Unit 7 - Neuromuscular & Musculoskeletal Flashcards
2 classifications of Parkinson’s
- idiopathic (no known cause)
2. Secondary (antipsychotic meds)
neurogenerative disease that has the best response to medications that we know
Parkinson’s
In Parkinson’s there is _____ dopamine being secreted and the little that is secreted is being broken down by ____
less
MAO
In Parkinson’s there is an imbalance of dopamine to acetylcholine causing…
decreased balance and coordination
What disease:
there is a drop in the amount of dopamine in the brain
Parkinson’s
2 causes of Parkinson’s
- # of nerve cells that produce dopamine is decreased
2. levels of MAO at the synapse remains unchanged
purpose to drugs used in treatment of Parkinson’s
help improve mobility and functioning in ADL’s
T/F: Parkinson’s patients will sometimes be prescribed both Dopamine Agonists & Anticholinergics
T
postural and autonomic movements
dyskinesias
4 types of dyskinesias
acute dystonia
akathisia
Parkinsonism
tardive dyskinesia
severe muscle spasms of the back, neck, tongue, & face
acute dystonia
inability to rest or relax, repetitive movements
akathisia
tremor, loss of fine motor skills, muscle rigidity, stooped posture, shuffling gate
Parkinsonism
involuntary and unusual tongue and facial movements; lip smacking, tongue thrusting, eye blinking
tardive dyskinesia
Extrapyramidal Symptoms (EPS)…is there treatment?
Dyskinesias
- no treatment for symptoms and they may last for years after therapy is discontinued
goal of antipsychotic meds
decrease dopamine
Drug of choice for Parkinson’s
Levodopa…precursor to dopamine
- crosses BBB
What drug: treat Parkinsonism; to relieve tremors & rigidity
Levodopa
Adverse effects of Levodopa
- adverse reactions associated with anticholinergic properties (dry mouth, blurred vision, urinary retention)
- spazzy dance movements (involuntary choreiform)
- psychosis because of increase dopamine
- quick jerking movements = need to get dosage lowered
Nursing Considerations for Levodopa
- monitor liver & kidney function (metabolism & excretion probs)
- monitor for adverse affects
- assist with ambulation
- assess for narrow-angle-glaucoma
9 Pt & Family teaching for Levodopa
- DO NOT abruptly stop taking-NMS
- do not crush/chew
- report s/s of toxicity: twitching, winking, mood changes
- make position changes slowly
- increase fiber in diet
- avoid foods high in protein & B-6
- understand affects may take several months
- may have darkening of urine/sweat
- can take other meds to help with N,V
life threatening, potentially fatal adverse reactions (like having extreme Parkinson’s)
NMS - neuroleptic malignant syndrome
5 symptoms of NMS
- muscle rigidity
- tachycardia
- BP fluctuations
- high fever
- diaphoresis
T/F: NMS is rare & and be fatal
true
how to treat NMS
- antipyretics (lower fevers)
- electrolytes (fluids)
- muscle relaxants (muscle rigidity)
Levodopa is almost always combined with…
carbidopa = Sinemet
What drug:
has no physiologic action by itself. It does not cross BBB
Carbidopa
What drug:
prevents the breakdown of Levodopa in the GI tract & allows from much lower doses of Levodopa
Carbidopa
T/F: Carbidopa therapeutic effects, adverse effects, contraindications, interactions, nursing considerations, & pt teachings are the same as Levodopa
T
prototype for dopamine agonist for Parkinson’s
Levodopa
main active ingredient in Sinemet
Levodopa
Dopaminergic Agent Prototype
Sinemet (Levodopa + Carbidopa)
T/F: Pramipexole is a dopamine antagonist
FALSE! It’s a dopamine agonist
What drug:
treats early stages of Parkinson’s
Pramipexole
potential interactions of pramipexole
dopamine antagonists - phenothiazines & metaclopramide
5 nursing considerations for Pramipexole
- monitor s/s of Parkinson’s…ensuring med is helping
- monitor VS (BP because of orthostatic hypotension)
- make sure not a fall risk
- monitor for tarted dyskinesias (repetetive purposeless movements)
- monitor for potential mental status/mood changes
5 pt teaching for Pramipexole
- change positions slowly
- avoid alcohol & CNS depressants = drowsiness
- can cause sleep attacks
- full effects may take several months
- report hallucinations . uncontrolled movements
classify benztropine
anticholinergic
drug best for tremors & rigidity of Parkinson’s
benztropine
3 nursing considerations for benztropine
- assess mood changes
- assess response to tremor/rigidity
- monitor eyes & nose, urinary retention, bowel status
6 pt teaching for benztropine
- avoid alcohol & CNS depressant = drowsiness
- change positions slowly
- be careful overheating because of inability to sweat from anticholinergic properties
- chew gum/candy for dry mouth properties
- can take with food
- increase fluid & fiber due to constipation properties
most commonly the result of a traumatic injury or overworking a muscle or muscle group.
muscle spasms
most commonly the result of a traumatic injury or overworking a muscle or muscle group. (charlie horse, due to inujry, etc.)
muscle spasms
a chronic “muscle spasm” or muscle rigidity related to a disorder that affects the excitability of the motor neurons like: multiple sclerosis, cerebral palsy, cerebrovascular accidents (CVA or stroke), head injuries, and spinal cord injuries
muscle spastacity
a chronic “muscle spasm” or muscle rigidity related to a disorder that affects the excitability of the motor neurons like: multiple sclerosis, cerebral palsy, cerebrovascular accidents (CVA or stroke), head injuries, and spinal cord injuries (chronic muscle spasm, contractures due to nerve injury, etc.)
muscle spastacity
medications that help with Parkinson’s
Levodopa
Sinemet
Pramipexole
Bexntropine
medications that help with Muscle Spasms
Central Acting (work in CNS, because of muscle injury, not nerve injury, so if you tell a nerve to do something, it will do it)
medications that help with Muscle Spasticity
Direct Acting (acts directly on the muscle to decrease influx of calcium = muscle contraction)
Prototype of Skeletal Muscle Relaxants Central Acting
Cyclobenzaprine (Flexeril)
Prototype of Skeletal Muscle Relaxants Direct Acting
Dantrolene Sodium (Dantrium)
6 Skeletal Muscle Relaxants Central Acting drugs (Muscle Spasms )
Prototype: Cyclobenzaprine (Flexeril) Baclofen (Lioresal) Cardopodol (Soma) Metaxalone (Skelaxin) Methocarbamol (Robaxin) Orphendarine (Norflex)
3 Skeletal Muscle Relaxants Direct Acting drugs (Muscle Spasticity)
Prototype: Dantrolene Sodium (Dantrium)
Botulinum taxin type A (Botox)
Botulinum taxin type B (Myobloc)
Classify Cyclobenzaprine (Flexeril)
Central Acting muscle relaxer
What drug:
- short term use for muscle spasm (no longer than a couple of weeks)
- not effective in treating spasticity
Cyclobenzaprine (Flexeril)
4 Contraindications for Cyclobenzaprine (Flexeril)
- with other sedative hypnotics = can cause excessive CNS depression
- geriatric pt’s = more risk for hallucinations & cardiac effects
- similar to TCAs = infinity to heart muscle = adversely affect heart muscle
- don’t use with breast feeding!
9 Nursing Considerations/pt teaching for Cyclobenzaprine (Flexeril)
- protect pt from falls due to drowsiness/dizziness
- watch for rashes, itching, hives
- hold med if symptoms of hypersensitivity
- discourage alcohol use
- can give with food or milk
- teach measure to treat dry mouth
- teach to report cardiovascular adverse affects & excessive sedation
- report if not showing signs of improvement after 1-2 weeks
- encourage nonpharmacological methods (positioning & strengthening exercises, heat packs, massage, etc.)
Classify Dantrolene sodium
direct acting muscle relaxer
What drug:
- to relax spasticity
- drug of choice/antidote for malignant hyperthermia
Dantrolene sodium
serious side effects of Dantrolene sodium
- hepatotoxicity = monitor LFTs
9 Nursing Considerations/pt teaching for Dantrolene sodium
- monitor LFTs
- therapeutic affects often take ~1wk
- discourage alcohol use = added sedation
- monitor VT (especially with IV administration = EKG)
- prevent falls/supervise ambulation
- notify provider if see no improvement within 45 days
- monitor for heart & lung sounds
- monitor bowel function
- teach s/s liver dysfunction (jaundice, clay colored stools, N, V)
How does the body regulate calcium in the blood
parathyroid puts calcium in the blood (tells intestines to increase absorption, bones to breakdown, kidneys to withhold calcium)
thyroid takes calcium away from blood (puts out calcitonin = tells osteoclasts to keep, osteoblasts to keep, kidneys to eliminate)
medications that affect bones
Bisphosphonates: Alendronate
Hormonal (SERMs): Raloxifene
what vitamin is required to be able to absorb calcium in intestines
vitamin D
Too much calcium causes muscles to…
spasm
pseudohypoparathyroidism
has parathyroid hormone, but organ/tissues are resistant to it
What drug:
to increase serum calcium because we want more Ca+ in the bone & maintain normal neuromuscular function
calcium carbonate
nursing considerations/pt teaching for calcium carbonate
- monitor IV site
- administer calcium supplements through IV SLOWLY
- can take with meals with oral administration
- lethargy/drowsiness (hypercalcemia)
- muscle twitches/spasms (hypocalcemia)
- monitor for N,V (hypercalcemia)
- for IV use monitor EKG
- encourage weight bearing exercise
- avoid Zinc rich foods (nuts, legumes, seeds, sprouts)
- encourage calcium rich foods (milk, dark green veggies, soy beans, tofu, canned fish, sardines)
Bone Resorption Inhibitor Drugs
Bisphosphonates (Alendronate sodium - Fosamax) Hormonal SERMs (Raloxifene - Evista)
What drug:
- slows rate of bone resoprtion (Ca+ being sucked out of bones to increase blood Ca+ levels)
- lowers serum alkaline phosphatase
- used postmenopausal
- used for steroid induced osteoporosis
Alendronate
nursing considerations/pt. teaching for Alendronate
- take on empty stomach at least 30 min. before eating
- take with full glass of water
- encouraged to take Ca+ & Vitamin D supplements & increase Ca+ rich food intake, but don’t take within 2 hours of taking drug
- encourage weight bearing exercise
- pt needs to stay upright at least 30 min after taking med (med can cause a lot of problems to esophagus)
- teach s/s of hypocalcemia: muscle spasms/twitching
what med is an estrogen agonist & antagonist
- depends on receptors med it interacting with
- agonist: encourages bones build up, Ca+ placement in bone = increase bone strength
- antagonist: doesn’t act on uterine or breast tissue like estrogen normally would = benefit of med
raloxifene
what drug:
- binds with estrogen receptors
- decreases bone resorption increasing bone density in postmenopausal women
raloxifene
12 Nursing considerations/pt teaching for raloxifene
- BLACK BOX: Category X for pregnancy/breast feeding
- monitor for bone density & liver function
- monitor lipid level labs
- monitor pt for thromboembolic events
- teach to monitor/report calf pain, dyspnea
- don’t sit for a long period of time
- stop med for 72 hours before being immobilized
- don’t take with other estrogen drugs or herbal medications
- monitor for drugs that affect cholesterol levels…space them apart
- monitor PT (clotting lab)
- teach what to expect for adverse effects: common = weight gain, hot flashes
- don’t use in men, only in postmenopausal women
most common noninflammatory disorder
osteoarthritis
what is osteoarthritis caused by
breakdown of articular cartilage
what is osteoarthritis treated with
NSAIDs, tylenol, nonpharmacologic and pharmacologic therapies
what is rheumatoid caused by
autoimmune disease, own body attacks joints
what is rheumatoid treated with
nonpharmacologic therapies (heat, icy hot, etc) & pharmacologic therapies (antirheumatic drugs)
Question: do we need to know slide 41?
Drugs used to treat osteoarthritis
- acetominophen (tylenol)
- NSAIDs (not aspirin)
- tramadol (Ultram)
- opioids
- intra-articular steroid injections
- topical medications (icy-hot)
- sodium hyaluronate (hyalgan)
autoimmune disease that causes joint inflammation
rheumatoid arthritis
what is rheumatoid arthritis characterized by
joint stiffness & deformation
What drug:
- Decrease inflammation associated with RA
- Treatment of malaria
- Treatment of lupus
- prototype for rheumatoid arthritis
Hydroxychloroquine
Nursing considerations/pt teaching for Hydroxychloroquine
- monitor LFTs & renal function tests, CBCs, urinalysis, VS
- monitor vision = eye tests, more frequent eye exams
- give with food or milk to decrease GI upset
- don’t take with antacids = affects absorption
- therapeutic affects may take several months
- no alcohol use = liver damage
- discontinue if signs of extreme weakness, hearing loss, bruising, bleeding
- encourage to take at same time every day
- report s/s of infection
- don’t participate in hazardous activities
- need to wear sunglasses/protective clothing = because med encourages photosensitivity/light
Q: What is the best way to describe the pathophysiology of Parkinson’s Disease?
Not enough dopamine, too much acetylcholine
Q: What is a common adverse effect of levodopa?
involuntary movements
Q: Why is carbidopa combined with levodopa?
Carbidopa prevents the destruction of levodopa and allows for lower doses of levodopa.
Q: What is a common adverse effect of the Parkinson’s Disease medication, benztropine?
dry mouth
Q: Cyclobenzaprine, a medication often used for muscle spasms caused by injury, is what class of medication?
central-acting muscle relaxer
Q: Which of the following TWO are common adverse effects of dantrolene sodium?
- muscle weakness
2. drowsiness
***Q: Which of the following is NOT a teaching point for clients using oral calcium carbonate?
avoid calcium-rich foods
Q: Which of the following is NOT an important teaching point associated with the medication, alendronate?
alendronate include all EXCEPT:
A. take at the same time as calcium supplements
B. Keep patient upright for 30 minutes after administering
C. Encourage weight bearing exercise
D. Take on an empty stomach
take at the same time as calcium supplements
Q: Which type of patient should NOT take raloxifene?
pregnant women & men! (men will ALWAYS be a contraindication for Raloxifene because it’s estrogen)
Q: What is hydroxychloroquine used to treat?
rheumatoid arthritis
Q: Drugs used to treat Parkinson’s Disease are in the following classes: A. NSAIDS and immunosuppressants B. Bisphosphonates and SERMS C. Anticholinergics and dopaminergics D. Adrenergics and anticholinergics
C. Anticholinergics and dopaminergics
Q: Levodopa is combined with carbidopa because:
A. Carbidopa minimizes the adverse effects of levodopa.
B. The combined action of the two drugs together is more effective.
C. Carbidopa has a greater effect on dopamine receptors.
D. Carbidopa allows for much lower doses of levodopa.
D. Carbidopa allows for much lower doses of levodopa.
Q: Patient teaching for the anti-cholinergic medication, benztropine, should include all of the following EXCEPT:
A. Take with other CNS depressants for full effect.
B. Chew gum or suck on hard candy.
C. Increase fluid and fiber.
D. Make position changes slowly.
A. Take with other CNS depressants for full effect.
Q: The class of medication that works best on muscle spasms due to muscle injury are:
A. Central acting muscle relaxers
B. Direct acting muscle relaxers
A. Central acting muscle relaxers
Q: The class of medication that works best on spasticity due to strokes or spinal cord injury is:
A. Central acting muscle relaxers
B. Direct acting muscle relaxers
B. Direct acting muscle relaxers
The length of time a patient should safely use cyclobenzaprine is: A. 2 days B. 2 weeks C. 5 years D. It can be used indefinitely.
B. 2 weeks
Q: The drug of choice for malignant hyperthermia is: A.. Pramipexole B. Hydroxychloroquine C. Dantrolene sodium D. Alendronate
C. Dantrolene sodium
Q: Nursing considerations and patient teaching for alendronate include all EXCEPT:
A. Take with milk
B. Keep patient upright for 30 minutes after administering
C. Encourage weight bearing exercise
D. Take on an empty stomach
A. Take with milk
Q: Common side effects of raloxifene include: A. Hot flashes B. Hepatotoxicity C. Increased blood sugar D. Tachycardia
A. Hot flashes
Q: Hydroxychloroquine is used: A. To prevent osteoclasts from breaking down bone B. To balance neurotransmitters in PD C. To stop muscle contraction in the CNS D. To decrease the inflammation of RA
D. To decrease the inflammation of RA
Main symptoms of Parkinsons
- tremors
- postural instability (front half moves faster than the lower half = falls)
- Bradykinesia
- muscle rigidity (stiffness)
- pill rolling
TQ: A nurse is working a night shift at the hospital and is caring for a pt receiving zolpidem for sleep. Which nursing intervention should be included for this pt?
A. keep the bathroom light on and the bathroom door slightly open so the pt can easily see the way to the bathroom at night
B. assist the pt to the bathroom every half hour to prevent falling
C. leave the room light on so the pt will not get distorted when waking up in a strange room
D. make sure the pt is fully assessed every 15 minutes through the night to assure no negative outcomes from the chemical restraint
A. keep the bathroom light on and the bathroom door slightly open so the pt can easily see the way to the bathroom at night
TQ: Which of the following statements are related to the fact that Zolpidem is a Schedule IV controlled substance?
A. two nurses must count zolpidem every shift
B. Zolpidem has a short-half life
C. Zolpidem can be abused and lead to dependency
D. Zolpidem needs to be kept in a safe place to prevent abuse and misuse
A. two nurses must count zolpidem every shift
C. Zolpidem can be abused and lead to dependency
D. Zolpidem needs to be kept in a safe place to prevent abuse and misuse
TQ: What instructions should be given to a pt who is taking carbidop/levodopa for Parkinson’s Disease?
A. increase intake of fluid and fiber
B. avoid drinking caffeinated beverages
C. take the medication between meals
D. take the medication at least 30 mintues before a meal
A. increase intake of fluid and fiber
TQ: Which of the following is NOT a potential adverses effect of oral calcium carbonate? Select all that apply. A. hypercalcemia B. kidney stones C. IV site problems D. muscle twitching
C. IV site problems
D. muscle twitching
TQ: the nurse is creating a teaching plan for a client on the cardiac unit and is researching the medications the client is currently taking to understand how each drug produces its effects in the body. To find this information, the nurse looks up which classification for each medication? A. therapetic B. pharmacologic C. cardiac D. disease
B. pharmacologic
TQ: A nurse is administering a new drug to a pt. The nurse researched the drug prior to giving it to the pt and discovered the drug was a prodrug. How would the nurse best describe what a prodrug is to the pt?
A. a drug that activated another chemical substance
B. a drug that has an additive affect
C. a drug that is inactive until it is broken down in the liver
D. a drug that stimulates a receptor to active the cell
C. a drug that is inactive until it is broken down in the liver
