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63 Cards in this Set

  • Front
  • Back
What is Parkinson's Disease?
a degenerative disease of the neurons
What are s/s of parkinson's disease?
tremor, rigidity, postural instability, slowed movement, autonomic disturbances, depression, psychosis and dementia - symptoms appear middle age and keep progressing
What is the cause of parkinson's disease (PD)?
degeneration of neurons that supply dopamine - neurol degernation begins long before symptoms appear can take 5-20 years, can be caused from genetics or enviromental toxins
How do drugs help someone with PD?
improving bradykinesia, gait disturbancess and postural instability - then provide symptoms support. There is no cure for PD
Name mech of action for Levodopa
promotes sysnthesis of dopamine first line drug
How long does it take for Levodopa to work in PD?
full therapeutice effects several months - rise steadily over first few months - drug becomes less effective with time
Adverse effects of levodopa
N/V, dyskinesais, posturnal hypotension, dysrhythmias, psychosis, darken sweat and urine & activate malignant melanoma
Teaching with how to take levodopa
taken with food delays absorption & high protien foods will decrease effects of drug
drug interactions with Levodopa
first generation antipsychotics block receptors for dopamine, and can cause a hypertensive crisis if given with MAO inhibitors, avoid B6 as can decrease levels of levodopa
Is levodopa/carbidopa more effective thatn levodopa alone and why?
carbidopa used to enhance effects of levodopa and ineffective on its own
Why is adding carbiodopa superior to levodopa alone?
1) increases availability of levodopa for levodopa dose can be lowered 2) reduces CV and N/V side effects 3) Vitamine B6 can still be taken w/o decreasing effects of drug
What 2 drugs are a levodopa/carbiodopa mix
Sinemet & paracopa
How do dopamine agonists work?
directly acitivate dopamine receptors - less effective than levadopa, but used first with mild to mod PD
Side effects of dopamine agonists?
greater hallcinations, day time sleepiness and postunal hypotension reserved for younger patients
Name 2 types of dopamine agonists?
ergot and nonergot preparations - nonergot less side effects
Name the nonergot dopamine agonists that can be used alone in early stage PD or in addition to levodopa in late stage PD
Pramipexole, ropinirole, apomorphine
What are side effects of Nonergot dopamine agonists?
N/B, dizziness, daytime sleepi8ness or sleep attacks, weakness and hallicnations, complusive, self rewarding behaviors after about 9 months of med
Drug to avoid if on nonergot dopamine agonists?
cimetidine - inhibits renal excretion and thereby increases blood level
COMT Inhibitors use and indication
Entacapone - inhibits metabolism of levodopa in periphery so increases time levodopa can be used in teh brain - no good if used alone. use with levodopa
MOA - B Inhibitors
2nd or 3rd line drugs - combine with levodopa and can reduce wearing off effect. effects are modest
What is Alzeheimers Disease
progressive illness - memory loss, impaired thinking, neuropsychiatric s/s, (hallucinations and delusions) & inabililty to perform routine tasks - 4th leading cause of death
What is pathology of alzehiemers?
degeneration of cholinergic neurons and presence of neuritis places and neurofibrillary tangles. Damage irreversible
What happens with coritcal degernation with alzeheimers?
loss of speach, loss of bladder and bowel control, complete inability for sefl-care. Eventually destroys enough brain fx to cause death.
Risk factors for AD?
advancing age onset usually over 65, and family history
What is the progression of AD?
can take 20 years, from onset to death but usualy 4-8 years
Mild s/s of AD
confusion & memory loss, disorientation, problesm with routine tasks, changes in personality,
Moderate s/s of AD
Difficulty with ADL's, Anxiety, agitation, sleep disturbances, wandering, diff recognizing family and friends
Severe s/s of AD
loss of speach, loss of appetite, weight loss, loss of bladder and bowels, compelte dependence
Have AD meds shown to be effective?
No
What AD meds are available?
Cholinesterase inhibitors and memantine
How do cholinesterase inhibitors help with AD
provide modest improvement cognition & quality of life - improvment usualy short acting - only 25-30% people respond
How does memantine help with AD
works in moderate to severe
What is epilepsy?
excitabiltiy of neurons in the CNS, can produce unconsciencness and convulsions
How are seizures initiated?
by synchronous, high frequency discharge from group of yperexcitabel neurons called a focus
What 2 types of seizures are there?
partial or focal and generalized seizures
Name types of partial seizures
simple partial seizure - no loss of conscienceness persist for 20-60 seconds, complex partial: impaired consciencesness & lack of responsiveness - fixed stare w/ reptitive movements like lip smacking or hand writhing. Secondary generalized: start as simple or complex and move into tonic-clonic last 1-2 min
Name generalized seizures
tonic-clonic (grand mal), absence (petit mal), atonic seizure, myoclonic , status epilepticus and febrile
What is a tonic-clonic seizure
neuronal dischage across both hemispheres of brain, major convulsions, muscle rigidty, adn muscle jerks
What is an absence seizure?
loss of conscienceness for a brief time 10-30 seconds. usually involved mild eye blinking or staring - no motor activity
What is an atonic seizure?
sudden loss of muscle tone - can be a head drop or complete collapse
What is a myoclonic seizure?
sudden muslce contriactions that last for just 1 sec
What is status epilepticus
A seizure that lasts for more than 30 mintues
what are some non-drug therapies used for epilepsy?
Neurosurgery, vagus nerve stimulation and ketogenic diet
How do drugs work with seizures?
Drugs are seizure selective must first diagnosis type of seizure before know which med will work
What is best way to adjust drug levels for anti-seizure drugs?
draw drug plasma levels
What is a big risk with those taking antiepileptic drugs (AED)?
increaes risk of suicide
What 2 categories are there for AED?
traditional AEDa nd newer AED
Name the most commonly used traditional AEDs?
phenytion, carbamazepine, valproic acid, ethosuximide, phenobarbital, primidone
What are drawbacks of traditional AEDs?
less tolerated than new AEDs, pose greater risk to developing fetus, & greater interaction with other meds
What is most widley used AED
phenytion - dilantin
What is danger of phenytoin?
small therapuetic range - between effective dose and lethal dose - tetragenic in pregnancy
What kind of epilepsy can phenytoin not help?
absense seizures
How is phenytoin with other drugs?
decreases effectiveness of oral contraceptives, glucocorticoids and warfarin, need to avoid CNS depressants as decreases levels of phenytoin in bld
What is carbamazepine or Tegretol used for?
partial seizures and tonic-clonic seizures, bipolar disorder, and certain neuralgias
Adverse effects of Carbamazepine?
bone marrow suppression, birth defects, rash - do not drink grapefruit juice as it may inhibit metabolism of carbamazepine
How is valproic Acid (depakote) used for seizures?
all major seizure types, bipolar disorder, migraines
What is the drug of choice for absense seizures?
Ethosuximide (Zarontin)
How are the newer AED's better or worse
They are more expensive, they are less fetal toxic, less interaction with other medications, better tolerated that traditional AEDs
Name most used newer AEDs
oxcarbazepine (Trileptal) & Lamotrigine (Lamictal)
What type of seizures is oxcarbazepine used for?
partial seizures in adult and children
What is lamotrigine or lamictal used for?
adjuncitive therapy for seizures if over 2 yr old and for monotherapy ofor partial seizures if at least 16 and converting from another AED
What is a serious side effect with oxcarazepine and lamotrigine AED medication?
life-threatning skin rashes
How to treat AED in pregnancy?
give lowest dose possible to keep seizures under control and only use monotherapy - take folic acid at dose of 2mg/day to prevent neural tube defects, increase Vit K last weeks of pregnancy