Podcast
Questions and Answers
What is the main role of the central nervous system (CNS)?
What is the main role of the central nervous system (CNS)?
Which neurotransmitter is classified as an excitatory neurotransmitter?
Which neurotransmitter is classified as an excitatory neurotransmitter?
What typically characterizes Parkinson's disease (PD) in relation to neurotransmitters?
What typically characterizes Parkinson's disease (PD) in relation to neurotransmitters?
Which of the following conditions is specifically identified as a cause of epilepsy?
Which of the following conditions is specifically identified as a cause of epilepsy?
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What important role does the peripheral nervous system (PNS) play?
What important role does the peripheral nervous system (PNS) play?
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What symptom is NOT commonly associated with low blood glucose levels?
What symptom is NOT commonly associated with low blood glucose levels?
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What is the main reason dopamine agonists should be administered 30 to 60 minutes before meals?
What is the main reason dopamine agonists should be administered 30 to 60 minutes before meals?
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Which of the following should be carefully monitored if tolcapone is prescribed?
Which of the following should be carefully monitored if tolcapone is prescribed?
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Which statement about withdrawing dopamine agonists is correct?
Which statement about withdrawing dopamine agonists is correct?
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What is a common adverse effect of both entacapone and tolcapone?
What is a common adverse effect of both entacapone and tolcapone?
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What is believed to be a potential cause of Parkinson's Disease (PD)?
What is believed to be a potential cause of Parkinson's Disease (PD)?
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Which of the following statements about Dopamine Agonists is correct?
Which of the following statements about Dopamine Agonists is correct?
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What is the main issue associated with long-term use of levodopa in PD treatment?
What is the main issue associated with long-term use of levodopa in PD treatment?
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What is a commonly recognized adverse reaction to carbidopa/levodopa therapy?
What is a commonly recognized adverse reaction to carbidopa/levodopa therapy?
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Which action should be taken when evaluating a patient starting on dopamine agonists?
Which action should be taken when evaluating a patient starting on dopamine agonists?
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What is the recommended timing for administering tolcapone with carbidopa/levodopa?
What is the recommended timing for administering tolcapone with carbidopa/levodopa?
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What serious side effect should patients using tolcapone be monitored for?
What serious side effect should patients using tolcapone be monitored for?
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Which of the following foods should be avoided when taking MAO-B inhibitors due to the risk of a hypertensive crisis?
Which of the following foods should be avoided when taking MAO-B inhibitors due to the risk of a hypertensive crisis?
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What type of symptoms should patients on MAO-B inhibitors report to their healthcare provider immediately?
What type of symptoms should patients on MAO-B inhibitors report to their healthcare provider immediately?
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What should patients taking cholinesterase inhibitors for Alzheimer's disease understand about their treatment?
What should patients taking cholinesterase inhibitors for Alzheimer's disease understand about their treatment?
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What is the primary purpose of cholinesterase inhibitors in the treatment of Alzheimer's disease?
What is the primary purpose of cholinesterase inhibitors in the treatment of Alzheimer's disease?
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Which of the following is NOT a common side effect of cholinesterase inhibitors?
Which of the following is NOT a common side effect of cholinesterase inhibitors?
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What is a critical nursing implication when administering cholinesterase inhibitors?
What is a critical nursing implication when administering cholinesterase inhibitors?
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How do N-methyl-D-aspartate (NMDA) blockers contribute to the treatment of Alzheimer's disease?
How do N-methyl-D-aspartate (NMDA) blockers contribute to the treatment of Alzheimer's disease?
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Which symptoms may indicate adverse reactions to memantine?
Which symptoms may indicate adverse reactions to memantine?
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What should be done if a patient exhibits statements suggesting self-harm?
What should be done if a patient exhibits statements suggesting self-harm?
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Which of the following statements about the withdrawal from AEDs is true?
Which of the following statements about the withdrawal from AEDs is true?
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What impact can drugs that increase urine pH have on memantine treatment?
What impact can drugs that increase urine pH have on memantine treatment?
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Which of the following is an expected side effect of phenytoin?
Which of the following is an expected side effect of phenytoin?
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Which baseline measurements should be obtained before starting memantine therapy?
Which baseline measurements should be obtained before starting memantine therapy?
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What action should a patient take if they miss a dose of their AED?
What action should a patient take if they miss a dose of their AED?
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What should patients report while taking memantine?
What should patients report while taking memantine?
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Which category of antiepileptic drugs (AEDs) includes phenytoin and carbamazepine?
Which category of antiepileptic drugs (AEDs) includes phenytoin and carbamazepine?
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Which antiepileptic drug is known to raise the seizure threshold by enhancing GABA's action?
Which antiepileptic drug is known to raise the seizure threshold by enhancing GABA's action?
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What should be assessed in adolescents taking antiepileptic drugs?
What should be assessed in adolescents taking antiepileptic drugs?
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Which statement about the use of phenobarbital is true?
Which statement about the use of phenobarbital is true?
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What is a significant risk of valproic acid in pediatric patients?
What is a significant risk of valproic acid in pediatric patients?
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What is a recommended nursing implication for a patient on oxcarbazepine?
What is a recommended nursing implication for a patient on oxcarbazepine?
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Which of the following drugs is known to interact with both traditional and newer AEDs?
Which of the following drugs is known to interact with both traditional and newer AEDs?
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Which side effect is commonly associated with lamotrigine?
Which side effect is commonly associated with lamotrigine?
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What is the primary role of neurotransmitters in the nervous system?
What is the primary role of neurotransmitters in the nervous system?
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What imbalance in neurotransmitters is primarily associated with Parkinson's disease (PD)?
What imbalance in neurotransmitters is primarily associated with Parkinson's disease (PD)?
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How do photoreceptor cells in the retina contribute to vision?
How do photoreceptor cells in the retina contribute to vision?
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What does the central nervous system (CNS) primarily consist of?
What does the central nervous system (CNS) primarily consist of?
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Which of the following conditions is known to result from degenerative changes in nerve cells?
Which of the following conditions is known to result from degenerative changes in nerve cells?
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What is the primary reason for the increase in incidence of Parkinson's disease (PD) with age?
What is the primary reason for the increase in incidence of Parkinson's disease (PD) with age?
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What is a significant challenge in diagnosing Parkinson's disease?
What is a significant challenge in diagnosing Parkinson's disease?
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What causes the complications of depression and hallucinations in Parkinson's disease patients?
What causes the complications of depression and hallucinations in Parkinson's disease patients?
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Why are anticholinergic drugs no longer the main therapy for Parkinson's disease?
Why are anticholinergic drugs no longer the main therapy for Parkinson's disease?
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What is meant by the term 'wearing off' in the context of levodopa therapy?
What is meant by the term 'wearing off' in the context of levodopa therapy?
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What role do neurotransmitters play in the central nervous system (CNS)?
What role do neurotransmitters play in the central nervous system (CNS)?
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Which statement correctly describes a function of the central nervous system (CNS)?
Which statement correctly describes a function of the central nervous system (CNS)?
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Which problem is specifically linked to an imbalance of neurotransmitters in the CNS?
Which problem is specifically linked to an imbalance of neurotransmitters in the CNS?
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What is the main function of rods and cones in the retina?
What is the main function of rods and cones in the retina?
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What condition can result from degenerative changes in the support cells of the brain?
What condition can result from degenerative changes in the support cells of the brain?
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Study Notes
Central Nervous System Functions
- The central nervous system (CNS) includes the brain and spinal cord; peripheral nervous system (PNS) nerves connect the CNS to the body.
- Specialized photoreceptors in the retina convert light into signals sent to the brain via the optic nerve, which interprets visual information.
- Conditions impacting the CNS can disrupt brain function, with a focus on drug therapies for diseases like Parkinson's, Alzheimer's, epilepsy, and multiple sclerosis.
- Movement is coordinated by the brain, spinal cord, nerves, and muscles.
- Neurotransmitters facilitate communication between nerves, with excitatory types like acetylcholine, and inhibitory types including dopamine.
- Disorders such as Parkinson's disease result from neurotransmitter imbalances, affecting movement and other brain functions.
Parkinson’s Disease (PD)
- PD, the second most common neurodegenerative disease after Alzheimer's, involves movement disorders and is more prevalent in men.
- Diagnosis can be lengthy, as no specific test exists; it requires ruling out other neurological conditions.
- The disease is characterized by inadequate dopamine production in the midbrain's substantia nigra, necessary for muscle control.
- PD patients often experience complications such as depression, hallucinations, and worsening symptoms over time.
- Drug treatments include dopamine agonists and inhibitors that enhance dopamine levels, delaying symptom progression but not curing the disease.
Drug Treatment for PD
- Common drugs: dopamine agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase type B (MAO-B) inhibitors.
- Anticholinergic drugs were once primary but now pose significant side effects and don’t target the core issue of dopamine deficiency.
- Levodopa is crucial as it converts to dopamine in the brain, albeit with potential long-term issues like "wearing off" effects after prolonged use.
Side Effects and Drug Interactions
- Frequent side effects include hypotension, GI disturbances, insomnia, and confusion; dyskinesia may appear in long-term carbidopa/levodopa therapy.
- Drug combinations require caution; for example, using antihypertensives with dopamine agonists can lead to severe hypotension.
- Avoid combining these drugs with certain psychiatric medications, as they can exacerbate confusion and hallucinations.
Nursing Implications and Patient Teaching
- Monitor blood pressure and evaluate motor skills and functional abilities to safeguard against falls.
- Administer dopamine agonists 30-60 minutes before meals for optimal absorption; never crush extended-release forms.
- Gradual withdrawal of dopamine agonists is critical, given their long half-life and potential for withdrawal symptoms.
- Long-term use of dopamine agonists may lead to the emergence of akinesia, tardive dyskinesia, or dystonia, necessitating cautious dosage adjustments.
Patient and Family Education
- Effectiveness of PD drugs develops over time; continued medication adherence is essential even without immediate improvements.
- Advise on dietary restrictions, particularly avoiding high-protein foods with levodopa, which can hinder its effectiveness.
- Warn of potential serious side effects and direct patients to contact healthcare providers for sudden worsening of symptoms.
Catechol-O-Methyltransferase (COMT) Inhibitors
- COMT inhibitors enhance the effect of carbidopa/levodopa; side effects include GI upset and potential liver failure, particularly with tolcapone.
- Monitoring for signs of liver dysfunction and adjustment of doses is necessary, particularly when combining with other medications.
Monoamine Oxidase Type B (MAO-B) Inhibitors
- MAO-B inhibitors like selegiline and rasagiline help reduce the breakdown of dopamine and improve PD symptoms.
- Side effects include dry mouth and lightheadedness; high doses can lead to severe hypertension.
- Tyramine-rich foods must be avoided due to the risk of hypertensive crises.
Alzheimer's Disease (AD)
- Alzheimer's is a prominent form of dementia characterized by progressive memory loss and cognitive decline.
- Early-stage symptoms may resemble typical aging, making accurate diagnosis essential for effective treatment.### Alzheimer's Disease (AD) Overview
- Alzheimer's Disease is a progressive condition leading to increasing memory loss and cognitive challenges.
- More than 5 million individuals are affected by AD, with risk factors including age (over 65), family history, and the presence of the APOE-e4 gene.
- Diagnosis relies on symptoms, family interviews, physical examinations, and neurologic assessments, as there is no single test for AD.
Ten Warning Signs of Alzheimer's Disease
- Memory loss disrupting daily life.
- Difficulty in planning or solving problems.
- Challenges in completing familiar tasks.
- Confusion about time and place.
- Trouble understanding visual images and spatial relationships.
- New speech or writing difficulties.
- Misplacing items and inability to retrace steps.
- Poor judgment and decision-making.
- Withdrawal from work or social activities.
- Changes in mood and personality.
Drug Therapy for Alzheimer's Disease
- No cure exists; therapy aims to improve symptoms temporarily.
- Drugs include cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) and NMDA blockers (e.g., memantine).
- Drug effectiveness varies; benefits are short-lived.
Cholinesterase Inhibitors
- Mechanism: Increase acetylcholine (ACh) levels by inhibiting acetylcholinesterase, which breaks down ACh.
- Expected Side Effects: Mild diarrhea, drowsiness, headaches, and gastrointestinal discomfort.
- Serious Adverse Effects: Hallucinations, dysrhythmias, GI bleeding, and urinary incontinence.
- Concomitant use with drugs prolonging the QT interval can lead to life-threatening dysrhythmias.
Nursing Considerations for Cholinesterase Inhibitors
- Monitor baseline weight to check for appetite loss.
- Observe for signs of gastrointestinal bleeding and assess liver function.
- Patients should undergo an Alzheimer’s Disease Assessment Scale for objective evaluation.
- Teach patients to use the bathroom every few hours to manage increased urination and that it may take weeks for therapeutic effects.
NMDA Blockers
- Memantine protects against neurotoxic levels of calcium, slowing neuronal damage.
- Side Effects: Headaches, dizziness, constipation; severe reactions include hallucinations and worsening confusion.
- Drug interactions can arise with agents that affect urine pH or renal excretion.
Nursing Implications for NMDA Blockers
- Caution in patients with renal impairment.
- Baseline kidney function tests should be obtained before therapy.
- Assess for urinary tract infections as they may elevate memantine levels.
Antiepileptic Drugs (AEDs) Overview
- Epilepsy causes chronic and excessive neuronal excitability, leading to seizures.
- Seizures are categorized as partial or generalized, associated with a variety of stimuli or underlying conditions.
- Drug therapy is primary for seizure management, encompassing traditional and newer AEDs.
Traditional Antiepileptic Drugs
- Common AEDs: Phenytoin, carbamazepine, ethosuximide, phenobarbital, and valproic acid.
- Nursing strategies include monitoring for drug interactions, checking vital signs, and assessing for changes in consciousness.
Specific Actions and Side Effects of Traditional AEDs
- Phenytoin prevents neuron excitation via sodium channel binding; major side effects include gum hyperplasia.
- Carbamazepine alters sodium channels, with side effects like constipation and nausea.
- Ethosuximide primarily manages absence seizures; common effects are dizziness and fatigue.
- Phenobarbital enhances GABA activity; side effects may lead to CNS depression, especially when initiated.
- Valproic acid raises seizure thresholds and is involved in managing bipolar disorders; side effects can include drowsiness and weight changes.
Safety and Monitoring Concerns
- Teratogenic effects warrant caution for pregnant patients.
- Significant interactions are noted with many medications, necessitating thorough drug reference consultations before prescribing AEDs.
- Patients should be educated on the importance of adherence to prescribed therapy and reporting any new symptoms promptly.### Antiepileptic Drugs (AEDs) Overview
- Traditional AEDs are often combined with newer AEDs for effective treatment; newer drugs as adjuvant therapy enhance existing regimens.
- Monotherapy is an option for some patients; only four newer AEDs—oxcarbazepine, lamotrigine, lacosamide, and topiramate—are approved for this purpose.
Oxcarbazepine
- Mechanism: Inhibits sodium channels to increase the seizure threshold.
- Common Side Effects: Drowsiness, dizziness, headache, nausea; visual disturbances like double vision may occur.
- Serious Risks: Amnesia, hyponatremia (low sodium), bone marrow suppression, confusion.
- Drug Interactions: Reduces sodium levels, especially when taken with diuretics; interacts with drugs like aspirin, oral contraceptives, and psychiatric medications.
- Nursing Considerations: Monitor sodium levels, assess for visual changes, and warn against driving with visual impairments.
Lamotrigine
- Mechanism: Thought to block sodium channels; effective for partial and tonic-clonic seizures, and certain bipolar disorders.
- Common Side Effects: Drowsiness, abdominal pain, visual disturbances; black patients may experience lower clearance rates.
- Serious Risks: Life-threatening rashes such as Stevens-Johnson syndrome; require immediate discontinuation if rash develops.
- Drug Interactions: Extensive interactions with cardiac drugs, diabetes medications, and opioid analgesics.
- Nursing Considerations: Daily rash assessments, especially in black patients; monitor closely for significant side effects.
Lacosamide
- Mechanism: Stabilizes neuron membranes at sodium channels to prevent repetitive firing.
- Common Side Effects: Headache, dizziness, blurred vision; users may experience euphoria.
- Serious Risks: Orthostatic hypotension may lead to falls; not effective in reducing oral contraceptive efficacy.
- Drug Interactions: Interacts with cardiac drugs and antihypertensives; caution advised with multiple medications.
- Nursing Considerations: Monitor blood pressure, especially in patients with pre-existing low blood pressure; observe for mood changes.
Topiramate
- Mechanism: Reduces seizure spread by stabilizing neuron membranes; enhances GABA and blocks excitatory neurotransmitters.
- Common Side Effects: Abdominal pain, nausea, dizziness; may cause cognitive impairment and abnormal taste sensations.
- Serious Risks: Risk of metabolic acidosis and elevated ammonia, potentially leading to encephalopathy.
- Drug Interactions: Interacts significantly with contraceptives and various other drug categories.
- Nursing Considerations: Monitor for signs of encephalopathy; assess labs for electrolyte imbalances and ammonia levels.
Multiple Sclerosis (MS) Overview
- MS is an autoimmune disease impacting myelin sheaths in the CNS, leading to nerve function interruption.
- Symptoms vary based on myelin affected; early indicators include fatigue, visual problems, muscle weakness, and depression.
- MS predominantly affects women and is often characterized by relapsing-remitting forms, with worsening functions over time.
Treatment of Multiple Sclerosis
- Initial management by neurologists; treatments aim to slow progression and enhance patient independence.
- Non-specific anti-inflammatory drugs like corticosteroids provide symptom relief but do not alter disease progression.
Biological Response Modifiers (BRMs)
- Two categories: injectable (beta-interferon, glatiramer) and oral (fingolimod, teriflunomide) medications.
- BRMs alter immune response; regular administration under specialist supervision is necessary.
Monoclonal Antibodies
- Target and destroy lymphocytes that damage myelin; given via intravenous infusions with increased infection risk and potential allergic reactions.
Neurologic Drugs for MS
- Oral drugs like dimethyl fumarate (Tecfidera) and dalfampridine (Ampyra) improve symptoms.
- Administration requires strict adherence to prescribed schedules and monitoring for adverse reactions.
Central Nervous System Functions
- The central nervous system (CNS) includes the brain and spinal cord; peripheral nervous system (PNS) nerves connect the CNS to the body.
- Specialized photoreceptors in the retina convert light into signals sent to the brain via the optic nerve, which interprets visual information.
- Conditions impacting the CNS can disrupt brain function, with a focus on drug therapies for diseases like Parkinson's, Alzheimer's, epilepsy, and multiple sclerosis.
- Movement is coordinated by the brain, spinal cord, nerves, and muscles.
- Neurotransmitters facilitate communication between nerves, with excitatory types like acetylcholine, and inhibitory types including dopamine.
- Disorders such as Parkinson's disease result from neurotransmitter imbalances, affecting movement and other brain functions.
Parkinson’s Disease (PD)
- PD, the second most common neurodegenerative disease after Alzheimer's, involves movement disorders and is more prevalent in men.
- Diagnosis can be lengthy, as no specific test exists; it requires ruling out other neurological conditions.
- The disease is characterized by inadequate dopamine production in the midbrain's substantia nigra, necessary for muscle control.
- PD patients often experience complications such as depression, hallucinations, and worsening symptoms over time.
- Drug treatments include dopamine agonists and inhibitors that enhance dopamine levels, delaying symptom progression but not curing the disease.
Drug Treatment for PD
- Common drugs: dopamine agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase type B (MAO-B) inhibitors.
- Anticholinergic drugs were once primary but now pose significant side effects and don’t target the core issue of dopamine deficiency.
- Levodopa is crucial as it converts to dopamine in the brain, albeit with potential long-term issues like "wearing off" effects after prolonged use.
Side Effects and Drug Interactions
- Frequent side effects include hypotension, GI disturbances, insomnia, and confusion; dyskinesia may appear in long-term carbidopa/levodopa therapy.
- Drug combinations require caution; for example, using antihypertensives with dopamine agonists can lead to severe hypotension.
- Avoid combining these drugs with certain psychiatric medications, as they can exacerbate confusion and hallucinations.
Nursing Implications and Patient Teaching
- Monitor blood pressure and evaluate motor skills and functional abilities to safeguard against falls.
- Administer dopamine agonists 30-60 minutes before meals for optimal absorption; never crush extended-release forms.
- Gradual withdrawal of dopamine agonists is critical, given their long half-life and potential for withdrawal symptoms.
- Long-term use of dopamine agonists may lead to the emergence of akinesia, tardive dyskinesia, or dystonia, necessitating cautious dosage adjustments.
Patient and Family Education
- Effectiveness of PD drugs develops over time; continued medication adherence is essential even without immediate improvements.
- Advise on dietary restrictions, particularly avoiding high-protein foods with levodopa, which can hinder its effectiveness.
- Warn of potential serious side effects and direct patients to contact healthcare providers for sudden worsening of symptoms.
Catechol-O-Methyltransferase (COMT) Inhibitors
- COMT inhibitors enhance the effect of carbidopa/levodopa; side effects include GI upset and potential liver failure, particularly with tolcapone.
- Monitoring for signs of liver dysfunction and adjustment of doses is necessary, particularly when combining with other medications.
Monoamine Oxidase Type B (MAO-B) Inhibitors
- MAO-B inhibitors like selegiline and rasagiline help reduce the breakdown of dopamine and improve PD symptoms.
- Side effects include dry mouth and lightheadedness; high doses can lead to severe hypertension.
- Tyramine-rich foods must be avoided due to the risk of hypertensive crises.
Alzheimer's Disease (AD)
- Alzheimer's is a prominent form of dementia characterized by progressive memory loss and cognitive decline.
- Early-stage symptoms may resemble typical aging, making accurate diagnosis essential for effective treatment.### Alzheimer's Disease (AD) Overview
- Alzheimer's Disease is a progressive condition leading to increasing memory loss and cognitive challenges.
- More than 5 million individuals are affected by AD, with risk factors including age (over 65), family history, and the presence of the APOE-e4 gene.
- Diagnosis relies on symptoms, family interviews, physical examinations, and neurologic assessments, as there is no single test for AD.
Ten Warning Signs of Alzheimer's Disease
- Memory loss disrupting daily life.
- Difficulty in planning or solving problems.
- Challenges in completing familiar tasks.
- Confusion about time and place.
- Trouble understanding visual images and spatial relationships.
- New speech or writing difficulties.
- Misplacing items and inability to retrace steps.
- Poor judgment and decision-making.
- Withdrawal from work or social activities.
- Changes in mood and personality.
Drug Therapy for Alzheimer's Disease
- No cure exists; therapy aims to improve symptoms temporarily.
- Drugs include cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) and NMDA blockers (e.g., memantine).
- Drug effectiveness varies; benefits are short-lived.
Cholinesterase Inhibitors
- Mechanism: Increase acetylcholine (ACh) levels by inhibiting acetylcholinesterase, which breaks down ACh.
- Expected Side Effects: Mild diarrhea, drowsiness, headaches, and gastrointestinal discomfort.
- Serious Adverse Effects: Hallucinations, dysrhythmias, GI bleeding, and urinary incontinence.
- Concomitant use with drugs prolonging the QT interval can lead to life-threatening dysrhythmias.
Nursing Considerations for Cholinesterase Inhibitors
- Monitor baseline weight to check for appetite loss.
- Observe for signs of gastrointestinal bleeding and assess liver function.
- Patients should undergo an Alzheimer’s Disease Assessment Scale for objective evaluation.
- Teach patients to use the bathroom every few hours to manage increased urination and that it may take weeks for therapeutic effects.
NMDA Blockers
- Memantine protects against neurotoxic levels of calcium, slowing neuronal damage.
- Side Effects: Headaches, dizziness, constipation; severe reactions include hallucinations and worsening confusion.
- Drug interactions can arise with agents that affect urine pH or renal excretion.
Nursing Implications for NMDA Blockers
- Caution in patients with renal impairment.
- Baseline kidney function tests should be obtained before therapy.
- Assess for urinary tract infections as they may elevate memantine levels.
Antiepileptic Drugs (AEDs) Overview
- Epilepsy causes chronic and excessive neuronal excitability, leading to seizures.
- Seizures are categorized as partial or generalized, associated with a variety of stimuli or underlying conditions.
- Drug therapy is primary for seizure management, encompassing traditional and newer AEDs.
Traditional Antiepileptic Drugs
- Common AEDs: Phenytoin, carbamazepine, ethosuximide, phenobarbital, and valproic acid.
- Nursing strategies include monitoring for drug interactions, checking vital signs, and assessing for changes in consciousness.
Specific Actions and Side Effects of Traditional AEDs
- Phenytoin prevents neuron excitation via sodium channel binding; major side effects include gum hyperplasia.
- Carbamazepine alters sodium channels, with side effects like constipation and nausea.
- Ethosuximide primarily manages absence seizures; common effects are dizziness and fatigue.
- Phenobarbital enhances GABA activity; side effects may lead to CNS depression, especially when initiated.
- Valproic acid raises seizure thresholds and is involved in managing bipolar disorders; side effects can include drowsiness and weight changes.
Safety and Monitoring Concerns
- Teratogenic effects warrant caution for pregnant patients.
- Significant interactions are noted with many medications, necessitating thorough drug reference consultations before prescribing AEDs.
- Patients should be educated on the importance of adherence to prescribed therapy and reporting any new symptoms promptly.### Antiepileptic Drugs (AEDs) Overview
- Traditional AEDs are often combined with newer AEDs for effective treatment; newer drugs as adjuvant therapy enhance existing regimens.
- Monotherapy is an option for some patients; only four newer AEDs—oxcarbazepine, lamotrigine, lacosamide, and topiramate—are approved for this purpose.
Oxcarbazepine
- Mechanism: Inhibits sodium channels to increase the seizure threshold.
- Common Side Effects: Drowsiness, dizziness, headache, nausea; visual disturbances like double vision may occur.
- Serious Risks: Amnesia, hyponatremia (low sodium), bone marrow suppression, confusion.
- Drug Interactions: Reduces sodium levels, especially when taken with diuretics; interacts with drugs like aspirin, oral contraceptives, and psychiatric medications.
- Nursing Considerations: Monitor sodium levels, assess for visual changes, and warn against driving with visual impairments.
Lamotrigine
- Mechanism: Thought to block sodium channels; effective for partial and tonic-clonic seizures, and certain bipolar disorders.
- Common Side Effects: Drowsiness, abdominal pain, visual disturbances; black patients may experience lower clearance rates.
- Serious Risks: Life-threatening rashes such as Stevens-Johnson syndrome; require immediate discontinuation if rash develops.
- Drug Interactions: Extensive interactions with cardiac drugs, diabetes medications, and opioid analgesics.
- Nursing Considerations: Daily rash assessments, especially in black patients; monitor closely for significant side effects.
Lacosamide
- Mechanism: Stabilizes neuron membranes at sodium channels to prevent repetitive firing.
- Common Side Effects: Headache, dizziness, blurred vision; users may experience euphoria.
- Serious Risks: Orthostatic hypotension may lead to falls; not effective in reducing oral contraceptive efficacy.
- Drug Interactions: Interacts with cardiac drugs and antihypertensives; caution advised with multiple medications.
- Nursing Considerations: Monitor blood pressure, especially in patients with pre-existing low blood pressure; observe for mood changes.
Topiramate
- Mechanism: Reduces seizure spread by stabilizing neuron membranes; enhances GABA and blocks excitatory neurotransmitters.
- Common Side Effects: Abdominal pain, nausea, dizziness; may cause cognitive impairment and abnormal taste sensations.
- Serious Risks: Risk of metabolic acidosis and elevated ammonia, potentially leading to encephalopathy.
- Drug Interactions: Interacts significantly with contraceptives and various other drug categories.
- Nursing Considerations: Monitor for signs of encephalopathy; assess labs for electrolyte imbalances and ammonia levels.
Multiple Sclerosis (MS) Overview
- MS is an autoimmune disease impacting myelin sheaths in the CNS, leading to nerve function interruption.
- Symptoms vary based on myelin affected; early indicators include fatigue, visual problems, muscle weakness, and depression.
- MS predominantly affects women and is often characterized by relapsing-remitting forms, with worsening functions over time.
Treatment of Multiple Sclerosis
- Initial management by neurologists; treatments aim to slow progression and enhance patient independence.
- Non-specific anti-inflammatory drugs like corticosteroids provide symptom relief but do not alter disease progression.
Biological Response Modifiers (BRMs)
- Two categories: injectable (beta-interferon, glatiramer) and oral (fingolimod, teriflunomide) medications.
- BRMs alter immune response; regular administration under specialist supervision is necessary.
Monoclonal Antibodies
- Target and destroy lymphocytes that damage myelin; given via intravenous infusions with increased infection risk and potential allergic reactions.
Neurologic Drugs for MS
- Oral drugs like dimethyl fumarate (Tecfidera) and dalfampridine (Ampyra) improve symptoms.
- Administration requires strict adherence to prescribed schedules and monitoring for adverse reactions.
Central Nervous System Functions
- The central nervous system (CNS) includes the brain and spinal cord; peripheral nervous system (PNS) nerves connect the CNS to the body.
- Specialized photoreceptors in the retina convert light into signals sent to the brain via the optic nerve, which interprets visual information.
- Conditions impacting the CNS can disrupt brain function, with a focus on drug therapies for diseases like Parkinson's, Alzheimer's, epilepsy, and multiple sclerosis.
- Movement is coordinated by the brain, spinal cord, nerves, and muscles.
- Neurotransmitters facilitate communication between nerves, with excitatory types like acetylcholine, and inhibitory types including dopamine.
- Disorders such as Parkinson's disease result from neurotransmitter imbalances, affecting movement and other brain functions.
Parkinson’s Disease (PD)
- PD, the second most common neurodegenerative disease after Alzheimer's, involves movement disorders and is more prevalent in men.
- Diagnosis can be lengthy, as no specific test exists; it requires ruling out other neurological conditions.
- The disease is characterized by inadequate dopamine production in the midbrain's substantia nigra, necessary for muscle control.
- PD patients often experience complications such as depression, hallucinations, and worsening symptoms over time.
- Drug treatments include dopamine agonists and inhibitors that enhance dopamine levels, delaying symptom progression but not curing the disease.
Drug Treatment for PD
- Common drugs: dopamine agonists, catechol-O-methyltransferase (COMT) inhibitors, and monoamine oxidase type B (MAO-B) inhibitors.
- Anticholinergic drugs were once primary but now pose significant side effects and don’t target the core issue of dopamine deficiency.
- Levodopa is crucial as it converts to dopamine in the brain, albeit with potential long-term issues like "wearing off" effects after prolonged use.
Side Effects and Drug Interactions
- Frequent side effects include hypotension, GI disturbances, insomnia, and confusion; dyskinesia may appear in long-term carbidopa/levodopa therapy.
- Drug combinations require caution; for example, using antihypertensives with dopamine agonists can lead to severe hypotension.
- Avoid combining these drugs with certain psychiatric medications, as they can exacerbate confusion and hallucinations.
Nursing Implications and Patient Teaching
- Monitor blood pressure and evaluate motor skills and functional abilities to safeguard against falls.
- Administer dopamine agonists 30-60 minutes before meals for optimal absorption; never crush extended-release forms.
- Gradual withdrawal of dopamine agonists is critical, given their long half-life and potential for withdrawal symptoms.
- Long-term use of dopamine agonists may lead to the emergence of akinesia, tardive dyskinesia, or dystonia, necessitating cautious dosage adjustments.
Patient and Family Education
- Effectiveness of PD drugs develops over time; continued medication adherence is essential even without immediate improvements.
- Advise on dietary restrictions, particularly avoiding high-protein foods with levodopa, which can hinder its effectiveness.
- Warn of potential serious side effects and direct patients to contact healthcare providers for sudden worsening of symptoms.
Catechol-O-Methyltransferase (COMT) Inhibitors
- COMT inhibitors enhance the effect of carbidopa/levodopa; side effects include GI upset and potential liver failure, particularly with tolcapone.
- Monitoring for signs of liver dysfunction and adjustment of doses is necessary, particularly when combining with other medications.
Monoamine Oxidase Type B (MAO-B) Inhibitors
- MAO-B inhibitors like selegiline and rasagiline help reduce the breakdown of dopamine and improve PD symptoms.
- Side effects include dry mouth and lightheadedness; high doses can lead to severe hypertension.
- Tyramine-rich foods must be avoided due to the risk of hypertensive crises.
Alzheimer's Disease (AD)
- Alzheimer's is a prominent form of dementia characterized by progressive memory loss and cognitive decline.
- Early-stage symptoms may resemble typical aging, making accurate diagnosis essential for effective treatment.### Alzheimer's Disease (AD) Overview
- Alzheimer's Disease is a progressive condition leading to increasing memory loss and cognitive challenges.
- More than 5 million individuals are affected by AD, with risk factors including age (over 65), family history, and the presence of the APOE-e4 gene.
- Diagnosis relies on symptoms, family interviews, physical examinations, and neurologic assessments, as there is no single test for AD.
Ten Warning Signs of Alzheimer's Disease
- Memory loss disrupting daily life.
- Difficulty in planning or solving problems.
- Challenges in completing familiar tasks.
- Confusion about time and place.
- Trouble understanding visual images and spatial relationships.
- New speech or writing difficulties.
- Misplacing items and inability to retrace steps.
- Poor judgment and decision-making.
- Withdrawal from work or social activities.
- Changes in mood and personality.
Drug Therapy for Alzheimer's Disease
- No cure exists; therapy aims to improve symptoms temporarily.
- Drugs include cholinesterase inhibitors (e.g., donepezil, rivastigmine, galantamine) and NMDA blockers (e.g., memantine).
- Drug effectiveness varies; benefits are short-lived.
Cholinesterase Inhibitors
- Mechanism: Increase acetylcholine (ACh) levels by inhibiting acetylcholinesterase, which breaks down ACh.
- Expected Side Effects: Mild diarrhea, drowsiness, headaches, and gastrointestinal discomfort.
- Serious Adverse Effects: Hallucinations, dysrhythmias, GI bleeding, and urinary incontinence.
- Concomitant use with drugs prolonging the QT interval can lead to life-threatening dysrhythmias.
Nursing Considerations for Cholinesterase Inhibitors
- Monitor baseline weight to check for appetite loss.
- Observe for signs of gastrointestinal bleeding and assess liver function.
- Patients should undergo an Alzheimer’s Disease Assessment Scale for objective evaluation.
- Teach patients to use the bathroom every few hours to manage increased urination and that it may take weeks for therapeutic effects.
NMDA Blockers
- Memantine protects against neurotoxic levels of calcium, slowing neuronal damage.
- Side Effects: Headaches, dizziness, constipation; severe reactions include hallucinations and worsening confusion.
- Drug interactions can arise with agents that affect urine pH or renal excretion.
Nursing Implications for NMDA Blockers
- Caution in patients with renal impairment.
- Baseline kidney function tests should be obtained before therapy.
- Assess for urinary tract infections as they may elevate memantine levels.
Antiepileptic Drugs (AEDs) Overview
- Epilepsy causes chronic and excessive neuronal excitability, leading to seizures.
- Seizures are categorized as partial or generalized, associated with a variety of stimuli or underlying conditions.
- Drug therapy is primary for seizure management, encompassing traditional and newer AEDs.
Traditional Antiepileptic Drugs
- Common AEDs: Phenytoin, carbamazepine, ethosuximide, phenobarbital, and valproic acid.
- Nursing strategies include monitoring for drug interactions, checking vital signs, and assessing for changes in consciousness.
Specific Actions and Side Effects of Traditional AEDs
- Phenytoin prevents neuron excitation via sodium channel binding; major side effects include gum hyperplasia.
- Carbamazepine alters sodium channels, with side effects like constipation and nausea.
- Ethosuximide primarily manages absence seizures; common effects are dizziness and fatigue.
- Phenobarbital enhances GABA activity; side effects may lead to CNS depression, especially when initiated.
- Valproic acid raises seizure thresholds and is involved in managing bipolar disorders; side effects can include drowsiness and weight changes.
Safety and Monitoring Concerns
- Teratogenic effects warrant caution for pregnant patients.
- Significant interactions are noted with many medications, necessitating thorough drug reference consultations before prescribing AEDs.
- Patients should be educated on the importance of adherence to prescribed therapy and reporting any new symptoms promptly.### Antiepileptic Drugs (AEDs) Overview
- Traditional AEDs are often combined with newer AEDs for effective treatment; newer drugs as adjuvant therapy enhance existing regimens.
- Monotherapy is an option for some patients; only four newer AEDs—oxcarbazepine, lamotrigine, lacosamide, and topiramate—are approved for this purpose.
Oxcarbazepine
- Mechanism: Inhibits sodium channels to increase the seizure threshold.
- Common Side Effects: Drowsiness, dizziness, headache, nausea; visual disturbances like double vision may occur.
- Serious Risks: Amnesia, hyponatremia (low sodium), bone marrow suppression, confusion.
- Drug Interactions: Reduces sodium levels, especially when taken with diuretics; interacts with drugs like aspirin, oral contraceptives, and psychiatric medications.
- Nursing Considerations: Monitor sodium levels, assess for visual changes, and warn against driving with visual impairments.
Lamotrigine
- Mechanism: Thought to block sodium channels; effective for partial and tonic-clonic seizures, and certain bipolar disorders.
- Common Side Effects: Drowsiness, abdominal pain, visual disturbances; black patients may experience lower clearance rates.
- Serious Risks: Life-threatening rashes such as Stevens-Johnson syndrome; require immediate discontinuation if rash develops.
- Drug Interactions: Extensive interactions with cardiac drugs, diabetes medications, and opioid analgesics.
- Nursing Considerations: Daily rash assessments, especially in black patients; monitor closely for significant side effects.
Lacosamide
- Mechanism: Stabilizes neuron membranes at sodium channels to prevent repetitive firing.
- Common Side Effects: Headache, dizziness, blurred vision; users may experience euphoria.
- Serious Risks: Orthostatic hypotension may lead to falls; not effective in reducing oral contraceptive efficacy.
- Drug Interactions: Interacts with cardiac drugs and antihypertensives; caution advised with multiple medications.
- Nursing Considerations: Monitor blood pressure, especially in patients with pre-existing low blood pressure; observe for mood changes.
Topiramate
- Mechanism: Reduces seizure spread by stabilizing neuron membranes; enhances GABA and blocks excitatory neurotransmitters.
- Common Side Effects: Abdominal pain, nausea, dizziness; may cause cognitive impairment and abnormal taste sensations.
- Serious Risks: Risk of metabolic acidosis and elevated ammonia, potentially leading to encephalopathy.
- Drug Interactions: Interacts significantly with contraceptives and various other drug categories.
- Nursing Considerations: Monitor for signs of encephalopathy; assess labs for electrolyte imbalances and ammonia levels.
Multiple Sclerosis (MS) Overview
- MS is an autoimmune disease impacting myelin sheaths in the CNS, leading to nerve function interruption.
- Symptoms vary based on myelin affected; early indicators include fatigue, visual problems, muscle weakness, and depression.
- MS predominantly affects women and is often characterized by relapsing-remitting forms, with worsening functions over time.
Treatment of Multiple Sclerosis
- Initial management by neurologists; treatments aim to slow progression and enhance patient independence.
- Non-specific anti-inflammatory drugs like corticosteroids provide symptom relief but do not alter disease progression.
Biological Response Modifiers (BRMs)
- Two categories: injectable (beta-interferon, glatiramer) and oral (fingolimod, teriflunomide) medications.
- BRMs alter immune response; regular administration under specialist supervision is necessary.
Monoclonal Antibodies
- Target and destroy lymphocytes that damage myelin; given via intravenous infusions with increased infection risk and potential allergic reactions.
Neurologic Drugs for MS
- Oral drugs like dimethyl fumarate (Tecfidera) and dalfampridine (Ampyra) improve symptoms.
- Administration requires strict adherence to prescribed schedules and monitoring for adverse reactions.
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Explore the vital functions of the central nervous system, which includes the brain and spinal cord. This quiz delves into how the CNS interconnects with the peripheral nervous system for essential bodily functions.
