pns and cns drugs cont... Flashcards
- James parkinson1987
- shaking palsy
- progressive disorder that affects the central nervous system
- results from degeneration of dopamine producing cells in the substantia nigra
S/S:
T: Tremor- shaking
R: Rigidity- stiffness of the limbs
A: Akinesia- loss or impairment in the power of voluntary movement
P: Posture and Balance-
Parkinson’s disease
- Levodopa
- Dopamine agonist
- Anticholinergics
- Amantadine( Symmetrel)
- COMT Inhibitors
MAO- B Inhibitors
Parkinson’s medications
1._______? Most commonly used drug. This is the precursor of Dopamine.
- Converted to dopamine; most effective in diminishing the symptoms of Parkinson’s disease
S/E: nausea, vomiting, dyskinesia, hypotension, psychosis, cardiac dysrhythmias
2.______? Alternative drug combined with Levodopa; It works by preventing levodopa from being broken down before it reaches the brain.
NR to patients taking _____? /_____?:
- Monitor VS especially BP
- ECG
- Assess for signs and symptoms of parkinsonism
- Low protein foods
- Overdose: Psychotic episodes happen!!!
Dopaminergic
1.LEVODOPA
2.CARBIDOPA
ACTION: Stimulate the dopamine receptors. _______?
1._____? antiviral that acts on the dopamine receptors
S/E: orthostatic hypo, confusion, urinary retention, constipation
2.______? acts directly on CNS, CVS, and GIT
S/E: orthostatic hypo, palpitations, chest pain, edema, nightmares, delusions, confusion
NR to patients taking _____? :
- Report any signs of skin lesions, seizures, or depression
- Assess for orthostatic hypotension
- Avoid alcohol
- Monitor VS especially BP and HR
- Not to abruptly stop the drug
Dopamine Agonists
1.AMANTADINE HCL (SYMMETREL)
2.BROMOCRIPTINE (PARLODEL)
______? ACTION: Inhibit the release of acetylcholine
1._____? This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease.
2.____? Competitive antagonism of acetylcholine at cholinergic receptors in the corpus striatum, which then restores the balance.
3._____? Blocking a certain natural substance (acetylcholine). This helps decrease muscle stiffness, sweating, and the production of saliva, and helps improve walking ability in people with Parkinson’s disease. Anticholinergics can stop severe muscle spasms of the back, neck, and eyes that are sometimes caused by psychiatric drugs.
4._____? In patients with Parkinson’s disease, _____ may be used to decrease stiffness and tremors due to its anticholinergic effect.
Anti-Cholinergic
1.Benztropine (Cogentin)
2.Biperiden (Akineton)
3.Trihexyphenidyl (Artane)
4.Diphenhydramine HCl (Benadryl)
______? ACTION: Stops MAO enzyme so that more dopamine becomes available to treat your symptoms. Furthermore, prolongs Levodopa action.
1._____? Removes excess Dopamine in the brain!!!!
BUT………………_______? inhibits MAO-B
As a result…. More Dopamine inside the brain!!!!
Commonly used for Parkinson’s disease include:
2._____? It is used as an adjunct to levodopa-carbidopa medications to enhance their effectiveness and reduce motor fluctuations.
3._____? It is also used as an adjunct to levodopa-carbidopa medications to improve motor symptoms and reduce motor fluctuations.
4._____? It is used as an add-on therapy to levodopa-carbidopa medications to improve motor symptoms and prevent “off” episodes.
NOTE: By inhibiting MAO-B, these drugs increase dopamine levels and help alleviate Parkinson’s symptoms.
Mono-Amine Oxidase-B Inhibitor
(MAO-B Inhibitor)
- Mono Amine Oxidase
- Selegiline (brand names: Eldepryl, Zelapar)
- Rasagiline (brand name: Azilect)
- Safinamide (brand name: Xadago)
- Most common type of dementia
- A progressive disease beginning with mild memory loss and possibly leading to loss of the ability to carry on a conversation and respond to the environment.
- It later affects areas in the cerebral cortex responsible for language, reasoning, and social behavior.
Drugs commonly used for _____? :
- Relieves symptoms of:
Memory Loss
Confusion
Difficulty in thinking and reasoning
ACTION: They work by improving the communication between nerve cells in the brain or by regulating the levels of certain chemicals involved in Alzheimer’s disease
Note: Only slows down the progression of AD but not to cure!!!
Alzheimer’s Disease
- Cholinesterase inhibitors:
- Donepezil (Aricept)
- Rivastigmine (Exelon)
- Galantamine (Razadyne)
- N-methyl-D-aspartate (NMDA) receptor antagonist:
- Memantine (Namenda)
- Affect the nerves that control certain muscles in your body. These muscles are called your voluntary muscles — they’re the muscles you can choose to move such as the ones in your arms, legs, or face.
- Disorders that affect voluntary muscles can be genetically inherited (passed down from your parents) or may develop over time as a complication of certain health conditions such as an autoimmune disorder.
Neuromuscular disorders
- Autoimmune disease
- Destructs Acetylcholine due to
The presence of Acetylcholinesterase - Resulting to weakness of muscles
Myasthenia Gravis
1._____ increases muscle strength
2._____used to distinguish myasthenia crisis from cholinergic crisis
S/E & A/R: GI disturbances, increased salivation, tearing, miosis, HPN
NR to patients taking drug name 1._____:
- Administer IV undiluted
- “Atropine sulfate” as antidote for cholinergic crisis
- Take the drug before meals
- Assess for the effectiveness of the drug therapy
- Avoid: “Baclofen (Lioresal)” – paralysis!
Acetylcholinesterase Inhibitors/ Cholinesterase Inhibitors
Neostigmine (Prostigmin) – 1st drug
- Pyridostigmine bromide (Mestinon)
Ambenonium chloride (Mytelase) - Edrophonium chloride (Tensilon)
- chronic and progressive demyelinating disease of cns
Main symptoms:
fatigue.
difficulty walking.
vision problems, such as blurred vision.
problems controlling the bladder.
numbness or tingling in different parts of the body.
muscle stiffness and spasms.
problems with balance and co-ordination.
problems with thinking, learning and planning.
Commonly Used drug for MS:
1._____? Reducing inflammation and slowing down the progression of the disease. (Immunosuppressant)
2._____For inflammation
3._____To reduce frequent attacks and exacerbations.
MULTIPLE SCLEROSIS
- Interferon beta-1a
- Corticosteroids
- Monoclonal Antibody
a.1. Alemtuzumab
b. 2. Natalizumab
_____slow down muscle contraction
- relieve both acute and chronic muscle spasms and muscle spasticity
Nursing Consideration:
- Dizziness is expected upon changing position
- No alcohol while taking the medication
- Do not abruptly stop! (Rebound effect)
- Drowsiness is also excepted
Centrally Acting Skeletal Muscle Relaxants:
- Spasmolytics
- Suppress hyperactive reflexes
- Decrease pain and increase range of motion
- Have a sedative effect
Drugs for Skeletal Muscle Spasticity:
1._____It relieves the spasms, cramping, and tightness of muscles caused by certain medical problems such as multiple sclerosis (MS), cerebral palsy, stroke, or injury to the spine.
2._____Is a muscle relaxant. It’s used to relieve muscle spasms, cramping or tightness caused by conditions such as: cerebral palsy.
3._____relaxes muscle spasms that are causing pain or stiffness.
MUSCLE RELAXANTS
- Dantrolene
- Baclofen
- Diazepam (Valium)
Drugs for Skeletal Muscle Spasm
1._____Interrupts neuronal communication within the reticular formation and spinal cord, resulting in sedation and alteration in pain perception.
2._____Works by calming overactive nerves in your body, which helps your muscles relax.
3._____binds and inhibits both histamine H1 receptors and NMDA receptors. It restores the motor disturbances induced by neuroleptics, in particular the hyperkinesia.
Muscle relaxer side effects:
- constipation, dizziness
- low bp, dry mouth
- allergic reaction, weight gain
- impaired thinking, heart problems
Note: no need to report sleepiness and sedation because its normal…..
NR to patients taking Muscle Relaxants:
- Monitor serum liver enzyme levels
- Do not abruptly stop the medication
- Not to drive or operate dangerous machinery
- Avoid alcohol and CNS depressants
- C/I with pregnant women ; nursing mothers
- Take with food
Drugs for Skeletal Muscle Spasm
- Carisoprodol (Soma)
- Methocarbamol (Robaxin)
- Orphenadrine citrate (Norflex)
