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49 Cards in this Set
- Front
- Back
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Etiology of Parkinson's Disease |
Death of neurons that produce Dopamine Causes an imbalance of dopamine and acetylcholine |
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Sinamet, drug type and tx |
Dopaminergic (converts to dopamine) Carbidopa/Levodopa Levodopa crosses the blood-brain barrier and becomes Dopamine Carbidopa has a synergistic effect on Levodopa |
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Adverse Effects of Sinamet |
Dyskinesias Postual hypotension Psychosis Darkened color of sweat/urine *PT ED On-Off Phenomonon |
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On-Off Phenomonon
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Abrupt loss of drug effect when drug levels are high- sinamet
May be due to high protein meals PT ED- spread out the protein throughout the day |
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Dopamine Agonists |
Tx: Restless Leg Syndrome and Early Parkinsons Symptoms
Examples: Symmetrel Mirapex Requip |
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Advantages/Disadvantages of Dopamine Agonists |
Examples: Symmetrel Mirapex Requip
Advantages: no dietary protein interactions Disadvantages: Hallucinations, daytime sleepiness |
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COMT Inhibitors, Examples and Mech of Action |
Examples: Entacapone Tolcapone
COMT inhibitors stop the COMT enzyme from inactivating Dopamine
Can increase the half like of Sinamet by 50-75% |
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What is Stalevo? |
Levodopa/Carbidopa/Entacapone drug combo
Sinamet + COMT Inhibitor |
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MAO-B Inhibitors, Examples and Mech of Action |
Examples: Rasagiline Selegiline
Stops MAO-B enzyme from breaking down Dopamine
May increase the life of Levodopa and reduce the off phenomenon |
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In large doses Selegiline will inhibit MAO-A as well as MAO-B, what PT ED is important? |
MAO-A breaks down dietary tyramine. Inactivation of MAO-A and intake of dietary tyramine can lead to hypertensive crisis.
If taking a MAOI, avoid eating aged cheese, red win and bananas. |
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How does an anticholinergic help a Parkinsons PT? Examples of anticholinergics? |
Anticholinergics block the effect of Acetylcholine, which will decrease the symptoms by correcting the Acetylcholine-Dopamine inbalance.
Examples: Tihexphenidyl (Artane) Benztropine (Cogentin) |
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Side Effects of Anticholinergics and use in Tx Parkinsons |
Usually only given to PTs who cannot tolerate Sinamet
Side Effects: Can't See, Can't Pee Can't Spit, Can't Poop Blurred Vision Increases interocular pressure (not for PT with glaucoma) |
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Etiology of Alzheimers Disease |
Degeneation of cholinergic neurons and cerebral atrophy that is characterized by progessive memory loss, impaired thining, inability to communicatin effectively, and inability to perform ADLs. |
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Alzheimer's Disease Tx Goals and Drugs |
Goal: slow loss of memory, cognition, and independent function
Drugs: Cholinesterase Inhibitors NMDA Receptor Antagonists |
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Acetylcholinesterase Inhibitors, Examples and Mech of Action |
Examples: Donepezil hydrochloride (Aricept) 1/day * Best tolerated Tacrine (Cognex) 2-3/day Rivastigmine (Exelon) 2-3/day
Inhibits Acetylcholinesterase from breaking down acetylcholine, the main neurotransmitter responsible for learning and memory. Increases Acetylcholine levels. Parasympathomimetic
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Side Effects from Acetylcholineserase Inhibitors |
Examples: Donepezil hydrochloride (Aricept) Tacrine (Cognex) Rivastigmine (Exelon)
Drooling, broncoconstriciton, GI symptoms, Remember parasympathomimetic
Not for PT with Asthma, COPD, Peptic Ulcers
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NMDA ReceptorAntagonists, Example and Tx |
Example: Memantine
Tx: Moderate to severe Alzheimers thought to slow decline, by slowing the influx of Ca into cells |
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Antiepileptics, Mechanisms of Action (3) |
1. Potentiating GABA 2. Suppressing Na influx 3. Suppressing Ca influx |
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Partial (focal) Seizures |
Local symptoms Determined by the region of the brain involved |
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Generalized Seizures or Tonic-Clonic Seizures |
Caused by abnormal electrical activity throughout the hemispheres of the brain |
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Absence Seizures |
Brief lapse of consciousness Usually 2-10 Seconds Blank facial expression |
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Special considerations for Antiepileptics and PT ED |
Plasma Drug Levels- Drugs have narrow therapeutic range Cytochrome p450 Inducers- many drug-drug interactions
PT ED: Adherence is important (narrow range) Discontinuance- must happen slowly over 6 weeks to several months May reduce effectiveness of BC pills
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Phenytoin (Dilantin), Tx and considerations |
Tx: All seizures, except Absence. Also used fro cardiac dysrhytmias caused by digoxin toxicity
Narrow range 10-20mcg/mL Can cause gingival hyperplasia (preventable with oral hygiene) Liver Enzyme Inducer- Decreases effect of other drugs
PT ED: adherence and oral hygiene Don't take it pregnant, preg cat D, teratogenic Avoid Alcohol an opioids (exagerates CNS depessants) |
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Carbamazepine (Tegretol), Tx and considerations |
Tx: tonic-clonic and partial seizures, Bipolar disorder
Liver Enzyme Inducer, overtime decreases its own half life, 40 hrs --> 15 hrs
Need to monitor CBC! Causes bone marrow suppression*, leukopenia, anemia, and thrombocytopenia Teratogenic, Preg Cat D |
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Valproic Acid (Depakene, Depakote), Tx and Considerations |
Tx: ALL seizure types, bipolar disorder, migraines
Minimal sedation Teratogenic, Preg Cat D, neural tube defects, women encouraged to take folic acid May be hepatotoxic (rare) May cause pancreatitis |
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Ethosuximide (Zarotin), Tx and considerations |
Tx: Absence seizures
Does not require serum drug monitoring, dosage is based on observing seizure activity |
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Pheobarbital, considerations |
Antiepileptic, one of the oldest drugs, not commonly used
"barbiturate", causes physical dependency Side effects: learning impairment, lethargy, depression |
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Oxcarbazepine (Trileptal), Considerations and Adverse Effects
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anticonvulsant
Derivated of Carbamazipine, more expensive & better tolerated Adverse Effects: Dizziness and drowsiness *Hyponatremia (monitor NA, if PT taking a diruetic) No hemotologic problems (like carbamazepine) Preg Cat C, use BC |
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Gapapentin (Neurontin), Tx and considerations |
Tx: partial seizures, mostly used for off label use: neuropathic pain (shingles/herpes lesions), migrrains, Fibromyalgia, post-menopausal hot flashes
Well-tolerated (somnolence, dizziness, fatigue) No significant drug interactions |
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Pregabalin (Lyrica), Tx |
Tx: Seizures, pain from diabetic neuropathy, fibromyalgia, postherpetic neuralgia
Regulated Controlled Substance PT report euphoria |
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Levetiracetam (Keppra) |
Tx: seizures, not absence |
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Topiramate (Topamax) |
Tx: seizures (not absence) and migraine headaches |
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Effects of Status Epilecpticus and Nursing considerations |
tachycardia, hypertension, hypoxia, hypoglycemia, acidosis (Not breathing)
Start an IV and maintain airway |
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Tx for Status Epilecpticus |
Correct hypoglycemia, IV glucose Stop the seizure, Ativan or Valium Long term suppression, Dilantin or Cerebyx |
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What is a sedative hypnotic agent? |
CNS depressant
Tx anxiety- anxiolytic, antianxiety Tx insomina- hypnotic, sleeping pill
"sedative" depresses physical and mental responses but does not alter conciousness |
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Common side effects of Sedatives/Hypnotics |
Hangover, residual drowsiness REM Rebound, vivid dreams or nightmares Dependence Tolerance Excessive Depression Respiratory Depression Hypersenstivity, Allergic responses rare |
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Classes of CNS Depressants Used to treat anxiety/insomnia |
Barbiturates Benzodiazepines Nonbenzodiazepines |
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Barbiturates, considerations
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Tx anxiety and insomnia
Used to be the drug of choice Replaced by safer drugs Adverse Effects: Tolerance and dependence High potential for abuse Respiratory depression can be fatal with OD |
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Benzodiazepines, Tx and considerations |
Tx: anesthesia, status epilepticus, seizures, muscle spasms, panic, ETOH withdrawl
Lipid soluable- crosses the blood-brain barrier Should NOT be taken with ETOH OD antidote: Flumazenil (Romazicon) |
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Nonbenzodiazepines, examples and considerations |
Examples: Ambian, Sonata, Lunesta
Used for insomnia, NOT anxiety short term use only Schedule class IV, low abuse potential Lower dose for a geriatric patient |
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Therapuetic Effects of CNS Stimulants |
Increased wakfulness and alertness Reduced fatigue Elevated mood Self-confidence Stimulates respiration Stimulates appetite Suppresses pain perception
HIGH potential for abuse |
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CNS Stimulates, Examples and considerations |
Examples: Amphetamines Methylphenidate Methylxabthine
Used for: ADHD, Narcolepsy, Reversal of Respiratoy Distress
Tolerance, Dependence and Abuse Potential |
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Adverse Effects of CNS Stimulates |
Insomnia Restlessness Weight loss Increase HR and BP, not usually clinically significant |
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ADHD Treatment |
CNS Stimulants, Amphetamines
highten alertness and increase focus, release norepinephrine, dopamine and serotonin
Ritaline (Methylphenidate) Concerta (Methylphenidate) Daytrana (Methylphenidate) Focalin Dexedrine Adderall |
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Methylphenidate (Ritalin) considerations |
70% of children with ADHD use this Short duration- Ritalin is taken a breakfast and lunch
Concerta is sustained release, 1/day Daytrana is a patch, onset 2 hours, peaks at 9 hours and removed, effects last 3 hours post removal
Dependence Potential--> drug-free holidays
Adverse Effects: anorexia, growth delays |
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Considerations for amphetamines |
Should not be taken in the evening due to insomnia
Overdose treated by increasing urine acidity, decreases the half-life |
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ADHD Nonstimulant, Examples |
Atomoxetine (Strattera) Guanfacine (Tenex) Clonidine (Catapres)
Less effective than the stimulants |
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Atomoxetine (Strattera) considerations |
Tx: ADHD nonstimulant
no abuse potential 1/day warning for increase risk of suicidal ideation may increase HR and BP May cause appetite suppresssion |
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Guanfacine & Clonidine considerations |
Tx: ADHD, Alpha 2 agonists
Side effects: Somnolence Weight gain Reduced BP |
