Neuro - Myasthenia Gravis + Parkinson's + Alzheimers

Question 1

more ACh means

Answer 1

more cholinergic

-sludge dumbells

Question 2

cholinesterase

Answer 2

an enzyme that breaks down ACh

-allows cholinergic neuron to return into its resting state

Question 3

cholinesterase inhibitors
drug names (6)

Answer 3

neostigmine
donepazil
edrophonium
pilocarpine
physostigmine
pyridostigmine
(johNE DEPPP)

Question 4

cholinesterase inhibitors

MOA

Answer 4

extends the actionof ACh

-increase ACh effects

Question 5

cholinesterase inhibitors

AE

Answer 5

cholinergic crisis

• sludge
• dumbells

Question 6

cholinesterase inhibitors

CI

Answer 6

• patients receiving succinylcholine

- caution in asthma, bradycardia, low BP

Question 7

Myasthenia Gravis

Answer 7

low ACh

-immune system attacks ACh receptors

Question 8

Cholinergic Crisis

Answer 8

high ACh

-greatly increased secretions + RESPIRATORY DEPRESSION

Question 9

cholinergic crisis treatment

Answer 9

atropine (anti-ACh) + resuscitative equipment (crash cart)

Question 10

Tensilon Test

Answer 10

-give edrophonium 2 mg Q15-60 seconds until transient improvement
or
-give total dose of 10mg

-given via IV

Question 11

Tensilon Test

results

Answer 11

[+ MG] strong hand squeeze

[- MG] weak hand squeeze

Question 12

should monitor ___ + ____ + _____ during the tensilon test

Answer 12

• SpO2
• HR
• BP

Question 13

if + for MG,

Answer 13

indicates that they got too little ACh medication> myasthenic crisis
administer neostigmine or other cholinesterase inhibitor

Question 14

if - for MG,

Answer 14

indicates ACh overdose> cholinergic crisis

administer atropine (anti-ACh)

Question 15

edrophonium

Answer 15

short term acting cholinergic drug

Question 16

when is tensilon test indicated

Answer 16

patient that is receiving Ach medication has trouble breathing
-sign of either too much or too little Ach

Question 17

Anti-Parkinson’s

medication types

Answer 17

1 first line
2 COMT inhibitors
3 dopamine agonist
4 dopamine releasers
5 centrally acting anti-ACh

Question 18

anti-prknsn

first line medication

Answer 18

carbidopa/levodopa

Question 19

carbidopa

MOA

Answer 19

carbidopa is the car that carries and prevents breakdown of levodopa in the bloodstream
-increases the amt of levodopa that can enter the brain

Question 20

levodopa

MOA

Answer 20

converts itself into dopamine when it enters the brain

Question 21

which is the most effective symptomatic therapy for parkinson’s?

Answer 21

carbidopa/levodopa

aka first line medication for parkinsons

Question 22

carbidopa/levodopa

AE

Answer 22

psychosis

-visual hallucinations, nightmares, paranoia

Question 23

carbidopa/levodopa

CI

Answer 23

• melanoma

- skin lesions that haven’t been DDX bc can speed up cancer

Question 24

carbidopa/levodopa

PT teaching

Answer 24

• beneficial effects diminish by the end of year 5
• monitor protein intake
• avoid foods w pyridoxine
• can discolor sweat + urine (red or brown)

Question 25

is carbidopa/levodopa a cure for parkinsons?

Answer 25

NO, | it only slows the progression

Question 26

protein + carbidopa/levodopa

Answer 26

delays absorption + reduces med effect | -eat SMALL portions of protein throughout the day

Question 27

pyridoxine foods + carbidopa/levodopa

Answer 27

B6>interferes w absorption

Question 28

psych A/E of carbidopa/levodopa

Answer 28

expect 2nd generation antipsychotic meds | -clozapine or quetiapine

Question 29

COMT inhibitors

Answer 29

catelcholamine-O-methyltransferase inhibitors

Question 30

COMT inhibitors | drug names

Answer 30

entacalone

Question 31

entacapone [COMPT inhibit] | MOA

Answer 31

enhances effect of levodopa | -blocks its breakdown in intestines

Question 32

entacapone [COMPT inhibit] | AE

Answer 32

urine turns yellow orange

Question 33

entacapone [COMPT inhibit] | RN teaching

Answer 33

monitor for NMS-like s/s

Question 34

NMS

Answer 34

Neuroleptic malignant syndrome | -life-threatening idiosyncratic reaction to antipsychotic drugs

Question 35

NMS-like s/s

Answer 35

- hyperpyrexia (+106) | - dystonia (involuntary muscle contractions that cause slow repetitive mvmt)

Question 36

dopamine agonist | drugs

Answer 36

pramipexole | bromocriptine

Question 37

pramipexole [dope agonist] | MOA

Answer 37

- activates dopamine receptors - 1st line supplement to levodopa - ---allows for lower dosages

Question 38

pramipexole [dope agonist] | AE

Answer 38

- sudden inability to stay awake | - poor impulse control DO

Question 39

bromocriptine [dope agonist] | AE

Answer 39

-supresses breast milk production/lactation

Question 40

bromocriptine [dope agonist] | Tx

Answer 40

anti parkinsons - poorly controlled DM2 to reduce post meal glucose levels - decr triglycerides

Question 41

dopamine releaser | drug name

Answer 41

amantadine

Question 42

amantadine [dope releaser] | Tx

Answer 42

PD motor symptoms

Question 43

amantadine [dope releaser] | RN

Answer 43

monitor for livedo reticularis

Question 44

livedo reticularis

Answer 44

netlike pattern of reddish-blue skin discoloration

Question 45

centrally acting anti-ACh | drug names

Answer 45

benztropine | trihexyphenidyl

Question 46

benztropine, trihexyphenidyl | Tx

Answer 46

- PD - drug induced EPS - sialorrhea

Question 47

benztropine, trihexyphenidyl | AE

Answer 47

- dry mouth - blurred vision - mydriasis - urinary retention - constipation - sedation

Question 48

Alzheimers Medication Types

Answer 48

- Cholinesterase inhibitors | - NMDA Receptor Antagonist

Question 49

Cholinesterase inhibitors | drug name + alzheimer stage

Answer 49

donepezil -early to moderate stage

Question 50

NMDA Receptor Antagonist | drug name + alzheimer stage

Answer 50

memantine -moderate to severe stages of alzheimers

Question 51

NMDA Receptor Antagonist - memantine | AE

Answer 51

- blood clots - psychosis - HF (syncope)

Question 52

is there a cure for alzheimers?

Answer 52

NO, meds are just to treat cognitive symptoms -slows progression of disease by like 6 months max