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Midterm Review

Pharm-MOD 3

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.
Created by: ederight



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