Ch 12 Pharm – Flashcards
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What is true about current medications for Alzheimer's disease?
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result in only minor improvements
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What is among the early symptoms of Alzheimer's disease?
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An inability to remember or recall information
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What is multiple sclerosis (MS)?
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an autoimmune disorder of the central nervous system (CNS) in which antibodies target & slowly destroy unmyelinated tissues in the brain & spinal cord
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What are Interferon beta-1a (Avonex, Rebif) & interferon beta-1b (Betaseron) used as treatments for?
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they are the only clinically proven treatments for affecting the underlying course of multiple sclerosis & for decreasing overall relapse rate.
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What is the goal of drug therapy for spasticity?
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to improve the patient's mobility
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What does botulinum toxin do if given in high doses?
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acts as a poison
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What symptoms are common in patients with severe hypocalcemia?
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convulsions or muscle spasms
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What may a patient with Parkinson's disease experience difficulty doing?
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urinating & performing sexually, which are signs of disturbances of the autonomic nervous system.
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What does drug therapy for Parkinson's disease focus on?
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restoring dopamine function & blocking the effect of acetylcholine within the same area of the brain.
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What is Alzheimer's disease?
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a degenerative disorder characterized by progressive memory loss, confusion, & an inability to think or communicate effectively.
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What are the most common causes of dementia?
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Alzheimer's disease & multiple strokes
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What do patients with Alzheimer's disease experience?
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a dramatic loss of their ability to perform tasks that require acetylcholine as a neurotransmitter
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What is link is a possibility of Parkinson's disease?
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a genetic link because many patients have a family history of the disorder
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What medications may induce a Parkinson-like syndrome?
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extensive treatment with antipsychotic medications (may cause extrapyramidal symptoms)
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What do side effects of drugs used to treat parkinsonism include?
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hypotension & tachycardia. Signs of toxicity include muscle twitching & mood changes
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What is the goal of pharmacotherapy when treating Alzheimer's disease?
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to improve the function in three domains: cognitive, behavioral, & daily activities
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What can be used only in the early stages of Alzheimer's disease, and why?
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Acetylcholinesterase inhibitors because they are effective only in the presence of functioning neurons
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What are muscle spasms?
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involuntary contractions of a muscle or group of muscles
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What does pharmacotherapy for muscle spasm usually include?
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analgesics, anti-inflammatory agent, & antispasmodic drugs
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What is spasticity?
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a muscle condition that results from damage to the CNS
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What is dystonia?
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a chronic neurological disorder in which involuntary muscle contraction forces body parts into abnormal postures
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What is tetany?
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prolonged muscle spasms
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What characteristic does Levodopa have?
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drug of choice for parkinsonism
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What characteristic does Sinemet have?
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Carbidopa that is added to levodopa to make more levodopa available to enter the CNS
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What characteristic does Selegiline have?
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Inhibits enzymes that destroy levodopa or dopamine
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What characteristic does Bromocriptine have?
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Dopamine agent that activates dopamine receptors
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What characteristic does Amantadine have?
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antiviral that releases dopamine from its nerve terminals
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What characteristic does Tacrine have?
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acetylcholinesterase inhibitor used for Alzheimer's disease associated with hepatotoxicity
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What characteristic does Ginkgo Biloba have?
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Approved in Europe for dementia but not yet in the United States; can react with anticoagulants
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What characteristic does Donepezil have?
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Antioxidant possibly useful in Alzheimer's disease
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What characteristic does Pyridoxine have?
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decreases the effect of dopaminergics
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Parkinson's disease is a degenerative disorder of the nervous system caused by the death of neurons that produce:
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Dopamine
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If the patient is in the early stages of Parkinson's disease, what would be seen on assessment?
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tremor, muscle rigidity & weakness, & bradykinesia (NOT usually seen: dementia)
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What is the relationship between acetylcholine & dopamine in the area of the brain that affects balance, posture, & involuntary muscle movement?
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Dopamine inhibits & acetylcholine stimulates this region
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What class of drugs may induce artificial parkinsonism by interfering with the same neural pathway & functions modified by a lack of dopamine?
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Phenothiazines
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What drug has been prescribed more extensively than any other drug for patients with Parkinson's disease?
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Levodopa (Larodopa)
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What type of side effects would be expected when a patient is started on levodopa for Parkinson's disease?
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sleep disorders such as insomnia
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What class of drugs would likely be prescribed if a patient is unable to tolerate dopaminergic medications?
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Anticholinergic drugs
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What normally causes vascular dementia?
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Multiple strokes
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Amyloid plaques & neurofibrillary tangles within the brain are diagnostic signs of what?
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Alzheimer's disease
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Acetylcholine inhibitors enhance the action of what chemical in the brain?
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Acetylcholine
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Drugs that inhibit the enzyme acetylcholinesterase (AchE):
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increase levels of acetylcholine
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What do causes of muscle spasms include?
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Overmedication with antipsychotic drugs, hypocalcemia, epilepsy (does NOT include: overdose of calcium)
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What are nonpharmacological measures that may be used to treat muscle spasms?
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thermotherapy, hydrotherapy, ultrasound (NOT used: use of affected muscle)
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What statement about cyclobenzaprine (Flexeril) is false?
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It is effective in cerebral palsy (TRUE: its mechanism of action is similar to that of tricyclic antidepressants; it is meant for short-term use; it is not recommended for use in children)
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What drugs are effective in the treatment of spasticity?
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Balcofen, Diazepam, Dantrolene (NOT effective: cyclobenzaprine)
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How does botulinum toxin (Botox, Myobloc) produce its effects?
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it blocks the release of acetylcholine from cholinergic nerve terminals.
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What statement is incorrect about a centrally acting antispasmodic drug?
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If you have severe side effects, stop taking the drug at once. (CORRECT: you should avoid hazardous activities, such as driving, if the drug makes you drowsy. You should avoid alcohol & antihistamines. You should not take this drug if you have liver disease. )
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What are some correct statements regarding dantrolene (Dantrium)?
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It is useful in spasms of head & neck muscles. It is useful in cases of spinal cord injury or CVA. It does not affect cardiac or smooth muscle. (NOT correct: Its use is contraindicated in patients with malignant hyperthermia)
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What best describes the etiology of tetany?
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blood calcium levels are too low, leading to cell membranes being extremely excitable.
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What drug is produced by bacteria & is responsible for food poisoning in high quantities?
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Botulinum toxin
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What drug class increases the risk for unfavorable reactions to antispasmodics?
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MAO Inhibitors
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What may patients experience who abruptly discontinue baclofen (Lioresal)?
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Hallucinations, paranoia, & seizures
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What precautions should a patient take if he is using cayenne (Capsicum annum) for his muscle spasms, in addition to his drug therapy?
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Never apply to broken skin.
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The patient taking levodopa must avoid foods high in:
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Vitamin B6
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What degenerative CNS disease is characterized by progressive dementia & involuntary muscle spasms?
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Huntington's chorea
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What does drug therapy for the patient with Parkinson's disease focus on?
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Restoring dopamine function & blocking acetylcholine within the brain.
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The patient on haloperidol (Haldol) is experiencing tardive dyskinesia. What drug would the nurse anticipate being ordered?
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Benztropine (Cogentin)
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What would the nurse assess for a patient with Alzheimer's disease that has been started on rivastigmine (Exelon)?
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weight loss
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The patient taking gingko biloba must be assessed for use of what drug?
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Coumadin
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What symptoms should be reported for a patient with MS that is prescribed an interferon?
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flulike symptoms
