Quiz 1 Flashcards
What is multiple sclerosis (MS)?
autoimmune disorder that affects nerve cells in the brain and the spinal cord
MS= myelin sheath destruction
Who is most likely to get multiple sclerosis?
young adults (20-50 years)
women
those w/ genetic disposition
Are there definitive diagnostic studies for MS? What can be done to see if it is MS?
no
MRI of brain can show sclerotic plaques in CNS
What is the criteria for an MS diagnosis?
- at least 2 inflammatory demyelinating lesions in at least 2 different CNS locations
- damage or an attack occurring at different times
- all other possible diagnoses ruled out
What are the clinical manifestations of multiple sclerosis?
weakness
diplopia (double vision)
tinnitus
paresthesia
chronic neuropathic pain
nystagmus (shaking of eyes)
dysphagia (difficulty swallowing)
ataxia (poor muscle control)
cognitive difficulties (word finding)
bowel/bladder problems
sexual dysfunction
depression
What immunosuppressants are given for MS? When is it given?
corticosteroids (prednisone, methylprednisolone, dexamethasone)
methylprednisolone: treats MS exacerbations
give in AM w/ food
What immunomodulators are used for MS? WHich one will treat/prevent relapses?
- interferon beta-1a and 1b: used to treat or prevent relapses
- glatiramer acetate
What antispasmodics are used for MS? Why?
Which one is given for severe symptoms and why?
- baclofen
- dantrolene
helps with spasms
dantrolene is used for severe symptoms bc it is fast acting
What is important to monitor with dantrolene with MS? What should be reported?
monitor liver damage
report jaundice
What antiseizures are used for MS? Why?
- carbamazepine
- gabapentin
used for paresthesia
What anticholinergics used for MS? Why?
- oxybutynin
- tolterodine
- propantheline
used for bladder dysfunction
What laxatives are used for MS? Why?
- stool softener (docusate sodium)
- bulk forming (psyllium)
used for constipation
What antidepressants are used for MS?
- amitriptyline (TCA helps w/ nerve pain)
- sertraline
- fluoxetine
What phosphodiesterase inhibitor is used for MS? What should not be given with this medication? Why?
Sildenafil
Do not give with nitroglycerin because it will decrease BP
What CNS stimulants are given for MS? What do they do?
- Methylphenidate (focus)
- Modafinil (alertness)
What K+ channel blocker is given for MS? Why is it not used as often?
Dalfampridine
Not used often due to risk of cardiac dysrhythmias
Why would a thalamotomy be used for MS?
It is deep brain stimulation for tremors unmanageable with drugs
What nursing interventions can be done with MS?
- promote exercise with rest/diet (fiber)
- encourage independence
- prevent injury, and avoid stressors
- teach self injection and self catheterization 
Describe Parkinson’s disease
Chronic neurological disorder that affects motor function and destroys neurons which results in low dopamine and high acetylcholine
No DOPE in the PARK = low dopamine in Parkinson’s
High acetylcholine = high secretions
Who is more likely to get Parkinson’s disease?
Men
What are the clinical manifestations of Parkinson’s disease?
Triad:
- Tremors at rest
- Rigidity
- Brady kinesia
Shuffling gait
Expressionless
Drooling/slurred speech (dysarthria)
Pill rolling twitch
Depression
Constipation
What are complications of Parkinson’s disease?
Dysphasia
Orthostatic hypotension (dopamine regulates BP)
Are there any specific tests for Parkinson’s Disease?
No
but MRI will show substantia nigra breakdown
What is the criteria for a Parkinson’s Disease diagnosis?
at least two of three characteristics of the classic triad (tremor, rigidity, bradykinesia)
What dopaminergic agent is used for Parkinson’s Disease? Why? What should be avoided when taking this medication?
levodopa: leaves more dopamine
carbidopa: conserves more dopamine
Caution: psychosis can occur
avoid protein
What dopamine agonist is used for Parkinson’s Disease? Why? What should be monitored while taking this medication?
bromocriptine (more commonly used)
apomorphine
stimulates dopamine response
monitor psychosis
What MAO-B inhibitors are used for Parkinson’s Disease? Why? What should be avoided while taking this medication?
rasagiline
selegiline
prevents the breakdown of dopamine
avoid tyramine bc hypertensive crisis
What COMT inhibitors are used for Parkinson’s Disease? Why? WHat is a normal finding?
entacapone
tolcapone
prevents the breakdown of dopamine
dark urine is normal
What anticholinergic is used for Parkinson’s Disease? Why?
benztropine
less secretions
treats resting tremors
What antihistamine is used for Parkinson’s Disease?
diphenhydramine
What antiviral is used for Parkinson’s Disease? Why?
amantadine
increase dopamine levels
What antidepressant is used for Parkinson’s Disease?
amitriptyline
What anticholinesterase inhibitor is used for Parkinson’s Disease? Why?
donepezil
used when pt starts having bowel/bladder problems to reestablish secretions
What nursing interventions can be done for Parkinson’s Disease?
- promote exercise/diet
- encourage independence
- deep brain stimulation (fast access increase dopamine for severe PD)
What is amyotrophic lateral sclerosis (ALS)?
aka Lou Gehrig’s disease
- destroys motor neurons in the brain & spinal cord
- results in total body paralysis
Who is most likely to get amyotrophic lateral sclerosis (ALS)?
more common in men than women
What are the clinical manifestations of ALS?
typical symptoms:
- dysarthria (difficulty w/ speech)
- dysphagia (difficulty swallowing)
- muscle weakness
dyspnea (difficulty breathing) — respiratory failure
fasciculations (twitching)
fatigue
drooling — aspiration pneumonia
Are there definitive diagnostic studies for ALS? What can be done to see if it is ALS?
no
Electromyography (view muscle response)
Muscle biopsy
Pulmonary function test- PFT (to see how much air can be pushed out)
What is the drug therapy for ALS? Why? What should be monitored while taking this medication? How should it be taken?
rilutek
to slow disease progression
monitor liver enzymes and take on empty stomach
What nursing interventions can be done for ALS?
ALS = advanced life support
Monitor for pneumonia
Monitor fever over 100F
Monitor lung sounds - rhonchi
What is Myasthenia Gravis (MG)?
autoimmune disease that destroys acetylcholine receptors which leads to low acetylcholine levels
What can be seen in patients who have myasthenia gravis?
thymic tumor in 15% of patients
seen by MRI
What are the clinical manifestations of myasthenia gravis?
ptosis (droopy eyes)
diplopia
dysphagia (difficulty swallowing)
dyspnea (difficulty breathing)
muscle weakness (hard time picking things up)
What is myasthenic crisis?
DRY
undermedicated
respiratory distress
MG symptoms but worse
What test can be done to determine if MG diagnosis is correct? What is the antidote?
edrophonium chloride (tensilon)
antidote: atropine
What other diagnostic studies can be done for MG?
- serum Ach receptor antibodies
- electromyography
- MRI of the thymus gland
What anticholinesterase drugs are used for MG? Why?
- pyridostigmine (best for long term treatment bc long acting, they cause secretions, give before meals)
- atropine
What immunosuppressants are used for MG?
corticosteroid
azathioprine
What other therapy is used for MG? Why?
thymectomy
intravenous immunoglobulin (IVIG)
plasmapheresis (filters blood products to remove antibodies to decrease symptoms)
What nursing interventions are done for MG?
maintain airway
small, frequent, high calorie meals
provide eye care
exercise/rest
What is Guillain-Barre Syndrome?
acute rapidly progressing form of polyneuritis, caused by infection starting from the legs up
What are the clinical manifestations of Guillain-Barre Syndrome?
muscle weakness
hyporeflexia
paresthesia and pain
respiratory failure
- inability to cough
- shallow respirations
- dyspnea/hypoxia
What diagnostic studies are done for Guillain Barre Syndrome?
cerebrospinal fluid study
EMG
MRI brain to rule out MS
Does the flu cause GBS?
no it will reactivate it
What nursing interventions are done for GBS?
intravenous immunoglobulin (IVIG)
plasmapheresis
pain management
ventilatory support
What are the clinical manifestations of multiple sclerosis?
weakness
diplopia (double vision)
tinnitus
paresthesia
chronic neuropathic pain
nystagmus (shaking of eyes)
dysphagia (difficulty swallowing)
ataxia (poor muscle control)
cognitive difficulties (word finding)
bowel/bladder problems
sexual dysfunction
depression
