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Questions and Answers
Which of the following factors is least likely to trigger a myasthenic crisis?
Which of the following factors is least likely to trigger a myasthenic crisis?
- Surgery
- Increased calcium intake (correct)
- Pregnancy
- Hypokalemia
A patient with Parkinson's Disease (PD) is experiencing 'off' episodes while on levodopa/carbidopa. Which medication, when added to their regimen, requires cautious use in patients with hepatic disease?
A patient with Parkinson's Disease (PD) is experiencing 'off' episodes while on levodopa/carbidopa. Which medication, when added to their regimen, requires cautious use in patients with hepatic disease?
- Levodopa
- Tolcapone
- Amantadine
- Istradefylline (correct)
A patient with Myasthenia Gravis (MG) is taking pyridostigmine. What is the primary mechanism of action of this drug?
A patient with Myasthenia Gravis (MG) is taking pyridostigmine. What is the primary mechanism of action of this drug?
- Blocking acetylcholine receptors at the neuromuscular junction.
- Stimulating the synthesis of acetylcholine.
- Inhibiting the breakdown of acetylcholine in the synaptic cleft. (correct)
- Enhancing acetylcholine release from presynaptic neurons.
Why might aminoglycoside antibiotics potentially exacerbate Myasthenia Gravis?
Why might aminoglycoside antibiotics potentially exacerbate Myasthenia Gravis?
Which of the following medications used for Parkinson's Disease has a black box warning for hepatotoxicity?
Which of the following medications used for Parkinson's Disease has a black box warning for hepatotoxicity?
A geriatric patient is started on amantadine for Parkinson's disease. What is the generally recommended initial dose?
A geriatric patient is started on amantadine for Parkinson's disease. What is the generally recommended initial dose?
A patient with MG is suspected of having a cholinergic crisis. Which of the following signs and symptoms would the nurse expect to observe?
A patient with MG is suspected of having a cholinergic crisis. Which of the following signs and symptoms would the nurse expect to observe?
Which of the following is the MOST likely physiological mechanism behind the effectiveness of thymectomy in treating Myasthenia Gravis (MG)?
Which of the following is the MOST likely physiological mechanism behind the effectiveness of thymectomy in treating Myasthenia Gravis (MG)?
A patient taking a monoamine oxidase inhibitor (MAOI) is diagnosed with Parkinson's disease. Which of the following medications is contraindicated?
A patient taking a monoamine oxidase inhibitor (MAOI) is diagnosed with Parkinson's disease. Which of the following medications is contraindicated?
A patient in myasthenic crisis is being treated with neostigmine. What is the most critical assessment the nurse should prioritize?
A patient in myasthenic crisis is being treated with neostigmine. What is the most critical assessment the nurse should prioritize?
Which of the following medications used in Parkinson's disease treatment, when abruptly discontinued, requires a titration period to avoid potential complications?
Which of the following medications used in Parkinson's disease treatment, when abruptly discontinued, requires a titration period to avoid potential complications?
A patient with Myasthenia Gravis (MG) is experiencing increased dysphagia and dysarthria. What pharmacological intervention would MOST directly address the underlying cause of these symptoms?
A patient with Myasthenia Gravis (MG) is experiencing increased dysphagia and dysarthria. What pharmacological intervention would MOST directly address the underlying cause of these symptoms?
How does a cholinergic crisis lead to muscle weakness and potential respiratory paralysis?
How does a cholinergic crisis lead to muscle weakness and potential respiratory paralysis?
A patient on levodopa is experiencing excessive daytime sleepiness. Which of the following medications, when added to their regimen, may exacerbate this side effect?
A patient on levodopa is experiencing excessive daytime sleepiness. Which of the following medications, when added to their regimen, may exacerbate this side effect?
A 25-year-old female patient is diagnosed with Myasthenia Gravis (MG). Based on epidemiological data, which of the following symptoms is she MOST likely to initially experience?
A 25-year-old female patient is diagnosed with Myasthenia Gravis (MG). Based on epidemiological data, which of the following symptoms is she MOST likely to initially experience?
A patient with MG is prescribed a beta blocker for hypertension. What potential risk should the healthcare provider consider when prescribing this medication?
A patient with MG is prescribed a beta blocker for hypertension. What potential risk should the healthcare provider consider when prescribing this medication?
A patient is admitted with suspected cholinergic crisis. After discontinuing the anticholinesterase inhibitor, what additional intervention is MOST crucial?
A patient is admitted with suspected cholinergic crisis. After discontinuing the anticholinesterase inhibitor, what additional intervention is MOST crucial?
A patient with Myasthenia Gravis (MG) is admitted to the emergency department with severe respiratory distress. Which of the following conditions should be the PRIMARY concern?
A patient with Myasthenia Gravis (MG) is admitted to the emergency department with severe respiratory distress. Which of the following conditions should be the PRIMARY concern?
Which of the following medications used for Parkinson's disease is LEAST likely to cause orthostatic hypotension?
Which of the following medications used for Parkinson's disease is LEAST likely to cause orthostatic hypotension?
A patient exhibits symptoms of neuroleptic malignant syndrome. Which of the following medications, if the patient is taking it, should be immediately discontinued and the patient be closely monitored?
A patient exhibits symptoms of neuroleptic malignant syndrome. Which of the following medications, if the patient is taking it, should be immediately discontinued and the patient be closely monitored?
If a patient with Myasthenia Gravis (MG) has muscular weakness that becomes generalized, with the muscles of respiration affected, what is this condition called?
If a patient with Myasthenia Gravis (MG) has muscular weakness that becomes generalized, with the muscles of respiration affected, what is this condition called?
Which of the following drug groups is used to control Myasthenia Gravis (MG)?
Which of the following drug groups is used to control Myasthenia Gravis (MG)?
What percentage of Myasthenia Gravis (MG) patients have thymic hyperplasia?
What percentage of Myasthenia Gravis (MG) patients have thymic hyperplasia?
A patient diagnosed with Myasthenia Gravis (MG) is prescribed acetylcholinesterase inhibitors. What is the PRIMARY mechanism of action of these medications?
A patient diagnosed with Myasthenia Gravis (MG) is prescribed acetylcholinesterase inhibitors. What is the PRIMARY mechanism of action of these medications?
A patient with Alzheimer's disease is prescribed donepezil. Which instruction regarding dietary considerations is most appropriate for the nurse to provide to the family?
A patient with Alzheimer's disease is prescribed donepezil. Which instruction regarding dietary considerations is most appropriate for the nurse to provide to the family?
A patient taking memantine for Alzheimer's disease develops a rash and flu-like symptoms. What is the nurse's priority action?
A patient taking memantine for Alzheimer's disease develops a rash and flu-like symptoms. What is the nurse's priority action?
A patient with moderate Alzheimer's disease is prescribed rivastigmine. What is the most important assessment the nurse should make prior to initiating therapy?
A patient with moderate Alzheimer's disease is prescribed rivastigmine. What is the most important assessment the nurse should make prior to initiating therapy?
A patient has been taking donepezil for Alzheimer's disease for several weeks. Which assessment finding would indicate a potential adverse effect of this medication?
A patient has been taking donepezil for Alzheimer's disease for several weeks. Which assessment finding would indicate a potential adverse effect of this medication?
Which outcome indicates that drug therapy for Alzheimer's disease has been effective?
Which outcome indicates that drug therapy for Alzheimer's disease has been effective?
A patient is being switched from immediate-release memantine to extended-release memantine. What is an important consideration for the nurse when educating the patient about this change?
A patient is being switched from immediate-release memantine to extended-release memantine. What is an important consideration for the nurse when educating the patient about this change?
When administering an acetylcholinesterase inhibitor to a patient with Alzheimer's disease, the nurse anticipates which intended effect?
When administering an acetylcholinesterase inhibitor to a patient with Alzheimer's disease, the nurse anticipates which intended effect?
A patient is prescribed rivastigmine for Alzheimer's disease. Which of the following instructions should the nurse include in the patient's education?
A patient is prescribed rivastigmine for Alzheimer's disease. Which of the following instructions should the nurse include in the patient's education?
A patient with Parkinson's Disease (PD) is experiencing rigidity and tremors. Which category of drugs would be MOST appropriate to address these specific symptoms, according to the provided information?
A patient with Parkinson's Disease (PD) is experiencing rigidity and tremors. Which category of drugs would be MOST appropriate to address these specific symptoms, according to the provided information?
Which of the following interventions focuses on improving both physical mobility/flexibility and promoting psychosocial well-being for individuals with Parkinson's Disease (PD)?
Which of the following interventions focuses on improving both physical mobility/flexibility and promoting psychosocial well-being for individuals with Parkinson's Disease (PD)?
A researcher is studying the effects of a new drug on Parkinson's Disease (PD). The drug aims to prevent the breakdown of dopamine in the brain. Which enzyme would this drug MOST likely target?
A researcher is studying the effects of a new drug on Parkinson's Disease (PD). The drug aims to prevent the breakdown of dopamine in the brain. Which enzyme would this drug MOST likely target?
A patient with Parkinson's Disease (PD) is considering using medical marijuana to manage their symptoms. What potential risk should the healthcare provider discuss with the patient, based on the information provided?
A patient with Parkinson's Disease (PD) is considering using medical marijuana to manage their symptoms. What potential risk should the healthcare provider discuss with the patient, based on the information provided?
Which pharmacological approach aims to directly stimulate dopamine receptors in the brain, mimicking the effects of natural dopamine?
Which pharmacological approach aims to directly stimulate dopamine receptors in the brain, mimicking the effects of natural dopamine?
A patient newly diagnosed with Parkinson's Disease (PD) asks about non-pharmacological ways to manage their symptoms. Which combination of lifestyle adjustments would be MOST beneficial?
A patient newly diagnosed with Parkinson's Disease (PD) asks about non-pharmacological ways to manage their symptoms. Which combination of lifestyle adjustments would be MOST beneficial?
How do anticholinergic drugs alleviate some Parkinson's Disease (PD) symptoms?
How do anticholinergic drugs alleviate some Parkinson's Disease (PD) symptoms?
Which of the following drug categories disrupts dopamine activity by occupying dopamine receptor sites without activating them?
Which of the following drug categories disrupts dopamine activity by occupying dopamine receptor sites without activating them?
Why was levodopa initially effective in managing Parkinson's disease symptoms?
Why was levodopa initially effective in managing Parkinson's disease symptoms?
What is the primary reason for combining carbidopa with levodopa in treating Parkinson's disease?
What is the primary reason for combining carbidopa with levodopa in treating Parkinson's disease?
Levodopa requires high doses for therapeutic effect because:
Levodopa requires high doses for therapeutic effect because:
Which of the following side effects is NOT commonly associated with high doses of levodopa?
Which of the following side effects is NOT commonly associated with high doses of levodopa?
How does carbidopa enhance the effectiveness of levodopa?
How does carbidopa enhance the effectiveness of levodopa?
Which property correctly describes apomorphine?
Which property correctly describes apomorphine?
What is a primary disadvantage of using apomorphine for managing Parkinson's disease?
What is a primary disadvantage of using apomorphine for managing Parkinson's disease?
How does the introduction of carbidopa typically affect the dosage requirements and side effect profile of levodopa?
How does the introduction of carbidopa typically affect the dosage requirements and side effect profile of levodopa?
Flashcards
Nonpharmacologic PD Measures
Nonpharmacologic PD Measures
Non-drug methods like exercise, diet, education, and support groups used to manage PD symptoms.
PD Drug Categories
PD Drug Categories
Medications that boost dopamine (DA) activity in the brain, classified into several categories.
Anticholinergics
Anticholinergics
Drugs that boost dopamine effects by reducing acetylcholine (ACh) influence.
Dopaminergic Replacement Therapy
Dopaminergic Replacement Therapy
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Dopamine Agonists
Dopamine Agonists
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MAO-B Inhibitors
MAO-B Inhibitors
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COMT Inhibitors
COMT Inhibitors
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Dopamine Antagonists
Dopamine Antagonists
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Consistency in Care
Consistency in Care
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Drug Regimen Effectiveness
Drug Regimen Effectiveness
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Donepezil Use
Donepezil Use
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Donepezil Side Effects
Donepezil Side Effects
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Memantine Use
Memantine Use
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Memantine Side Effects
Memantine Side Effects
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Ambulation
Ambulation
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Assisting with Ambulation and Activity
Assisting with Ambulation and Activity
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Entacapone
Entacapone
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Tolcapone
Tolcapone
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Amantadine
Amantadine
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Istradefylline
Istradefylline
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Dyskinesia
Dyskinesia
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Neuroleptic Malignant Syndrome (NMS)
Neuroleptic Malignant Syndrome (NMS)
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Orthostatic Hypotension
Orthostatic Hypotension
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Serotonin Syndrome
Serotonin Syndrome
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Thymic Hyperplasia (MG)
Thymic Hyperplasia (MG)
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Thymectomy (MG)
Thymectomy (MG)
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Myasthenia Gravis (MG)
Myasthenia Gravis (MG)
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Ptosis (MG)
Ptosis (MG)
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Diplopia (MG)
Diplopia (MG)
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Dysphagia (MG)
Dysphagia (MG)
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Dysarthria (MG)
Dysarthria (MG)
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Myasthenic Crisis
Myasthenic Crisis
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Dopaminergics
Dopaminergics
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Levodopa
Levodopa
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Dopa Decarboxylase
Dopa Decarboxylase
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Carbidopa
Carbidopa
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Carbidopa-Levodopa
Carbidopa-Levodopa
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Levodopa Side Effects
Levodopa Side Effects
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Apomorphine
Apomorphine
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"Off" Episodes
"Off" Episodes
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Neostigmine
Neostigmine
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Cholinergic Crisis
Cholinergic Crisis
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Neuromuscular Blockade (in Cholinergic Crisis)
Neuromuscular Blockade (in Cholinergic Crisis)
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Miosis
Miosis
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Fasciculations
Fasciculations
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Pyridostigmine
Pyridostigmine
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Medications Exacerbating Myasthenia Gravis
Medications Exacerbating Myasthenia Gravis
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Study Notes
Drugs for Parkinsonism and Alzheimer Disease
- Parkinson's disease (PD) and Alzheimer's disease (AD) are common neurological disorders
- Antiparkinson drugs have various side effects
Parkinson's Disease
- PD is a chronic, progressive neurological disorder affecting the extrapyramidal motor tract
- Impacts posture, balance, and locomotion
Parkinsonism Symptoms
- Parkinsonism is a syndrome with features such as rigidity (increased muscle tone)
- Bradykinesia (slow movement), gait disturbances, and tremors
Parkinson's Disease Progression
- Rigidity increases with movement
- Postural changes include a forward-thrust chest and head, flexed knees and hips, shuffling gait, and absence of arm swing
- Other symptoms include masked facies, head and neck tremors, and pill-rolling motions of the hands
- Tremors are more prevalent at rest
Incidence of PD
- James Parkinson first described it in 1817 as "shaking palsy"
- Characterized by involuntary tremors, muscle rigidity, and slow movement
- Approximately 1 million people in the United States have PD
- Annually, 60,000 new cases are diagnosed
- PD generally affects individuals aged 50 to 60 and older
- Men are more prone to PD than women
Development of PD
- It is a long-term (chronic) and progressive condition
- Results from a loss of neurons in the substantia nigra
- The substantia nigra produces dopamine (DA), a neurotransmitter crucial for controlling movement
- As PD worsens, less DA is made, leading to difficulty in controlling movement
Cardinal symptoms of PD
- Rigidity
- Tremors
- Gait disturbance
- Bradykinesia
Early Symptoms of PD
- Gradual onset and are typically mild and unilateral initially but worsen over time
Extrapyramidal Symptoms
- Certain drugs, like neuroleptics, can cause parkinsonism and extrapyramidal symptoms
- Lack of dopamine can mimic idiopathic pathologies of the extrapyramidal system
- Symptoms include acute dyskinesias, dystonic reactions, tardive dyskinesia, parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome
Nonpharmacologic measures for treating PD
- Nonpharmacologic measures can lessen Symptoms
- Patient teaching, exercise, nutrition, and group support can help
- Exercise improves mobility and flexibility
- Patients should enroll in a therapeutic exercise program tailored to this disorder
- A balanced diet with fiber and fluids helps prevent constipation and weight loss
- Support groups can aid patients and families in coping with and understanding the disorder
Medical Cannabis and PD
- Medical cannabis (marijuana) is legalized in many states, but its benefits for PD are not definitively proven
- Cannabis may impair executive function (planning and limiting risky behavior)
- Caution is advised when using cannabis with PD
Pathophysiology of Parkinson's
- Imbalance of dopamine (DA) and acetylcholine (ACh) and degeneration of neurons in the extrapyramidal (motor) tract in the substantia nigra
- Reason for the degeneration is unknown; genetics and environmental factors may play a role.
- DA is an inhibitory neurotransmitter and ACh is an excitatory neurotransmitter
- DA maintains control of ACh and inhibits its excitatory response
- In PD, degeneration of dopaminergic neurons leads to an imbalance where ACh's excitatory response exceeds DA's inhibitory control
Result of DA and ACh Imbalance
- Excessive ACh stimulates neurons that release gamma-aminobutyric acid (GABA)
- Increased GABA stimulation leads to symptomatic movement disorders in PD
- Levodopa helps synthesize DA from levodopa and releases DA as needed
- Before next dose of levodopa, symptoms such as slow walking and loss of dexterity return or worsen
- Patients will have improved functioning in 30 to 60 minutes of recieving a dose
Drug Therapies for PD
- Aim to replace deficit DA and reduce symptoms
- Medications fall into five categories:
- Anticholinergics: Enhance DA effects by reducing ACh effects
- Dopaminergic replacement therapy: Boost DA production in the brain
- Dopamine agonists: Mimic DA effects by directly stimulating DA receptors
- Monoamine oxidase B (MAO-B) inhibitors: Block DA inactivation in the brain
- Catechol-O-methyltransferase (COMT) inhibitors: Inhibit COMT enzyme that inactivates DA
- Dopamine Antagonists: disrupt the activity of DA by blocking DA receptor sites without activating them.
Anticholinergics for PD
- They increase the effects of DA in the brain by reducing the effects of ACh
- They reduce rigidity and tremors but have minimal effect on bradykinesia
- They are parasympatholytics that inhibit the release of ACh
- Useful for treating drug-induced parkinsonism (pseudoparkinsonism) caused by antipsychotic phenothiazines
- Trihexyphenidyl and benztropine is useful for PD
Dopaminergics
- Used to treat symptoms of PD and parkinsonism
- Carbidopa, a decarboxylase inhibitor, helps more levodopa reach the striatum nerve terminals, where it's converted to dopamine
- With carbidopa, less levodopa is needed, so side effects decrease
Alzheimer Disease
- It is a chronic, progressive, neurodegenerative disorder involving cognitive dysfunction and changes in behavior.
Symptoms of Alzheimer's
- Cognitive dysfunction includes impairments in memory, reasoning, language, and perception
Potential causes of Alzheimer's
- Various theories about its cause:
- Neuritic plaques (senile plaques)
- Degeneration of cholinergic neurons
- Deficiency in acetylcholine (ACh)
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Description
Questions about Myasthenia Gravis (MG) and Parkinson's Disease (PD) medications. Includes pyridostigmine, levodopa/carbidopa, and amantadine. Explore the mechanisms, side effects, and management of these conditions.