Pharm - Stroke, Parkinsons, Dementia Flashcards Preview

2nd Semester Nursing > Pharm - Stroke, Parkinsons, Dementia > Flashcards

Flashcards in Pharm - Stroke, Parkinsons, Dementia Deck (28):
1

What is the primary recommendation to avoid stroke?

Decrease BP to 140/90 or less (old numbers) or 130/80 or less (new numbers)

2

First-line agents (which class) for dyslipidemia? (Goal is stroke prevention)

Statins

3

Should ASA be used as antiplatelet therapy for everyone?

No - only those with a high risk of CV events or stroke.

4

What’s an Rx antiplatelet therapy other than aspirin?

Cilostazol

5

In a lacunar stroke, what is blocking the flow?

An atherosclerotic plaque

6

In an embolic stroke, what is blocking the flow?

An embolism

7

In an atherothrombotic stroke, what is blocking the flow?

Plaque and embolus together

8

Alteplase:
MOA
Risks
Route
Monitoring

(aka tPA)
MOA: fibrinolytic: converts plasminogen to plasmin, breaking up clots.

Risk of hemorrhagic transformation
Must administer within 3-4.5 hrs of onset

IV administration: bolus plus infusion
Must monitor BP regularly during infusion

9

Secondary stroke prevention - what does this mean and what is it?

After a stroke, HTN is still the most important goal: 140/90 or 130/90 for lacunar strokes.

diuretics and ACEis for HTN management.

10

Lipids and secondary stroke prevention: recommendations?

High intensity statins if stroke/TIA was related to atherosclerosis.

11

Diabetes and secondary stroke prevention: recommendations?

Screen for DM2 after a stroke... using HbA1C

12

Sleep apnea and secondary stroke prevention?

Provide a CPAP

13

Lifestyle changes after a stroke?

Quit smoking, decrease heavy alcohol consumption.

14

Antithrombotic Therapy options for noncardioembolic stroke or TIA

ASA 50-325mg monotherapy

ASA 25/Dipyridamole 200

Clopidogrel 75mg monotherapy

ASA+Clopidogrel for 21 days after stroke

15

Parkinson’s: What does SOAP stand for?

Sleep disturbances
Other misc (fatigue, nausea, speech, pain, vision)
Autonomic symptoms (drooling, constipation, sexual dysfunction, dysphasia)
Psychological symptoms (anxiety, psychosis, depression, cognitive impairment)

16

Carbidopa/Levodopa for Parkinson’s motor symptoms: what happens over time? Tx?

Will become less effective over time

Can have wearing-off problems (take more frequently or add other drugs - MAO, COMT inhibitor, or apomorphine (dopamine agonist))

Can have peak dose dyskinesia (reduce levodopa dose, add amantadine)

Can have delayed or no “on” response (take on empty stomach or add apomorphine)

Can have ‘freezing” (use PT, increase dose, add apomorphine or MAO inhibitor)

17

Difference between:
-Lewy body dementia
-Alzheimer’s dementia
-Vascular dementia

Can all occur together, or separately, but...

Lewy body dementia: similar disease process to Parkinson’s.
Vascular dementia: d/t TBI, stroke, etc.
Alzheimer’s dementia: most common - default diagnosis when the type is unknown.

18

Apraxia (define)

Loss of ability to execute learned, purposeful movements

19

Agnosia (define)

Loss of ability to recognize objects)

20

Wandering, repetitive speech, motor hyperactivity, psychosis, depression, combativeness are all symptoms of...

Dementia

21

Alzheimer’s pathology is characterized (physiologically) by

B-amyloid plaques and tangles
Acetylcholine shortage
Dysregulated glutamate activity
Cholesterol
Estrogen

22

Life expectancy after Alzheimer’s diagnosis?

Usually 4-8 years, but can live up to 20 years.

23

How does the treatment focus change for vascular dementia?

Goal is to reduce cardiovascular risks

24

How to evaluate where the patient is in their dementia? Does it matter what type?

MMSE
Doesn’t matter what kind of dementia. This evaluates all cognitive function.
The lower the score, the worse the impairment. (Severe is 9 or less. Mild is 18-26).

25

What are cholinesterase inhibitors for? SEs? MOA? Names (DGR)?

To slow the progress of dementia.
MOA: increases ACH availability at the synapse

Donepezil, Galantamine, Rivastigmine

GI upset is common.
Diarrhea, cholinergic effects.

Stop treatment if: lack of improvement, poor adherence or tolerance.

26

What is Memantine? MOA? When would you start it? SEs?

NMDA receptor antagonist. Protects neurons from excessive glutamate. Only blocks glutamate when there are excessive amounts.

Start it in Moderate to Severe AD. Available as a liquid, too.

Constipation, Confusion, Dizziness, HA.

27

What should be addressed first when you see neurobehavioral symptoms in dementia patients?

Pain
Nicotine withdrawal
Alcohol use
Medication SEs
Environmental problems

28

When should you use medications with dementia?

Caregiver or patient distress
Dementia is causing a disability or interferes with necessary care (baths, insulin, exams)
Patients are becoming a danger to themselves or others.