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Midterm Review
Pharm-MOD 3
| Question | Answer |
|---|---|
| What are the four major features of Parkinson's Disease? | 1. Rest tremor of a limb 2. Slowness of movement 3. Rigidity of limbs or trunk 4. Poor balance |
| Define the BBB | The blood brain barrier impedes entry of drugs into the brain-allowing only lipid-soluble agents or drugs w/specific transport sys. It provides protection from toxic substances. |
| Therapy w/ CNS drugs may result in? (3) | 1. Increased side effects @ beginning of tx. 2. Decreased therapeutic effects @ beginning of tx. 3. Physical Dependence & Tolerance |
| What two neurotransmitters are imbalanced in Parkinson's Disease? What causes this imbalance? | Dopamine and ACh. Dopamine is inhibitory and ACh is excitatory. The imbalance occurs from degeneration of the neurons that supply dopamine to the striatum from the substantial nigra. Thus, GABA-releasing neurons are excited by ACh more constantly. |
| How do we choose which drugs to use in Parkinson's and can the drugs help cure the disease? | Drugs are chosen based on the extent PD interferes with work, walking, dressing, eating, bathing, etc. Drugs ONLY provide symptomatic relief, the CANNOT CURE PD!!!! |
| What two types of drugs are used in PD? | 1.Dopaminergic agents- Levadopa (Dopar)/Carbidopa, Pramipexole (Mirapex), Ropinirole (Requip). 2.AntiCholinergics |
| How do Levadopa and Carbidopa work? What are their actions? | Levodopa promotes activation of dopamine receptors. Carbidopa enhances the effects of Levodopa and inhibits its peripheral decarboxylation/ degradation, so more gets tot he brain. |
| What adverse effect do we see with most drugs used to treat PD? What are specific to dopamine Agonists? | Hallucinations with all PD drugs. Dopamine Agonists cause nausea, postural hypotension, dyskinesias. |
| What are the nursing implications for Dopamine agonists? | High protein meals must be avoided w/ Levadopa!!! Take Rx w/ food to decrease nausea. Evaluate daily activity improvements and symptoms that interfere with daily living activities. |
| What drug can be given INITIALLY for mild PD that consists of tremor at rest? | Anticholinergics |
| What is the primary goal of medication therapy for PD? | To reduce or slow symptoms, as PD can't be treated. |
| Describe the difference between a partial (focal) seizure and a generalized seizure. | In partial seizures, the activity begins focally in the cerebral cortex and only spreads limited amounts. In generalized seizures, focal seizure activity is conducted through both hemispheres. |
| Describe Simple Partial Seizures | There is NO loss of consciousness. Seizures last for 20-60 seconds. Symptoms are related to the area of the brain affected. |
| Describe Complex Partial Seizures | Loss of consciousness!!! Staring w/a fixed gaze followed by automatism during which the pt has repetitive, purposeless mvmts. These last for 45-90 seconds. |
| Describe Secondarily Generalized Seizures | These begin as simple or complex partial seizures and evolve into tonic-clonics. Consciousness is LOST!!! |
| Describe Tonic-Clonic Seizures(Grand Mal) | Neuronal discharge goes through both hemispheres. Convulsions go to muscle rigidity-tonic phase, followed by synchronous muscle jerks-clonic phase. These often cause urination, last 90 secs or less, and are followed by a postictal state-CNS depression. |
| Describe Absence Seizures (Petit Mal) | Loss of consciousness for about 10-30 seconds with or w/out mild symmetric motor activity. Occur primarily in children and subside by teen years. |
| Describe Atonic Seizures | Sudden loss of muscle tone, head drop or drop attack can occur. Mainly seen in children. |
| Describe Myoclonic Seizures | Sudden muscle contractions that last for just 1 second. |
| Describe Status Epilepticus and what two drugs are used to treat them. | A seizure that lasts for 30 minutes or longer. Use Valium (Diazepam) or Ativan (lorazepam)via IV. |
| Describe Febrile Seizures | Fever-associated seizures that occur in children 6 mo-5 yrs. Children who experience these are NOT at a high-risk of epilepsy later in life. |
| What are the 2 hallmark changes in the body that cause Alzheimer's disease? | Neuritic Plaques-form outside neurons and are mainly composed of beta-amyloid. Neurofibrillary tangles-form inside neurons when abnormal Tau is produced-the protein that produces cross-bridges between microtubules to keep them stable. |
| What are the symptoms of Alzheimer's Disease? | Early in the disease-memory loss, confusion. With disease progression, self care becomes more difficult. Later in the disease, sundowning occurs and pts can't recognize close family members. |
| Which 5 drugs are approved for Alzheimer's disease? What two classes do they fall into? | Class 1: Cholinesterase inhibitors-Donezepil, Galantamine, rivastigmine, tacrine. Class 2: NMDA receptor antagonists- Memantine. |
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ederight
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