Podcast
Questions and Answers
What is the primary characteristic of Alzheimer Disease?
What is the primary characteristic of Alzheimer Disease?
Which of the following factors is NOT commonly associated with the causes of dementia?
Which of the following factors is NOT commonly associated with the causes of dementia?
What percentage of people over the age of 85 may be affected by Alzheimer's Disease?
What percentage of people over the age of 85 may be affected by Alzheimer's Disease?
What role do cholinesterase inhibitors play in the treatment of Alzheimer's Disease?
What role do cholinesterase inhibitors play in the treatment of Alzheimer's Disease?
Signup and view all the answers
Which of the following symptoms is NOT typically associated with Alzheimer's Disease?
Which of the following symptoms is NOT typically associated with Alzheimer's Disease?
Signup and view all the answers
What is the typical efficacy of drug therapy for Alzheimer's Disease?
What is the typical efficacy of drug therapy for Alzheimer's Disease?
Signup and view all the answers
Which of the following is NOT a recommended treatment goal for Alzheimer's Disease?
Which of the following is NOT a recommended treatment goal for Alzheimer's Disease?
Signup and view all the answers
Which of the following structural changes is typically found in the brains of Alzheimer's Disease patients?
Which of the following structural changes is typically found in the brains of Alzheimer's Disease patients?
Signup and view all the answers
Which of the following neurotransmitters is categorized as a natural catecholamine?
Which of the following neurotransmitters is categorized as a natural catecholamine?
Signup and view all the answers
Which receptor type is involved in the treatment of hypertension through a centrally acting mechanism?
Which receptor type is involved in the treatment of hypertension through a centrally acting mechanism?
Signup and view all the answers
What clinical application is associated with Alpha1 adrenergic receptors?
What clinical application is associated with Alpha1 adrenergic receptors?
Signup and view all the answers
Adrenergic agonists are also referred to as which of the following?
Adrenergic agonists are also referred to as which of the following?
Signup and view all the answers
Which of the following actions is NOT associated with Beta1 adrenergic receptors?
Which of the following actions is NOT associated with Beta1 adrenergic receptors?
Signup and view all the answers
What is a characteristic of sympathomimetics?
What is a characteristic of sympathomimetics?
Signup and view all the answers
Which category of adrenergic agents primarily deals with the management of shock and hypotension?
Which category of adrenergic agents primarily deals with the management of shock and hypotension?
Signup and view all the answers
Which of the following is a noncatecholamine adrenergic agent?
Which of the following is a noncatecholamine adrenergic agent?
Signup and view all the answers
What is a primary action of GABA in the brain?
What is a primary action of GABA in the brain?
Signup and view all the answers
Which of the following is a known trigger for seizures?
Which of the following is a known trigger for seizures?
Signup and view all the answers
What is the main reason barbiturates are not the first-line treatment for seizures?
What is the main reason barbiturates are not the first-line treatment for seizures?
Signup and view all the answers
Which class of drugs is commonly used to potentiate GABA action?
Which class of drugs is commonly used to potentiate GABA action?
Signup and view all the answers
What characterizes Eclampsia during pregnancy?
What characterizes Eclampsia during pregnancy?
Signup and view all the answers
What is a key characteristic of status epilepticus?
What is a key characteristic of status epilepticus?
Signup and view all the answers
What type of seizure is not effectively treated with barbiturates?
What type of seizure is not effectively treated with barbiturates?
Signup and view all the answers
Which of the following conditions does NOT contribute to the risk of seizures?
Which of the following conditions does NOT contribute to the risk of seizures?
Signup and view all the answers
Which antiseizure medication is an agonist at GABA A receptors?
Which antiseizure medication is an agonist at GABA A receptors?
Signup and view all the answers
What is one effect of excessive GABA potentiation in the brain?
What is one effect of excessive GABA potentiation in the brain?
Signup and view all the answers
Study Notes
Autonomic Nervous System
- The autonomic nervous system controls involuntary functions like heart rate and digestion.
- Two branches of the autonomic nervous system exist: sympathetic and parasympathetic.
- The sympathetic system is activated under stress, triggering the "fight-or-flight" response. This response readies the body for immediate action.
- The parasympathetic nervous system is activated under nonstressful conditions, fostering the "rest-and-digest" response, promoting digestion and a decline in heart rate and blood pressure.
Autonomic Neurotransmitters
- Acetylcholine (ACh) is a neurotransmitter for the parasympathetic system.
- Norepinephrine (NE) is the primary neurotransmitter for the sympathetic system.
Acetylcholine and Cholinergic Transmission
- Cholinergic nerves release acetylcholine.
- Two main types of cholinergic receptors exist: nicotinic and muscarinic.
- Nicotinic receptors are affected by nicotine, while muscarinic receptors are affected by muscarine.
Prototype Drug: Bethanechol
- Bethanechol is a medication that affects muscarinic cholinergic receptors.
- Used to treat nonobstructive urinary retention.
- Atropine sulfate is the antidote for an overdose.
- Subcutaneous injection is the preferred method for treating an overdose of bethanechol, unless in an emergency
Prototype Drug: Physostigmine
- Physostigmine is used to reverse anticholinergic toxicity.
- It acts by inhibiting acetylcholinesterase.
- It is useful in cases of poisoning with atropine, diphenhydramine, and related substances.
- The usual mode of administration is injectable (IM or IV)
Cholinergic Crisis
- A medical emergency.
- Caused by an overdose of an acetylcholinesterase inhibitor (example: physostigmine).
- Leads to intense parasympathetic stimulation.
- Symptoms include hypersalivation, small pupils, muscle twitching, sweating, muscle weakness, and difficulty breathing.
- Atropine is the antidote.
Anticholinergic Drugs
- These drugs block the action of acetylcholine.
- They are frequently used to treat various conditions, including bradycardia, symptoms of hypermotility diseases of the digestive tract, and to dilate pupils.
- Side effects include dry mouth, constipation, urinary retention, and increased heart rate.
Prototype Drug: Atropine
- It blocks muscarinic receptors.
- Can be used to treat bradycardia, irritable bowel syndrome, or as an antidote for organophosphates poisoning.
- Expected side effects include dry mouth, constipation, urinary retention, and increased heart rate (tachycardia).
- An overdose may produce delirium and coma. Physostigmine is an antidote.
Norepinephrine (NE)
- NE is part of the sympathetic nervous system.
- It's involved in the body's fight-or-flight response.
- Natural catecholamines along with epinephrine and dopamine.
- Released from postganglionic nerve terminals.
Adrenergic Agonists
- These drugs mimic the effects of norepinephrine.
- They're administered to treat shock, hypotension, nasal congestion, and other conditions.
- They can produce many of the same responses as anticholinergics.
- They can be described as catecholamines or noncatecholamines.
Alpha receptors
- Alpha receptors (alpha1 and alpha2) are involved in vasoconstriction and other actions.
Beta receptors
- Beta receptors (beta1 and beta2) are involved in increasing heart rate, bronchodilation, and other effects.
Prototype Drug: Phenylephrine
- Phenylephrine is a sympathomimetic drug used as a nasal decongestant and mydriatic (pupil dilating).
- Primarily administered intranasally (as a spray or drops).
- This drug constricts nasal blood vessels, reducing congestion, and dilates pupils.
Adrenergic Antagonists
- Block the effects of norepinephrine.
- Treat conditions like hypertension and cardiac effects.
- Known as adrenergic blockers or sympatholytics, and act on vascular smooth muscle, causing vasodilation.
- Adverse effect, orthostatic hypotension, reflex tachycardia, nasal congestion, and impotence.
Prototype Drug: Prazosin
- A drug used to treat hypertension, a chronic condition involving high blood pressure.
- Reduces blood pressure by acting on alpha1-adrenergic receptors in blood vessels.
- Acts as an adrenergic blocking drug.
Seizures
- A disturbance of electrical activity in the brain.
- Can affect consciousness, motor activity, and sensation; leading to involuntary, violent muscle spasms in convulsions
Causes of Seizures:
- Triggers (strobe lights, fluid/electrolyte imbalances)
- Idiopathic (no specific cause)
- Neurologic conditions
- Medications (psychoses, mood disorders)
- Local anesthesia (high doses)
- Drug abuse/withdrawal
- Fever
- Metabolic conditions
- Neoplastic disease
- Trauma
- Vascular disease
- Pregnancy and Epilepsy
- Eclampsia (severe hypertension in pregnancy)
Mechanisms of Action for Antiseizure Drugs
- Increase GABA activity (chloride ions)
- Inhibit sodium/calcium influx into neurons
- Correct neurotransmitter imbalances
- Block glutamate receptors
Drugs That Potentiate GABA Action
- Barbiturates
- Miscellaneous drugs
Treating Seizures with Barbiturates
- Barbiturates intensify GABA's effects, depressing CNS firing.
- Phenobarbital is an example and commonly used for treating various seizure types.
- Newer drugs are now the primary choice.
Prototype Drug: Phenobarbital
- A long-acting barbiturate used for treating various seizure types; sedation; and to promote sleep.
- It may increase a patient's sensitivity to pain.
- Acts by enhancing inhibitory effects of GABA neurotransmitter.
Administration Alerts for Phenobarbital
- Parenteral administration can cause irritation and tissue necrosis.
- Teratogenic to humans; not recommended during pregnancy. Not recommended for breastfeeding.
Nursing Clinical Judgment: Antiseizure Drugs
- Monitor vital signs, mental status, coordination, and balance periodically.
- Caution is necessary, especially with older adults, because of increased risk of falls due to drowsiness, dizziness, and impaired abilities.
Prototype Drug: Diazepam
- A benzodiazepine used to treat status epilepticus (prolonged seizure).
- Treats other seizures, and prevents seizures during alcohol or benzodiazepine withdrawal.
- Acts by binding to GABA receptor-chloride channels in the brain suppressing neuronal activity, especially in the limbic system.
- It has a short half-life (in the case of IV administration) of about 20 minutes.
Administration Alerts of Diazepam
- Monitor respirations closely.
- This drug causes fetal harm in pregnancy and neonates.
- Caution required when using it with other drugs, such as MAOIs that may increase blood pressure or in cases of shock.
Adverse Effects of Diazepam
- Common effects include tolerance and dependency, hypotension, muscular weakness, tachycardia, drowsiness, respiratory depression.
Contraindications for Diazepam
- Shock, coma, depressed vitals, uncontrolled open-angle glaucoma, or MAOI therapy within 14 days.
- Use in infants less than 6 months old or during pregnancy should be done cautiously.
Prototype Drug: Phenytoin
- It's a hydantoin used for treating all seizure types except absence seizures.
- It suppresses the spread of abnormal electrical charges in the brain, preventing seizures.
- It has an antidysrhythmic effect.
- The therapeutic dose is carefully monitored due to a narrow range between therapeutic doses and toxic doses.
Administration Alerts for Phenytoin
- Use of a filter in IV administrations to prevent microscopic precipitation of particles.
- Avoid intramuscular (IM) administration to prevent local tissue damage.
Prototype Drug: Ethosuximide
- Used for absence seizures, but less effective against other types of seizures.
- Specifically affects neurons in the motor cortex by elevating the neuronal threshold.
Prototype Drug: Valproic Acid
- Treats various seizure types, particularly absence and generalized tonic-clonic seizures, as well as other neurological conditions.
- Available in various forms (valproic acid, divalproex sodium).
- Mechanism involves altering neuronal activity associated with these conditions.
Nursing Clinical Judgment: Antiseizure Drugs
- Monitor vital signs, mental status, coordination, and balance periodically; and caution is necessary, especially with older adults.
Local Anesthesia
- Used for regional loss of sensation
- Topical (surface) • applied to skin, mucous membranes. Safe unless absorbed. • examples; creams, sprays, drops, lozenges
- Infiltration (field block) • injection into the tissue. Blocks specific groups of nerves.
- Nerve block • injection into tissues. Affects nerve bundles to block sensations in a larger area.
- Spinal anesthesia • Injection into CSF. Affects large regional areas.
- Epidural anesthesia • Injection into epidural space. Commonly used in labor and delivery
Classification of Local Anesthetics
- Esters: contain an ester chemical linkage, low incidence of allergic reaction. Ex. Cocaine
- Amides: longer duration of action and contain amide chemical linkage. Ex. Lidocaine, articaine, bupivacaine
Prototype Drug: Lidocaine
- A local anesthetic commonly used as a nerve block.
- Fast onset of action and is used for nerve blocks; spinal and epidural anesthesia; and dental procedures.
- It acts by blocking sodium channels within the neuronal membranes.
Prototype Drug: Propofol
- Propofol is a quick-acting intravenous anesthetic, the primary use for rapid emergence from surgery.
- It has shown to cause severe metabolic acidosis and hyperkalemia, so patients need to be constantly monitored.
General Anesthesia
- Anesthetic treatment that produces unconsciousness and muscle relaxation.
- Achieved through multiple medications with distinct stages.
Pharmacotherapy with Intravenous General Anesthetics
- Opioids (alfentanil, remifentanil, sufentanil, fentanyl) • Used in combination with antipsychotic agents for neuroleptanalgesia.
Pharmacotherapy with Inhaled General Anesthetics
- Therapeutic gases and volatile liquids are used to prevent sodium influx into neurons.
Prototype Drug: Nitrous Oxide
- A general anesthetic used in short surgical or dental procedures.
Prototype Drug: Isoflurane
- Isoflurane is a potent inhalational anesthetic used in surgical procedures. It rapidly produces general anesthesia and has a low degree of metabolism in the body.
Prototype Drug: Succinylcholine
- Succinylcholine is a depolarizing neuromuscular blocker.
- Used to relax muscles during surgical procedures.
Parkinson's Disease
- Characterized by progressive loss of dopamine.
- Symptoms include tremors, muscle rigidity, bradykinesia (slow movement), postural instability, and affective flattening.
- Other issues commonly experienced include: anxiety, depression, sleep disturbances and dementia.
Prototype Drug: Levodopa, Carbidopa, and Entacapone
- These drugs are often used to treat Parkinson disease by increasing dopamine levels in the brain.
- Stalevo is the drug combination.
- Some side-effects associated with levodopa include uncontrollable movements, nausea, vomiting, muscle twitching, and orthostatic hypotension.
Treating Parkinson's Disease with Anticholinergic Drugs
- Anticholinergics block the effects of acetylcholine, reducing overactivity in the brain.
- These drugs are beneficial for patients primarily experiencing tremors.
- Side effects include dry mouth, constipation, blurred vision, and other issues.
Prototype Drug: Benztropine
- Benztropine blocks excess cholinergic stimulation in the corpus striatum.
- It's often used to relieve Parkinson-like symptoms and extrapyramidal side effects.
Alzheimer's Disease
- A type of dementia, characterized by progressive loss of brain function.
- Symptoms include memory loss, confusion, difficulty communicating, aggressive behavior, depression, psychosis and anxiety.
- Structural damage to the brain found at autopsy consists of amyloid plaques and neurofibrillary tangles. • Possible causes can include multiple cerebral infarcts, infections, and toxins, as well as genetic factors, chronic inflammation, and nutritional and environmental factors, viruses.
Treating Alzheimer's Disease with Cholinesterase Inhibitors
- Donepezil (Aricept) is commonly used to treat mild to moderate Alzheimer's disease.
- It improves memory by enhancing the levels of acetylcholine in the brain.
- Cholinesterase inhibitors have limited efficacy and are not a cure.
Treating Alzheimer's Disease with Memantine
- Memantine is a drug used as an adjunct treatment for moderate or severe stages of Alzheimer's Disease.
- It reduces abnormally high levels of glutamate.
Multiple Sclerosis
- A chronic inflammatory disorder that affects the myelin sheath in the central nervous system.
- Symptoms include fatigue, heat sensitivity, and neuropathic pain, problems with balance and coordination, vision impairment, sexual dysfunction, and bowel and bladder issues. • The etiology is unknown. Potentially genetic, microbial factors, climate or other environmental factors, toxins and various viral infections.
- Disease-modifying drugs such as interferon beta are commonly used.
Causes of Muscle Spasms
- Excessive muscle use or injury
- Overmedication (antipsychotics)
- Neurological disorders
- Epilepsy
- Hypocalcemia
- Dehydration
Pharmacologic Treatment of Muscle Spasticity
- Combination of analgesics, anti-inflammatory agents, and centrally acting skeletal muscle relaxants.
Prototype Drug: Cyclobenzaprine
- A centrally acting skeletal muscle relaxant that reduces muscle spasms.
- It is used for conditions such as spasticity.
Prototype Drug: Dantrolene
- Dantrolene is a skeletal muscle relaxant used primarily for spasticity cases often in the head and neck region.
- It reduces calcium release in skeletal muscles.
- It is a direct-acting antispasmodic and is a calcium release blocker.
Neuromuscular Blockers
- Used during surgical procedures to relax muscles.
- Bind to nicotinic receptors on skeletal muscle fibers.
Shock
- Inadequate blood flow to meet the body's needs, considered a medical emergency.
- Signs may include nonspecific symptoms such as pallor, cold and clammy skin, reduced blood pressure, thirst, reduced consciousness and shallow breathing.
- Causes include fluid loss (hypovolemic shock), failure of the heart to pump enough blood (cardiogenic shock), and severe allergic reactions (anaphylactic shock).
Treatment of Shock
- Initially, administer oxygen, monitor vital signs, keep the patient warm and quiet, and provide psychological support.
- Intravenous fluids (colloids and crystalloids) are used for fluid replacement.
Prototype Drug: Normal Serum Albumin
- This drug is a blood product that increases blood osmotic pressure; replacing plasma volume and supporting red blood cells.
- It's helpful for treating hypovolemic shock.
Prototype Drug: Norepinephrine
- A vasoconstrictor, also known as a vasopressor, to treat shock by raising blood pressure.
- Norepinephrine acts directly on alpha-adrenergic receptors in blood vessels to quickly increase blood pressure, and the beta receptors in the heart.
- A caution is that when the IV treatment is over, the effect is short lasting, and therefore the symptoms and effects do not continue.
Prototype Drug: Dopamine
- A nonselective adrenergic agonist used to treat shock—particularly hypovolemic and cardiogenic shock.
- The drug works by increasing blood flow to the kidneys, and at higher doses, it stimulates the alpha-adrenergic receptors to raise blood pressure and increase cardiac output.
Anaphylaxis
- A potentially life-threatening hypersensitivity reaction to an allergen.
- Symptoms include tightness in the throat, chest pain, itching, flushing, hives, swelling, wheezing, cough, and rapid drop in blood pressure.
- Treatment involves administering epinephrine, oxygen, antihistamines, glucocorticoids, and bronchodilators.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Related Documents
Description
Test your knowledge on Alzheimer's Disease through a series of questions that cover its characteristics, causes, treatment options, and associated symptoms. This quiz is designed for students and professionals seeking to deepen their understanding of dementia and its management.
