapy

nursing considerations:
- pts should avoid high protein meals –> competes for absorption in gut
- pts should not transfer to a standing position abruptly

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11
Q

What are the 2 phenomenon of SINEMET?

A
  • on/off phenomenon –> long term usage, sudden drop of symptoms (reversal symptoms recurrence), no connection to timing of doses
  • wearing of phenomenon –> gradual wearing off, drugs need to be given frequently, may other drugs to prolong effect
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12
Q

What is the classification of Pramipexole (Mirapex)?

A

non-ergot dopamine receptor agonist

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13
Q

What is the MOA of Pramipexole (Mirapex)?

A

stimulates dopamine receptors in the striatum

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14
Q

What is the indication for Pramipexole (Mirapex)?

A

PD

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15
Q

What is the therapeutic effect of Pramipexole (Mirapex)?

A

improve ability to carry out ADL’s –> improvement in motor symptoms
NOTE: does not cure/delay PD

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16
Q

What are the adverse effects of Pramipexole (Mirapex)?

A
  • nausea, dizziness, sleepiness, confusion, hallucinations
  • sleep attacks (come on without warning)
  • impulse control disorders (compulsive gambling, shopping, binge eating, hypersexuality)
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17
Q

What happens when Pramipexole (Mirapex) is taken with Levodopa?

A

increase risk of developing orthostatic hypotension, hallucinations and dyskinesias

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18
Q

What are the nursing considerations and assessments of Pramipexole (Mirapex)?

A

assess:
- monitor BP regularly

nursing considerations:
- warnings about potential to develop drowsiness (avoid sedating meds/alcohol while on pramipexole)
- avoid driving or engaging in dangerous activities (when starting the med)
- medication should be discontinued if pt experiences sleep attacks !!!
- used on its own in early PD
- used in combo with other PD drugs in advanced progression
- effects take several weeks to develop
- given orally
- alone –> no dyskinesia

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19
Q

What is the classification for Selegiline (Deprenyl)?

A

MAO-B inhibitor

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20
Q

What is a MAO-B?

A

an enzyme that inactivates dopamine in the striatum

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21
Q

What is the MOA of Selegiline (Deprenyl)?

A

selective inhibitor of MAO-B –> when used with Levodopa = suppresses the destruction of dopamine derived from Levodopa, reducing wearing off effect

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22
Q

What is the indication for Selegiline (Deprenyl)?

A

PD, depression

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23
Q

What is the therapeutic effect of Selegiline (Deprenyl)?

A

improvement in motor function, reduces wearing off effect

24
Q

What are the adverse effects of Selegiline (Deprenyl)?

A

insomnia, hypertensive crisis (high doses - increased risk with younger people
- with Levodopa = worsen orthostatic hypotension, dyskinesias, psychiatric symptoms

25
Q

What are the nursing considerations and assessments of Selegiline (Deprenyl)?

A

assess:
- gait and motor function –> effectiveness of treatment and identify dyskinesia (adverse effect)
- monitor behavioural changes and psychiatric symptoms
- BP (combo w/ Levodopa)

nursing considerations:
- discuss risk for falls
- not be taken with meperidine or SSRIs
- often recommended for newly diagnosed PD (first line drugs)
- used alone/combo with Levodopa
- administered orally

26
Q

What is the MOA of Methylprednisolone (Solu-Medrol)?

A

mimics cortisol, potents anti-inflammatory and immunosuppressant, works rapidly (short term use)

27
Q

What is the indication for Methylprednisolone (Solu-Medrol)?

A

exacerbation of MS (neurologic symptoms, increased disability, impairments in vision/strength/cerebellar function)

28
Q

What is the therapeutic effect of Methylprednisolone (Solu-Medrol)?

A

anti-inflammatory and immunosuppressive effects

29
Q

What are the nursing considerations and assessments of Methylprednisolone (Solu-Medrol)?

A

assess:
- signs of acute infection (fever, increased WBC, cough, soft tissue pain/swelling, UTI)

nursing considerations:
- IV or IM
- immunosuppressive –> can exacerbate infections

30
Q

What is the classification of Interferon Beta drugs (Betaseron)?

A

immunomodulator

31
Q

What is the MOA of Interferon Beta drugs (Betaseron)?

A
  • inhibits migration of proinflammatory leukocytes across the BBB (cannot reach neurons of the CNS)
  • suppresses T-helper cell activity
  • naturally occurring as glycoprotein
32
Q

What is the indication for Interferon Beta drugs (Betaseron)?

A

MS

33
Q

What is the therapeutic effect of Interferon Beta drugs (Betaseron)?

A

decreases the frequency and severity of relapse, reduce the size and number of lesions and delay progression of disability

34
Q

What are the adverse effects of Interferon Beta drugs (Betaseron)?

A
  • flu-like symptoms (decreases overtime, minimized by low doses and gradually increases = antipyretic)
  • hepatotoxicity
  • myelosuppression (suppress bone marrow function = low blood cells)
  • injection site reaction (pain, erythema, rash, itching)
  • depression and suicidal ideation
35
Q

What are the CI of Interferon Beta drugs (Betaseron)?

A
  • hypersensitivity
  • pts with previous suicide attempts/depression (use cautiously)
  • pts with liver disease and alcoholism (use cautiously)
36
Q

What are the nursing considerations and assessments of Interferon Beta (Betaseron)?

A

assess:
- MS symptoms during therapy
- liver function tests + CBC = prior to treatment, 1/3/6 months
- signs of depression

nursing considerations:
- educate pt about likelihood of experiencing flu-like symptoms and offer tylenol for relief
- educate pt about signs of depression, suicidal ideation, worsening anxiety
- should not combine w/ alcohol or other hepatotoxic meds
- should not take with other immunosuppressants
- IM/SC

37
Q

What are the classifications of Mitoxantrone (Novantrone)?

A

immunosuppressant, cytotoxic drugs (kills cells in body)

38
Q

What is the MOA of Mitoxantrone (Novantrone)?

A
  • binds w/ DNA = inhibits DNA/RNA synthesis –> causing breakage of DNA strands
  • more lethal to rapidly dividing cells (hair, skin, mucosa, bone marrow)
  • suppresses production of immune system cells and decreases immune system destruction of myelin
39
Q

What are the indication for Mitoxantrone (Novantrone)?

A

MS, used to treat cancer

40
Q

What is the therapeutic effect of Mitoxantrone (Novantrone)?

A

delays MS pts going into relapse, delays disability progression, decrease lesions

41
Q

What are the adverse effects of Mitoxantrone (Novantrone)?

A
  • myelosuppression (toxic to bone marrow = low blood cells, high risk of infection)
  • cardiotoxicity (affects left ventricular EF = HF, occur months to yrs after treatment has ended)
  • teratogenic (potential for fetal harm)
  • hair loss, N/V, mouth sores
42
Q

What are the CI of Mitoxantrone (Novantrone)?

A

hypersensitivity

precautions in pts with cardiac diseases or active infections

43
Q

What are the nursing considerations and assessments of Mitoxantrone (Novantrone)?

A

assess:
- bone marrow depression (bleeding, bruising d/t decreased platelets)
- signs of infections (decreased neutrophils)
- signs of anemia (decreased RBC)
- GI symptoms
- mouth sores
- fluid/electrolytes
- I/Os
- appetite
- nutrition
- baseline EKG, chest xray, echo (EF and cardiac status prior to starting therapy and during
- signs of HF (crackles, edema, SOB, chest pain)

nursing considerations:
- administer antiemetics prophylactically
- careful w/ IV administration
- monitor pt IV site carefully (d/c = pain, swelling, redness)

44
Q

What is the classification of Gabapentin (Neurontin)?

A

GABA analog (antiseizure agent)

45
Q

What is the MOA of Gabapentin (Neurontin)?

A
  • does not directly affect GABA receptors
  • may enhance GABA release = increasing GABA-mediated inhibition of neuronal firing
46
Q

What is the indication for Gabapentin (Neurontin)?

A
  • off-label uses (relief of neuropathic pain)
  • postherpetic neuralgia`
47
Q

What are the adverse effects of Gabapentin (Neurontin)?

A

very well tolerated
- somnolence
- dizziness
- ataxia
- fatigue
- nystagmus
- peripheral edema
NOTE: mild to moderate and often diminished with continued drug use
- mood changes, suicidal ideation

48
Q

What is the CI of Gabapentin (Neurontin)?

A

hypersensitivity

49
Q

What are the nursing considerations and assessment of Gabapentin (Neurontin)?

A

assess:
- signs of CNS depression
- improvement of neuropathic pain
- changes in mood, depression, suicidal ideation

nursing considerations:
- caution w/ other CNS depressants (can cause resp. depression) –> opioids, benzodiazepines, anticholinergics, etoh
- withdrawal symptoms w/ abrupt d/c (high risk of seizure) –> slow taper required
-

50
Q

What is the classification of Baclofen (Lioresel)?

A

skeletal muscle relaxant

51
Q

What is the MOA of Baclofen (Lioresel)?

A

acts within SC to suppress hyperactive reflexes involved in the regulation of muscle movement
NOTE: mimic actions of GABA on spinal neurons –> structural analog of the inhibitory NT GABA

52
Q

What is the indication of Baclofen (Lioresel)?

A

relieve muscle spasticity with MS and SCI

53
Q

What is the therapeutic effect of Baclofen (Lioresel)?

A

relieve muscle spasticity (decreases flexor/extensor spasms and suppresses resistance to passive movement

54
Q

What are the adverse effects of Baclofen (Lioresel)?

A
  • drowsiness, dizziness, weakness, fatigue (CNS depressants)
  • N/V
  • constipating, urinary retention
  • orthostatic hypotension
55
Q

What are the nursing considerations and assessments of Baclofen (Lioresel)?

A

asses:
- intrathecal route –> infusion system closely

nursing considerations:
- extreme caution with other CNS depressants
- overdose or combo with other CNS depressants –> respiratory depression
- overdose –> resp. depression (NO ANTIDOTE)
- monitor for withdrawal symptoms (hallucinations, seizures, paranoid ideation) = doses tapered over 1-2 weeks for d/c of therapy
- intrathecal route has a higher risk of severe withdrawal symptoms (fever, muscle rigidity, exaggerated rebound spasticity, multiorgan failure, death)
- PO, intrathecal (placed directly into the spinal fluid of the back)

NURS 2514 (4 decks)

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