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NURS 2514 > Pharmacology for neuromuscular > Flashcards

Pharmacology for neuromuscular Flashcards

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1
Q

Neostigmine (Prostigmin) class

A

Cholinesterase inhibitor

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2
Q

Neostigmine (Prostigmin) MOA

A

Prevents degradation of acetylcholine by cholinesterase
Increases the amount of acetylcholine available to active receptors, thus increasing muscle strength
Improves impulse transmission at the neuromuscular junctions throughout the body

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3
Q

What is acetylcholinesterase?

A

Acetylcholinesterase is an enzyme that normally breaks down acetylcholine → Neostigmine binds to cholinesterase, taking it up the medication is broken down instead of acetylcholine

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4
Q

Neostigmine (Prostigmin) description

A

Therapeutic doses increase the force of muscle contraction. At toxic levels, the medication does the opposite and reduces the force of muscle contraction → cholinergic crises
Parasympathomimetic → acetylcholine is the primary neurotransmitter of the parasympathetic nervous system

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5
Q

Indications for neostigmine (Prostigmin)

A

Used as treatment for Myasthenia Gravis, reverses muscle relaxants

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6
Q

neostigmine (Prostigmin) therapeutic effect

A

Improved muscle strength

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7
Q

Additional info for neostigmine (Prostigmin)

A

Administered IV, IM, and Subcutaneous injection (poorly absorbed in the GI tract)
Does not cure Myasthenia Gravis but provides symptom relief
Lifelong use

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8
Q

Adverse effects of neostigmine (Prostigmin)

A

Excess acetylcholine → excessive salivation, increased gastric secretions, increased tone/ motility of GI tract, urinary urgency, bradycardia, and sweating, bronchial constriction
Toxic doses can cause accumulation of acetylcholine that leads to paralysis of respiratory muscles and worsened muscle weakness

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9
Q

Cholinergic Crises

A

SLUDGE and the Killer Bs:
S: salivation
L: lacrimation
U: urination
D: diaphoresis/ diarrhea
G: gastrointestinal cramping
E: emesis

B: bradycardia
B: bronchospasm
B: bronchorrhea

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10
Q

Contraindications and precautions for neostigmine (Prostigmin)

A

Hypersensitivity
Bowel obstruction
Bladder obstruction
Cardiac issues → bradycardia, arrhythmias
Asthma

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11
Q

Nursing considerations and assessment for neostigmine (Prostigmin)

A

Monitor patient for improvement → increased ability to swallow and open eyelids

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12
Q

Nursing considerations and assessment for neostigmine (Prostigmin)

A

Monitor patient for improvement → increased ability to swallow and open eyelids
Patient may need to adjust dosage based on activity level (situational)
Assess patient for signs of underdosage (difficulty swallowing, ptosis) and overmedicating (excessive salivation, sweating, bradycardia, urinary urgency, increased GI motility, bronchoconstriction)
Monitor for Myasthenic crisis (under medicating) → extreme muscle weakness and
Monitor for cholinergic crisis (over medicating) → extreme muscle weakness and eventual paralysis and respiratory failure
Reversal agent for excessive muscarinic stimulation (cholinergic crisis) is Atropine
Patient should wear a medic alert bracelet

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13
Q

Myasthenic crisis vs cholinergic crisis

A
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14
Q

The patient with myasthenia gravis is in suspected cholinergic crisis. Which medication do you anticipate the health care provider will order?

A

Anticholinergic (Atropine)

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15
Q

Levodopa MOA

A

Crosses the blood brain barrier and converts to dopamine once it reaches the brain → thus restoring a balance between acetylcholine and dopamine

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16
Q

Indications for levodopa

A

Parkinson’s disease

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17
Q

Therapeutic effect of levodopa

A

Reduction in symptom severity, improvement in carrying out ADL’s
Does not cure PD or delay disease progression

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18
Q

Additional info of levodopa

A

Administered orally
Therapeutic response can take several months
Most effective drug for PD
Effectiveness of Levodopa decreases over time (symptoms are usually well controlled in first 2 years of treatment and effectiveness declines)
A small fraction of medication reaches the brain when it is given alone, and for this reason, Levodopa is given in combination

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19
Q

Levodopa/ Carbidopa (Sinemet)

A

Carbidopa has no therapeutic effects on its own
When levodopa is taken on its own, only a small portion reaches the CNS → this requires high doses that lead to more side effects
Carbidopa delays the process of peripheral drug metabolism, allowing for more levodopa to enter the brain

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20
Q

Adverse effects of levodopa/ carbidopa (Sinemet)

A

Nausea and vomiting → due to activation of dopamine receptors in the chemoreceptor trigger zone of the medulla
Dyskinesias → can cause movement disorders; tics, head bobbing, grimacing, rapid involuntary jerking, writhing movements, etc
Postural hypotension
Psychosis → visual hallucinations, vivid dreams, paranoia
CNS effects → anxiety, agitation, memory loss, cognitive impairment, issues with impulse control
Other side effects → can darken sweat and urine

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21
Q

Precautions and contraindications of levodopa/ carbidopa (Sinemet)

A

Hypersensitivity

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22
Q

Nursing considerations of levodopa/ carbidopa (Sinemet)

A

On/ Off phenomenon
Wearing-off phenomenon

Patients should avoid high protein meals → compete for absorption in gut
Assess for parkinsonian and extrapyramidal symptoms before and during therapy (shuffling gait, bradykinesia, drooling, pill rolling, tremors, twisting motions, masked face, rigidity)
Monitor blood pressure frequently during therapy
Patient should not transfer to a standing position abruptly

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23
Q

pramipexole (Mirapex) classification

A

Nonergot dopamine receptor agonist

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24
Q

pramipexole (Mirapex) MOA

A

Stimulates dopamine receptors in the striatum

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25
Therapeutic effect of pramipexole (Mirapex)
Improve ability to carry out ADL's → improvement in motor symptoms Does not cure PD or delay progression of disease
26
Additional info of pramipexole (Mirapex)
Used on its own in early PD Used in combination with other Parkinson's drugs in advanced PD Effects take several weeks to develop Given orally
27
Adverse effects of pramipexole (Mirapex)
Associated with activating dopamine receptors → nausea, dizziness, sleepiness, confusion, hallucinations When taken on its own, patients do not experience dyskinesias (abnormal movements) When taken in combination with levodopa, the risk of developing orthostatic hypotension, hallucinations, and dyskinesias increases "Sleep attacks" are overwhelming and irresistible sleepiness that come on without warning → ++ dangerous Impulse control disorders → compulsive gambling, shopping, binge eating, hypersexuality
28
Nursing considerations & assessment of pramipexole (Mirapex)
Patients should be warned about potential to develop drowsiness → patients should not take sedating medications or alcohol while on pramipexole and should be asked about existing sleep disorders Patients recently started on pramipexole should avoid driving or engaging in dangerous activities until they know whether it affects their wakefulness If patient experiences sleep attacks, the medication should be discontinued Monitor blood pressure regularly → advise patient to change positions slowly
29
Selegiline (Deprenyl) classification
MAO-B inhibitor
30
What is MAO-B?
MAO-B is an enzyme that inactivates dopamine in the striatum
31
MOA of selegiline (Deprenyl)
Selegiline is a selective inhibitor of MAO-B. When used in combination with Levodopa, it suppresses the destruction of dopamine derived from Levodopa, so can reduce wearing off effect
32
Indication for selegiline (Deprenyl)
Parkinson's Disease, depression
33
Therapeutic effect of selegiline (Deprenyl)
Improvement in motor function When used in combination with levodopa, can reduce wearing off effect
34
Additional info for selegiline (Deprenyl)
This drug is often recommended for newly diagnosed PD → considered first-line drugs May be used alone or in combination with Levodopa Administered orally
35
Adverse effects of selegiline (Deprenyl)
Insomnia (should not take after noon time) Hypertensive crisis → if taken in high doses (increased risk with younger people)
36
Drug interactions with selegiline (Deprenyl)
In combination with Levodopa, will worsen orthostatic hypotension, dyskinesia, and psychiatric symptoms Should not be taken with meperidine or selective serotonin reuptake inhibitors (SSRIs)
37
Nursing considerations and assessment for selegiline (Deprenyl)
Assess gait and motor function to assess effectiveness of treatment and identity dyskinesia side effects of medication Monitor patient for changes in behaviour and psychiatric symptoms If used in combination with Levodopa, monitor blood pressure and discuss risk for falls
38
Anticholinergics MOA
Block action of acetylcholine Other treatments directly affect dopamine, whereas anticholinergics work on correcting the imbalance by focusing on acetylcholine Often used in combination with other antiparkinsonian medications
39
The goal of Parkinson's Disease pharmacotherapy is: a. To increase the amount of acetylcholine at the presynaptic neurons b. To reduce the amount of dopamine available in the substantia nigra c. To balance cholinergic and dopaminergic activity in the brain d. To block dopamine receptors in presynaptic and postsynaptic neurons
c. To balance cholinergic and dopaminergic activity in the brain
40
A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/ carbidopa (Sinemet) suddenly develops a relapse of symptoms. What is this called?
Wearing-off (WO) phenomenon is a frequent complication which is defined as a reoccurrence of motor and non-motor symptoms during levodopa free interval, which has a negative impact on the quality of life of patients.
41
Which statement should the nurse include in the teaching plan for a patient being started on levodopa/ carbidopa (Sinemet) for newly diagnosed Parkinson's disease? a. Take the medication on a full stomach b. Change positions slowly c. The drug may cause the urine to be very dilute d. Carbidopa has many adverse effects
b. Change positions slowly
42
Interferon beta drugs (Betaseron) classification
Immunomodulator
43
Interferon beta drugs (Betaseron) MOA
Naturally occurring glycoprotein Inhibits migration of proinflammatory leukocytes across the blood brain barrier (cannot reach neurons of the CNS) Suppresses t-helper cell activity
44
Indication for interferon beta drugs (Betaseron)
Multiple sclerosis
45
Therapeutic effect of interferon beta drugs (Betaseron)
Can decrease the frequency and severity of relapse, reduce the size and number of lesions, and delay progression of disability
46
Additional info for interferon beta drugs (Betaseron)
Intramuscular or subcutaneous → depends on the specific drug
47
Adverse effects of interferon beta drugs (Betaseron)
Flu-like symptoms → headache, fever, chills, malaise, muscle aches, and stiffness (this decreases over time and can be minimized by starting on lower doze and gradually increasing, as well as taking tylenol) Hepatoxicity → can damage liver cells Myelosuppression → can suppress bone marrow function, decreasing production of all blood cells Depression and suicidal ideation
48
Contraindications of interferon beta drugs (Betaseron)
Hypersensitivity Patients with previous suicide attempts and depression → use cautiously Patients with liver disease and alcoholism → use cautiously
49
Drug interactions for interferon beta drugs (Betaseron)
Should not combine with alcohol or other hepatotoxic medications Should not take with other immunosuppressants
50
Nursing considerations and assessment for interferon beta drugs (Betaseron)
Assess for MS symptoms during therapy Monitor liver function tests and CBC (hgb, platelets, WBC) → prior to treatment and at 1, 3, and 6 month Monitor for signs of depression Educate patient about likelihood of experiencing flu like symptoms and offer acetaminophen for relief Educate about the signs of depression, suicidal ideation, and worsening anxiety
51
Classification of mitoxantrone (Novantrone)
Immunosuppressant Cytotoxic drug → this means it kills cells in the body
52
Mitoxantrone (Novantrone) MOA
It binds with DNA and inhibits DNA and RNA synthesis, causing breakage of DNA strands Like chemotherapy, Mitoxantrone is more lethal to cells that divide fast → hair, skin, GI mucosa, and bone marrow Suppresses production of immune system cells and decreases immune system cells and decreases immune system destruction of myelin
53
Indication for mitoxantrone (Novantrone)
Was developed to treat cancer, but can be used for MS
54
Therapeutic effect of mitoxantrone (Novantrone)
It can delay MS patients going into relapse, delays disability progression, and can decrease lesions
55
Adverse effects of mitoxantrone (Novantrone)
Myelosuppression → toxic to bone marrow cells causing decreased platelets, white blood cells, and red blood cells. Reduced neutrophils leads to high risk of infection Cardiotoxicity → affects left ventricular ejection fraction and can cause heart failure. This can occur months to years after treatment has ended Teratogenic → potential for fetal harm Hair loss, nausea/ vomiting, and mouth sores → all related to the death of rapidly dividing cells
56
Contraindications of mitoxantrone (Novantrone)
Hypersensitivity Use cautiously in patients with cardiac diseases Use cautiously in patients with active infections
57
Nursing considerations and assessments for mitoxantrone (Novantrone)
Monitor for bone marrow depression (bleeding and bruising due to decreased platelets, signs of infection due to decreased neutrophils, signs of anemia due to decreased red blood cells) Monitor for GI symptoms → administer antiemetics prophylactically Inspect mouth for sores Assess fluid and electrolytes, intake, output, appetite, nutrition Patients should have baseline EKG, chest x-ray, and echo to determine ejection fraction and cardiac status prior to starting therapy and during therapy Assess for signs of heart failure (auscultate lungs for crackles, assess edema, shortness of breath, chest pain) IV administration → CAREFUL with handling Monitor patient IV site carefully - infusion to be stopped if patient develops pain, swelling, redness
58
Baclofen (Lioresel) classification
Skeletal muscle relaxant
59
Baclofen (Lioresel) MOA
Acts within the spinal cord (CNS) to suppress hyperactive reflexes involved in the regulation of muscle movement Structural analog of the inhibitory NT GABA (mimics actions of GABA on spinal neurons)
60
Indication for baclofen (Lioresel)
Used to relieve muscle spasticity with MS and spinal cord injury
61
Therapeutic effect of baclofen (Lioresel)
Relieve muscle spasticity Decrease flexor and extensor spasms and suppresses resistance to passive movement
62
Administration of baclofen (Lioresel)
PO, intrathecal (a pump surgically placed directly into the spinal fluid of the back)
63
Adverse effects of baclofen (Lioresel)
CNS depressants: drowsiness, dizziness, weakness, and fatigue (improves over time with longterm use) Withdrawal symptoms from stopping abruptly (hallucinations, seizures, paranoid ideation. Intrathecal route has a higher risk of severe symptoms (fever, muscle rigidity, exaggerated rebound spasticity, multi-organ failure, death)) Nausea and vomiting Constipation, urinary retention Orthostatic hypotension
64
Nursing considerations and assessment for baclofen (Lioresel)
Extreme caution with other CNS depressants (ETOH, antihistamines, opioids, benzodiazepines) -Overdose or combination with other CNS depressants can cause respiratory depression Overdose -Respiratory depression -NO ANTIDOTE Monitor for withdrawal symptoms Intrathecal route -monitor infusion system closely
65
Gabapentin (Neurontin) classification
GABA analog (antiseizure agent)
66
Gabapentin (Neurontin) MOA
Gabapentin is an analog of GABA but does not directly affect GABA receptors. Its precise mechanism of action is unknown, but it may enhance GABA release, thereby increasing GABA-mediated inhibition of neuronal firing
67
Indications for gabapentin (Neurontin)
Gabapentin also has approval for treating postherpetic neuralgia Most used for off-label uses, including relief of neuropathic pain (other than postherpetic neuralgia)
68
Adverse effects of gabapentin (Neurontin)
Gabapentin is very well tolerated The most common side effects are somnolence, dizziness, ataxia, fatigue, nystagmus, and peripheral edema. These are usually mild to moderate and often diminish with continued drug use Caution with other CNS depressants Mood changes, suicidal ideation Withdrawal symptoms with abrupt discontinuation
69
Contraindication for gabapentin (Neurontin)
Hypersensitivity
70
Nursing considerations and assessment for gabapentin (Neurontin)
Monitor for signs of CNS depression Improvement of neuropathic pain Monitor for changes in good, depression, suicidal ideation

NURS 2514 (14 decks)

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