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126 Cards in this Set
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anticholinergic agents
indications for use antiparkinson's meds |
primarily used with individuals with minimal symptoms, individuals who cannot tolerate levodops, or in combination with other agents
helpful in patients younger than 60 |
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anticholinergic agents
actions for antiparkinson's meds |
blocks access of acetylcholine to cholinergic receptors
decreases salivation, spasticity, tremors, and reduces rigidity |
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anticholinergic agents
side effects from antiparkinson's meds |
dry mouth, blurred vision, photophobia, constipation, urinary retention, and tachycardia
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anticholinergic agents
contraindicaitons for antiparkinson's meds |
allergy, narrow angle glaucoma, prostatci hypertrophy, myasthenia gravis
use caution with GI diagnoses, elderly patients, renal disease, and hepatic disease |
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Nursing concerns for
Antiparkinson's meds |
watch for tachycardia, compromised respiration due to thick secretions, constipation, and urinary retention secondary to anticholinergic use
should not give to patients with glaucoma* or BPH* |
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teaching measures for
antiparkinson's meds |
avoid alcohol, cigarettes, caffeine, and aspirin to decrese gastric acidity
avoid foods rich in vit B6 such as lima, navy, or kidney beans; these promote the breakdown of levodopa |
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anticholinergic meds
to treat parkinson's disease |
benztropine mesylate (Cogentin)
trihexyphenidyl hydrochloride (Artane) diphenhydramine hydrochloride (benadryl) |
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dopaminergic agents
indications for use and action antiparkinson's meds |
treatment of Parkinson's Disease
by increasing the amount of dopamine in the CNS, and helps improve mobility, balance, posture, gait, speech, and handwriting |
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dopaminergic agent
side effects from antiparkinson's meds |
nausea, vomiting, anorexia, psychosis, orthostatic hypotension, cardiac dysrhythmias,
**more serious are abnormal movements, bruxism, protrusion of tongue, neuroleptic malignant syndrome (crisis w/ fever) can occur if drug is stopped abruptly |
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dopaminergic agent
contraindications Parkinson's |
allergy, malignant melanoma, closed angle glaucoma, MAO inhibitors, breastfeeding, caution w/ history of psychosis and pregnancy
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Pathophysiology of Parkinson's
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Decreased dopamine, increased ACH
Degeneration of substantia niagra |
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Anticholinergic Agent
Action Parkinson's Disease |
Blocks access of ACH to cholinergic receptor
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Anticholinergic Agent
Side Effects Parkinson's Disease |
No pee, No see, No Spit, No Poo.
Oh, and tachycardia. |
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Anticholinergic Agent
Teaching Methods Parkinson's Disease |
No alcohol
No cigarettes No caffeine No aspirin No B6 |
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Cogentin
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Anticholinergic Agent
Parkinson's Disease |
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Trihexyphenidyl hydrocholoaride (Artane)
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Anticholinergic Agent
Parkinson's Disease |
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Diphenhydramine Hydrochloride (Benadryl)
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Anticholinergic Agent
Parkinson's Disease |
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Dopaminergic Agents
Action Parkinson's Disease |
Increase the amount of dopamine in the CNS
Helps mobility Helps balance Helps posture Helps gait Helps speech Helps handwriting |
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Dopaminergic Agents
Side Effects Parkinson's Disease |
N/V
Anorexia Psychosis Ortho Hypotension Dysrhythmias Serious: Bruxism, Tongue protrusion, neuroleptic malignant syndrome if drug is stopped abruptly |
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Dopaminergic Agents
Contraindications Parkinson's Disease |
Allergy
Malignant Melanoma Glaucoma MAO inhibitor Breastfeeing History of psychosis |
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Dopaminergic Agents
Nursing Concerns Parkinson's Disease |
Give with food
Avoid administering levadopa with iron -- Binds to iron |
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Dopaminergic Agents
Teaching Methods Parkinson's Disease |
May cause tachycardia, dyskinesia, discolartion of urine/sweat
Do not abruptly DC med May be weeks-months to control symptoms |
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Levadopa
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Dopaminergic Agents
Parkinson's Disease Inactive until crosses BBB |
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Cabidopa-levodopa (Sinemet)
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Dopaminergic Agent
Makes more dopamine available with fewer side effects Helps decrease peripheral biotransformation of levadopa so fewer dose is effective |
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Dopamine Agonists
Action Parkinson's Disease |
Stimulates dopamine in the brain
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Amantadine Hydrocholaride (Symmetrel)
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Dopamine Agonists
Parkinson's Disease Effective against rigidity and bradykinesia, less effective on tremors Prevent or treat influenza A |
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Bromocriptine Mesylate (Parlodel)
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Dopamine Agonists
Parkinson's Disease Used as an adjunct to levodopa in later stages of PD. Treats amenorrhea |
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Pramipexole (Mirapex)
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Dopamine Agonists
Parkinson's Disease Treats early PD who do not need Levadopa |
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Ropinrole (Requip)
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Dopamine Agonists
Parkinson's Disease Treats early PD who do not need Levadopa Treats restless leg syndrome |
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COMT Inhibitor
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Inhibits the COMT enzyme that inactivates dopmaine
Parkinson's Disease |
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Tolcapone (Tasmar)
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COMT inhibitor
Parkinson's Disease Side effect: liver damage Black Box Warning Monitor liver enzymes |
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Entacapone (Comtan)
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COMT inhibitor
Parkinson's Disease Causes dark yellow to orange urine |
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Carbidopa/levodopa/entacapone (Stalevo)
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COMT inhibitor
Parkinson's Disease |
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MAO-B inhibitor
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Inhibits MAO enzyme that INTEFERES with dopamine.
Parkinson's Disease |
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Selegiline Hydrochloride (Eldepryl)
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MAO-B Inhibitor
Used with levodopa Decreases "On-Off" fluctuations Avoid foods high in tryramine, cause hypertensive crisis Adverse drug reaction to SSRI |
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Rasagiline (Azilect)
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MAO inhibitor
Parkinson's Disease Adjunct to levodopoa Very Costly Headache, Constipation, MI, Arrhythmias, EPS, dyskinesia, mental status change |
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ALS: Lou Gehrig's Disease
Pathopyhsiology |
Affects upper and lower motor neurons, sensory and intellect intact
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Anti-amyotrophic Lateral Sclerosis Agents Use
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Will not CURE ALS
Delay the need for tracheotomy, or mechanical vent |
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Anti-amyotrophic Lateral Sclerosis Agents Action
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Inhibit release of glutamine
Inhibit voltage-dependent sodium channel |
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Anti-amyotrophic Lateral Sclerosis Agents Side Effects
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N/V/D
Anorexia Dizzy Insomnia Neutropenia Headache |
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Anti-amyotrophic Lateral Sclerosis Agents Contraindications
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Allergy
Hepatic/Renal disease Pregnant |
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Anti-amyotrophic Lateral Sclerosis Agents Nursing Concern
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Educate: DOES NOT CURE
Administer on empty stomach |
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Riluzole (Rilutek)
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Anti-amyotrophic Lateral Sclerosis Agent Drug
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Myasthenia Gravis
Pathology |
Impairs the receptors of acetylcholine
Muscle weakness and fatigue |
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Acetylcholinesterase Inhibitor
Use |
Myasthenia Gravis
Stops the breakdown of acetylcholine More ACH availabe at junction to enhance muscle contraction |
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Acetylcholinesterase Inhibitor Side Effects
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Cholinergic Crisis
(Parasympathetic Response) |
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Acetylcholinesterase Inhibitor Nursing Concerns
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Must have ATROPINE available and know how to administer it if cholinergic crisis occurs
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Cholingergic Crisis
Myasthenia Crisis |
Cholinergic - Overmedication
Myasthenia - Undermedication Better or worse after giving cholingergic medication |
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Neostigmine (Prostigmin)
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Acetylcholinesterase Inhibitor
Resistance may require a larger dose |
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Pyridostigmine (Mestinon, Regonol)
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Acetylcholinesterase Inhibitor
Maintance drug of choice |
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Ambenium (Mytelase)
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Acetylcholinesterase Inhibitor
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Epilepsy
Pathophysiology |
Abnormal and excessive pattern of electrical impulses to nerve cells
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Focal Seizure
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Simple or complex pattern of abnormal movements inappropriate for situation
Simple: no impairment of conscious Complex: Some impairment of conscious |
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Generalized Seizure
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Unidentified portion of the brain
Movements are bilateral and symmetrical |
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Tonic
Clonic |
Muscle contraction, absence of respiration
Rhythmic jerky movements |
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Absence Seizure
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Abrupt alteration in consciousness, stare, no movements
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Mycolonic Seizure
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Abrupt contraction of a muscle or group of muscles
(moving an arm) |
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Akinetic Seizure
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Without movements
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Status Elipticus
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Tonic-Clonic seizures in close intervals, no consciousness between seizure
Cause: abrupt stopping of medication |
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Status Elipticus side effects
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Hypotension, hypoxia, and cardiac arrhytmias
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Antiseizure Medication Action
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DO NOT CURE
Suppress abnormal impulses |
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Phenytoin (Dilantin)
Use |
Prevents grand mal, not effective for absence seizures
Prevents seizures in brain surgery and brain trauma |
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Phenytoin (Dilantin)
Contraindications |
Bradycardia
Heart Block |
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Phenytoin (Dilantin)
Side Effects |
Gingival Hyperplasia
Ataxia Drowsiness Lethargy Nausea/Vomit |
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Carbamazepine (Tegretol)
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Phenytoin-like
Simple, Complex, Tonic-Clonic Treats bipolar and trigeminal neuralgia Contraindicated for bone marrow depression: causes aplastic anemia |
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Lamotrigine (Lamictal)
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Phenytoin-like
Partial seizures Treats bipolar with few side effects Dizzy, drowsy, RASH, Steven-johnson Contraindicated for children |
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Phenobarbital (Luminal)
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Barbiturate
Reduces seizure by intensifying GABA action Main side effect: sedation |
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Clonazepam (Klonopin)
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Benzodiazepine
Anti-seizure |
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Clorazepate (Tranxene)
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Benzodiazepine
Anti-seizure |
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Diazepam (Valium)
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Benzodiazepine
Anti-seizure Acute onset Given IM for status elipticus |
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Lorazepam (Ativan)
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Benzodiazepine
Treats acute seizure and last longer than Diazepam (Valium) |
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Benzodiazepine Action and side effects
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Intensiying effect of GABA by stimulating GABA receptor
Not usually used alone, but with another antiseizure med Sedation, dependence, dizzy |
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Ethosuximide (Zarontin)
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Succinimide
Used for absence, atonic and myoclonic seizures Most common for absence seizures |
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Succinimide Action and side effects
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Suppress seizures by delaying calcium influx into neurons
Drowsy, dizzy, fatigue, depression, euphoria |
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Valproic Acid (Depakene, Depakote)
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Enhances effect of Gaba
Less sedation than phenytoin and phenobarbital Treats several kinds of seizures |
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Gabapentin (Neurontin)
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Partial seizures - use with other AED
dizzy, drowsy, fatigue Also treats Post-herpetic pain and peripheral neuropathy |
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Tiagabine (Gabitril)
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Partial seizures with AED
May increase GABA levels in brain Confusion, drowsy, impaired concentration |
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Topiramate (Topamax)
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Prevents migrain headaches, bipolar, obesity
Side effect: ataxia, drowsy Increases GABA |
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Levetiracetem (Keppra)
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treatment of partial seizures in combination with AEDs
Inhibits abnormal firings but not normal firings Dizzy, drowsy, fatigue |
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GABA
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major inhibitory neurotransmitter in the brain
Seizure meds enhance gaba to inhibit seizure impulses |
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Seizure Medication Teaching
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Avoid alcohol and CNS depressants
Take with food or a full glass of water Antipyschotics decrease seizure threshold |
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Cornea
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Transparent covering of the eye
Enables light to enter No blood vessels |
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Sclera
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White part of the eye
Posterior and Anterior chambers in the sclera Lens |
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Anterior Chamber
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Filled with aqueous humor
Lies in front of lens Rise in aqueous humor=glaucoma |
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Choroid
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Absorbs light
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Iris
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Gives the eye it's color
Controls quantity of light reaching lens |
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Retina
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Rods and cones
Connected to the brain via the optic nerve |
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Intraocular Pressure
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Impaired drainage or over production of aqueous humor
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Miosis
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Constriction of pupil
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Miotic
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Something the causes constriction
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Mydriasis
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Pupil Dialation
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Mydriatic
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Something that causes dialation
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Myopia
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Near Sightedness
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Floresceine Sodium
Florecein Sodum Benoxinate (Fluress) |
See scratches
Fix lenses Study Lacrimal System |
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Conjuctivitis
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bacterial, viral, allergic
Staph Aeurs or Step Pneumonia |
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Cromalyn Sodium (Crolam)
Kelotifen Fumarate (Zaditor) |
Antihistamines
Conjuctivitis |
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Antibacterial
Conjuctivitis |
Sulfactemaide (Sulamyd)
Ciprofloxacin (Cipro) Erythromycin |
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Antiviral
Conjuctivitis |
Trifuridine 1%
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Blepharitis
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Infection of margins of eyelids
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Chalazion
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infection of meibomian gland of the eyelid that may produce cysts
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Endophthalmitis
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Inflammation of the inner eye structures
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Hordeolum
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local eye infection of eyelash follicles and glands on lid margins
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Keratitis
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corneal inflammation
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Uveitis
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infection of vascular layer of eye
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Fungal infection
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commonly occur and may be caused by too frequent use of drops
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Dry Eyes Medications
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Isopta Tears
Tearisal Ultra Tears Tears Naturale Lens Mate Fresh Look |
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Glaucoma
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Increased IOP by excessive producation or diminished outflow of acqueous humor
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Open Angle Glaucoma
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Diminished outflow of aqeuous humor related to degenrative changes
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Closed angle glaucoma
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Triggered by emottions and drugs that dilate pupils
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Cholinergic Agents
Miotics |
Treat Glaucoma
Lower IOP by increased blood flow to retina Contraction of ciliary muscle and widening of trabecular meshwork |
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Direct Acting Cholinergic Action
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Mediate nerve impulse at all parasympathetic sites, causing contraction of pupil (miosis)
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Pilocarpine (Isopto Carpine)
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Direct Acting
Cholinergic Agents Miotic Glaucoma |
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Acetylcholine (Miocol)
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Direct Acting
Cholinergic Agents Miotic Glaucoma |
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Pilocarpine Nitrate (Ocusert)
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Direct Acting
Cholinergic Agents Miotic Glaucoma |
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Cholinergic Agents
Miotic Side effects and contraindications |
Headache, eye pain, decreased vision
Retinal detachment, adhesions between iris and lens, ocular infection |
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Indirect acting cholinesterase inhibitors
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Physostigmine Salicylate (Isopto eserine)
Demecarium Bromide (Humorsol) |
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Timolol Maleate (Timoptic) (Istalol)
betaxolol (Betoptic) |
Beta-adrenergic Blocker
Glaucoma Decrease production of aqueous humor |
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Carbonic Anhydrase Inhibitor Action
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Interfere with production of carbonic acid, decreased aqueous humor formation, decrease IOP
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Acetazolamide (Diamox)
Brinzolamide Opthalmic Suspension (Azopt) |
Carbonic Anhydrase Inhibitor
Glaucoma Lethargy, anorexia, drowsiness |
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Osmotics
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Preoperatively and postoperatively to decrease vitreous humor and IOP
Emergency Treatment |
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Isosorbide (Ismotic)
Mannitroal (Osmitral) |
Osmotic Drugs
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latanoprost (xalatan)
Unoprostone isopropyl (rescula) |
Prostaglandins
Glaucoma |
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Sympathomimetics
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Topically for open angle glaucoma
Epinepherine Phenylephrine (AK-Dilate) |
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Anticholinergic Mydriatics and cycloplegics
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Dilate pupils
Paralyze muslce of accomodation Diagnostic procedures and ophtlamic surgery Dialation and paralysis |
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Atropine (atropisal)
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Anticholinergic mydriatics and cycloplegics
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cycloplegics side effects
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tachycardia, dry mouth, edema,
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