Week 1 Flashcards
Parkinson’s Disease
Progressively debilitating diseases that affects motor function
Parkinson’s Disease
Main characteristics?
- tremor
- muscle rigidity
- bradykinesia (slow movement)
- postural instability
- at least 2 will lead to diagnosis*
Parkinson’s Disease
Expected Findings?
- report of fatigue
- stooped posture
- slow, shuffling, and propulsive GAIT
- tremors/pill-rolling tremor of the fingers
- muscle rigidity
- bradykinesia/akinesia
- orthostatic hypotension, flushing, diaphoresis
- difficulty chewing and swallowing
- drooling, dysarthria, progressive difficulty with ADLs , mood swings, dementia
Parkinson’s Disease
Nonmotor
- depression
- pain
- fatigue
- anxiety
- constipation (slow peristalsis)
- sleep problems
- short term memory loss
Parkinson’s Disease
Complications
- aspiration pneumonia- alterations in chewing and swallowing worsen, increasing the risk of aspiration
- dysphagia
- general debilitation
- orthostatic hypotension
Parkinson’s Disease
Levodopa/carbidopa
dose dependent- wears off after 5 years
N/V, drowsiness
administer w/food, small doses, avoid foods high in protein
*carbidopa may reduce N/V
dyskinesias (head bobbing, tics, grimacing, tremors)- administer amantadine to decrease dyskinesias
orthostatic hypotension- can be reducing by increasing intake of salt and water
psychosis- visual hallucinations, nightmares, paranoid ideation; administer clozapine
perform careful skin assessment for patients prescribed levodopa
Parkinson’s Disease
Apomorphine/Bromocriptine
used in conjunction with levodopa
used in younger clients who are better able to tolerate daytime drowsiness and postural hypotension
daytime sleepiness; avoid activities that require alertness
avoid alcohol
administer clozapine for psychosis
impulse control disorders; appear after 9 months after initial dose
Parkinson’s Disease
Amantadine
confusion, dizziness, restlessness
dry mouth, blurred vision, mydriasis (dilated pupils), urinary hesitancy or retention, constipation
monitor I&O, assess for urinary
chew sugarless gum, eat high-fiber foods, & increase fluid intake 2-3 l/day from food and beverage
Parkinson’s Disease
Selegiline
Rasagiline
first-line medication in combination with levodopa to decrease wear off effect
insomnia (selegiline)
-administer no later than noon
avoid foods containing tyramine (avocados, soy beans, figs, smoked meats, dried or cured fish, cheese, yeast products, beer, chianti wine, chocolate, caffeinated beverages
hypertensive crisis- avoid meperidine, fluoxetine, MAO inhibitors, antidepressants
MS
Interferon beta-1a
“ “ beta-1b
start early in the course of disease
flu like manifestations
prevent or treat relapses
MS
Methylprednisolone
reduces inflammation in acute exacerbation
3-5 days, large doses
monitor for increased risk of infection, hypervolemia, hypernatremia, hypokalemia, hyperglycemia, GI bleeding, personality changes
causes insomnia
give in the am
MS
baclofen
Muscle relaxer
treats muscle spasticity
severe cases of MS
observe for increased weakness
monitor liver damage (signs of jaundice-yellow discoloration of the eyes) with dantrolene
avoid stopping abruptly
MS
Dantrolene
Completely rigid—> complete relaxation
given to reverse reactions to anesthesia
reversal agent for malignant hyperthermia
MS
Carbamazepine
anticonvulsant used for paresthesia (tingling or numbness)
MS
Gabapentin
peripheral nerve pain, anxiety, deals with symptoms that come with MS
