Quiz 1 Flashcards by Emily Herrera

What is multiple sclerosis (MS)?

autoimmune disorder that affects nerve cells in the brain and the spinal cord

MS= myelin sheath destruction

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Who is most likely to get multiple sclerosis?

young adults (20-50 years)
women
those w/ genetic disposition

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Are there definitive diagnostic studies for MS? What can be done to see if it is MS?

MRI of brain can show sclerotic plaques in CNS

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What is the criteria for an MS diagnosis?

at least 2 inflammatory demyelinating lesions in at least 2 different CNS locations
damage or an attack occurring at different times
all other possible diagnoses ruled out

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What are the clinical manifestations of multiple sclerosis?

weakness
diplopia (double vision)
tinnitus
paresthesia
chronic neuropathic pain
nystagmus (shaking of eyes)
dysphagia (difficulty swallowing)
ataxia (poor muscle control)
cognitive difficulties (word finding)
bowel/bladder problems
sexual dysfunction
depression

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What immunosuppressants are given for MS? When is it given?

corticosteroids (prednisone, methylprednisolone, dexamethasone)

methylprednisolone: treats MS exacerbations

give in AM w/ food

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What immunomodulators are used for MS? WHich one will treat/prevent relapses?

interferon beta-1a and 1b: used to treat or prevent relapses
glatiramer acetate

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What antispasmodics are used for MS? Why?

Which one is given for severe symptoms and why?

baclofen
dantrolene
helps with spasms

dantrolene is used for severe symptoms bc it is fast acting

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What is important to monitor with dantrolene with MS? What should be reported?

monitor liver damage

report jaundice

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What antiseizures are used for MS? Why?

carbamazepine
gabapentin

used for paresthesia

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What anticholinergics used for MS? Why?

oxybutynin
tolterodine
propantheline

used for bladder dysfunction

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What laxatives are used for MS? Why?

stool softener (docusate sodium)
bulk forming (psyllium)

used for constipation

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What antidepressants are used for MS?

amitriptyline (TCA helps w/ nerve pain)
sertraline
fluoxetine

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What phosphodiesterase inhibitor is used for MS? What should not be given with this medication? Why?

Sildenafil
Do not give with nitroglycerin because it will decrease BP

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What CNS stimulants are given for MS? What do they do?

Methylphenidate (focus)
Modafinil (alertness)

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What K+ channel blocker is given for MS? Why is it not used as often?

Dalfampridine

Not used often due to risk of cardiac dysrhythmias

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Why would a thalamotomy be used for MS?

It is deep brain stimulation for tremors unmanageable with drugs

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What nursing interventions can be done with MS?

promote exercise with rest/diet (fiber)
encourage independence
prevent injury, and avoid stressors
teach self injection and self catheterization

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Describe Parkinson’s disease

Chronic neurological disorder that affects motor function and destroys neurons which results in low dopamine and high acetylcholine

No DOPE in the PARK = low dopamine in Parkinson’s

High acetylcholine = high secretions

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Who is more likely to get Parkinson’s disease?

Men

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What are the clinical manifestations of Parkinson’s disease?

Triad:
- Tremors at rest
- Rigidity
- Brady kinesia

Shuffling gait
Expressionless
Drooling/slurred speech (dysarthria)
Pill rolling twitch
Depression
Constipation

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What are complications of Parkinson’s disease?

Dysphasia
Orthostatic hypotension (dopamine regulates BP)

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Are there any specific tests for Parkinson’s Disease?

Study These Flashcards

but MRI will show substantia nigra breakdown

What is the criteria for a Parkinson’s Disease diagnosis?

Study These Flashcards

at least two of three characteristics of the classic triad (tremor, rigidity, bradykinesia)

What dopaminergic agent is used for Parkinson's Disease? Why? What should be avoided when taking this medication?

levodopa: leaves more dopamine carbidopa: conserves more dopamine Caution: psychosis can occur avoid protein

What dopamine agonist is used for Parkinson's Disease? Why? What should be monitored while taking this medication?

bromocriptine (more commonly used) apomorphine stimulates dopamine response monitor psychosis

What MAO-B inhibitors are used for Parkinson's Disease? Why? What should be avoided while taking this medication?

rasagiline selegiline prevents the breakdown of dopamine avoid tyramine bc hypertensive crisis

What COMT inhibitors are used for Parkinson's Disease? Why? WHat is a normal finding?

entacapone tolcapone prevents the breakdown of dopamine dark urine is normal

What anticholinergic is used for Parkinson's Disease? Why?

benztropine less secretions treats resting tremors

What antihistamine is used for Parkinson's Disease?

diphenhydramine

What antiviral is used for Parkinson's Disease? Why?

amantadine increase dopamine levels

What antidepressant is used for Parkinson's Disease?

amitriptyline

What anticholinesterase inhibitor is used for Parkinson's Disease? Why?

donepezil used when pt starts having bowel/bladder problems to reestablish secretions

What nursing interventions can be done for Parkinson's Disease?

- promote exercise/diet - encourage independence - deep brain stimulation (fast access increase dopamine for severe PD)

What is amyotrophic lateral sclerosis (ALS)?

aka Lou Gehrig's disease - destroys motor neurons in the brain & spinal cord - results in total body paralysis

Who is most likely to get amyotrophic lateral sclerosis (ALS)?

more common in men than women

What are the clinical manifestations of ALS?

typical symptoms: - dysarthria (difficulty w/ speech) - dysphagia (difficulty swallowing) - muscle weakness dyspnea (difficulty breathing) --- respiratory failure fasciculations (twitching) fatigue drooling --- aspiration pneumonia

Are there definitive diagnostic studies for ALS? What can be done to see if it is ALS?

no Electromyography (view muscle response) Muscle biopsy Pulmonary function test- PFT (to see how much air can be pushed out)

What is the drug therapy for ALS? Why? What should be monitored while taking this medication? How should it be taken?

rilutek to slow disease progression monitor liver enzymes and take on empty stomach

What nursing interventions can be done for ALS?

ALS = advanced life support Monitor for pneumonia Monitor fever over 100F Monitor lung sounds - rhonchi

What is Myasthenia Gravis (MG)?

autoimmune disease that destroys acetylcholine receptors which leads to low acetylcholine levels

What can be seen in patients who have myasthenia gravis?

thymic tumor in 15% of patients seen by MRI

What are the clinical manifestations of myasthenia gravis?

ptosis (droopy eyes) diplopia dysphagia (difficulty swallowing) dyspnea (difficulty breathing) muscle weakness (hard time picking things up)

What is myasthenic crisis?

DRY undermedicated respiratory distress MG symptoms but worse

What test can be done to determine if MG diagnosis is correct? What is the antidote?

edrophonium chloride (tensilon) antidote: atropine

What other diagnostic studies can be done for MG?

- serum Ach receptor antibodies - electromyography - MRI of the thymus gland

What anticholinesterase drugs are used for MG? Why?

- pyridostigmine (best for long term treatment bc long acting, they cause secretions, give before meals) - atropine

What immunosuppressants are used for MG?

corticosteroid azathioprine

What other therapy is used for MG? Why?

thymectomy intravenous immunoglobulin (IVIG) plasmapheresis (filters blood products to remove antibodies to decrease symptoms)

What nursing interventions are done for MG?

maintain airway small, frequent, high calorie meals provide eye care exercise/rest

What is Guillain-Barre Syndrome?

acute rapidly progressing form of polyneuritis, caused by infection starting from the legs up

What are the clinical manifestations of Guillain-Barre Syndrome?

muscle weakness hyporeflexia paresthesia and pain respiratory failure - inability to cough - shallow respirations - dyspnea/hypoxia

What diagnostic studies are done for Guillain Barre Syndrome?

cerebrospinal fluid study EMG MRI brain to rule out MS

Does the flu cause GBS?

no it will reactivate it

What nursing interventions are done for GBS?

intravenous immunoglobulin (IVIG) plasmapheresis pain management ventilatory support

What are the clinical manifestations of multiple sclerosis?

weakness diplopia (double vision) tinnitus paresthesia chronic neuropathic pain nystagmus (shaking of eyes) dysphagia (difficulty swallowing) ataxia (poor muscle control) cognitive difficulties (word finding) bowel/bladder problems sexual dysfunction depression

Quiz 1 Flashcards

(56 cards)