NUR 210 PHARMACOLOGY UNIT 5 CHAPTER 20-21
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Questions and Answers

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?

  • Levodopa
  • Tolcapone
  • Amantadine
  • Istradefylline (correct)

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?

<p>They possess neuromuscular blocking effects. (D)</p> Signup and view all the answers

Which of the following medications used for Parkinson's Disease has a black box warning for hepatotoxicity?

<p>Tolcapone (A)</p> Signup and view all the answers

A geriatric patient is started on amantadine for Parkinson's disease. What is the generally recommended initial dose?

<p>100 mg daily (B)</p> Signup and view all the answers

A patient with MG is suspected of having a cholinergic crisis. Which of the following signs and symptoms would the nurse expect to observe?

<p>Miosis, excessive salivation, and muscle fasciculations. (B)</p> Signup and view all the answers

Which of the following is the MOST likely physiological mechanism behind the effectiveness of thymectomy in treating Myasthenia Gravis (MG)?

<p>It reduces the production of autoantibodies that attack acetylcholine receptors. (C)</p> Signup and view all the answers

A patient taking a monoamine oxidase inhibitor (MAOI) is diagnosed with Parkinson's disease. Which of the following medications is contraindicated?

<p>Levodopa (B)</p> Signup and view all the answers

A patient in myasthenic crisis is being treated with neostigmine. What is the most critical assessment the nurse should prioritize?

<p>Assessing respiratory rate and depth. (A)</p> Signup and view all the answers

Which of the following medications used in Parkinson's disease treatment, when abruptly discontinued, requires a titration period to avoid potential complications?

<p>Amantadine (D)</p> Signup and view all the answers

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?

<p>Increasing the dose of acetylcholinesterase (AChE) inhibitors. (A)</p> Signup and view all the answers

How does a cholinergic crisis lead to muscle weakness and potential respiratory paralysis?

<p>By continuously depolarizing postsynaptic membranes, leading to neuromuscular blockade. (B)</p> Signup and view all the answers

A patient on levodopa is experiencing excessive daytime sleepiness. Which of the following medications, when added to their regimen, may exacerbate this side effect?

<p>Tolcapone (C)</p> Signup and view all the answers

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?

<p>Drooping eyelids (ptosis) and double vision (diplopia). (D)</p> Signup and view all the answers

A patient with MG is prescribed a beta blocker for hypertension. What potential risk should the healthcare provider consider when prescribing this medication?

<p>Exacerbation of myasthenia gravis symptoms. (C)</p> Signup and view all the answers

A patient is admitted with suspected cholinergic crisis. After discontinuing the anticholinesterase inhibitor, what additional intervention is MOST crucial?

<p>Providing continuous cardiac monitoring for bradycardia. (D)</p> Signup and view all the answers

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?

<p>Myasthenic crisis due to inadequate dosing of AChE inhibitors. (A)</p> Signup and view all the answers

Which of the following medications used for Parkinson's disease is LEAST likely to cause orthostatic hypotension?

<p>Istradefylline (A)</p> Signup and view all the answers

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?

<p>Levodopa (B)</p> Signup and view all the answers

If a patient with Myasthenia Gravis (MG) has muscular weakness that becomes generalized, with the muscles of respiration affected, what is this condition called?

<p>Myasthenic crisis (C)</p> Signup and view all the answers

Which of the following drug groups is used to control Myasthenia Gravis (MG)?

<p>Acetylcholinesterase (AChE) inhibitors (C)</p> Signup and view all the answers

What percentage of Myasthenia Gravis (MG) patients have thymic hyperplasia?

<p>Approximately 70% (A)</p> Signup and view all the answers

A patient diagnosed with Myasthenia Gravis (MG) is prescribed acetylcholinesterase inhibitors. What is the PRIMARY mechanism of action of these medications?

<p>Inhibiting the breakdown of acetylcholine in the synaptic cleft. (C)</p> Signup and view all the answers

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?

<p>Provide foods that are easily digestible due to potential gastrointestinal side effects. (C)</p> Signup and view all the answers

A patient taking memantine for Alzheimer's disease develops a rash and flu-like symptoms. What is the nurse's priority action?

<p>Hold the next dose of memantine and notify the healthcare provider immediately. (C)</p> Signup and view all the answers

A patient with moderate Alzheimer's disease is prescribed rivastigmine. What is the most important assessment the nurse should make prior to initiating therapy?

<p>Evaluate the patient's history of peptic ulcer disease. (D)</p> Signup and view all the answers

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?

<p>Heart rate of 52 bpm. (C)</p> Signup and view all the answers

Which outcome indicates that drug therapy for Alzheimer's disease has been effective?

<p>Stabilization of cognitive decline. (C)</p> Signup and view all the answers

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?

<p>The dosage of the extended-release formulation will be lower initially and gradually increased. (C)</p> Signup and view all the answers

When administering an acetylcholinesterase inhibitor to a patient with Alzheimer's disease, the nurse anticipates which intended effect?

<p>Enhanced cognitive function and memory. (C)</p> Signup and view all the answers

A patient is prescribed rivastigmine for Alzheimer's disease. Which of the following instructions should the nurse include in the patient's education?

<p>Report any significant changes in weight to the healthcare provider. (A)</p> Signup and view all the answers

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?

<p>Anticholinergics (B)</p> Signup and view all the answers

Which of the following interventions focuses on improving both physical mobility/flexibility and promoting psychosocial well-being for individuals with Parkinson's Disease (PD)?

<p>Enrollment in a therapeutic exercise program and attending a support group (B)</p> Signup and view all the answers

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?

<p>Monoamine oxidase B (MAO-B) (D)</p> Signup and view all the answers

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?

<p>Exacerbation of impaired executive function (B)</p> Signup and view all the answers

Which pharmacological approach aims to directly stimulate dopamine receptors in the brain, mimicking the effects of natural dopamine?

<p>Dopamine agonists (C)</p> Signup and view all the answers

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?

<p>Balanced diet with fiber and fluids, and regular exercise (D)</p> Signup and view all the answers

How do anticholinergic drugs alleviate some Parkinson's Disease (PD) symptoms?

<p>By reducing the effects of acetylcholine, thus increasing the relative influence of dopamine (D)</p> Signup and view all the answers

Which of the following drug categories disrupts dopamine activity by occupying dopamine receptor sites without activating them?

<p>Dopamine antagonists (C)</p> Signup and view all the answers

Why was levodopa initially effective in managing Parkinson's disease symptoms?

<p>Levodopa is converted to dopamine in the brain and can cross the blood-brain barrier, unlike dopamine itself. (D)</p> Signup and view all the answers

What is the primary reason for combining carbidopa with levodopa in treating Parkinson's disease?

<p>To prevent the conversion of levodopa to dopamine in the periphery, thus reducing side effects and increasing the levodopa available to the brain. (A)</p> Signup and view all the answers

Levodopa requires high doses for therapeutic effect because:

<p>Most of the drug is converted to dopamine in the peripheral system before it can reach the brain. (D)</p> Signup and view all the answers

Which of the following side effects is NOT commonly associated with high doses of levodopa?

<p>Increased salivation (A)</p> Signup and view all the answers

How does carbidopa enhance the effectiveness of levodopa?

<p>By inhibiting dopa decarboxylase in the periphery, reducing levodopa's conversion to dopamine outside the brain. (A)</p> Signup and view all the answers

Which property correctly describes apomorphine?

<p>A dopamine receptor agonist used for acute management of 'off' episodes in advanced Parkinson's disease. (C)</p> Signup and view all the answers

What is a primary disadvantage of using apomorphine for managing Parkinson's disease?

<p>It needs to be administered via subcutaneous injection due to its formulation and rapid metabolism. (C)</p> Signup and view all the answers

How does the introduction of carbidopa typically affect the dosage requirements and side effect profile of levodopa?

<p>Decreases the required levodopa dosage and reduces side effects. (C)</p> Signup and view all the answers

Flashcards

Nonpharmacologic PD Measures

Non-drug methods like exercise, diet, education, and support groups used to manage PD symptoms.

PD Drug Categories

Medications that boost dopamine (DA) activity in the brain, classified into several categories.

Anticholinergics

Drugs that boost dopamine effects by reducing acetylcholine (ACh) influence.

Dopaminergic Replacement Therapy

Therapy that attempts to replace missing dopamine in the brain.

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Dopamine Agonists

Drugs that act like dopamine by directly activating dopamine receptors.

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MAO-B Inhibitors

Drugs that prevent the breakdown of dopamine in the brain.

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COMT Inhibitors

Drugs that block the COMT enzyme, preventing dopamine breakdown.

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Dopamine Antagonists

Drugs that disrupt dopamine by blocking receptor sites without activating them.

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Consistency in Care

Ensuring consistent approaches in patient care activities.

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Drug Regimen Effectiveness

Evaluating if the drug is improving the patient's mental and physical state.

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Donepezil Use

Used for mild to moderate Alzheimer's; watch for GI side effects.

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Donepezil Side Effects

Diarrhea, headache, infection, vomiting, nausea, dizziness

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Memantine Use

Alzheimer's drug; watch for rash, dizziness, confusion, and GI issues.

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Memantine Side Effects

Rash, dizziness, confusion, GI issues

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Ambulation

Ambulation refers to the ability to walk or move around.

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Assisting with Ambulation and Activity

Helping a patient walk or engage in physical activities to maintain or improve mobility.

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Entacapone

Medication used for Parkinson's Disease (PD); contraindicated with MAOIs and pheochromocytoma.

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Tolcapone

Medication for PD; can cause dyskinesia and hepatotoxicity.

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Amantadine

Medication used for Parkinson's Disease (PD) and drug-induced extrapyramidal symptoms.

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Istradefylline

As add-on treatment to levodopa and carbidopa in adult PD patient in experiencing “off” episodes

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Dyskinesia

Involuntary, erratic, writhing movements, often a side effect of Parkinson's medications.

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Neuroleptic Malignant Syndrome (NMS)

A dangerous reaction to neuroleptic drugs, causing fever, muscle rigidity, and altered mental status.

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Orthostatic Hypotension

Low blood pressure that occurs when standing up.

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Serotonin Syndrome

A life-threatening condition caused usually by reaction to MAOI and/or other serotonergic medications.

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Thymic Hyperplasia (MG)

Enlargement of the thymus gland, common in MG patients.

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Thymectomy (MG)

Surgical removal of the thymus gland. Can reduce MG symptoms.

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Myasthenia Gravis (MG)

Chronic autoimmune neuromuscular disease causing skeletal muscle weakness and fatigue.

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Ptosis (MG)

Drooping eyelids, a common symptom in MG.

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Diplopia (MG)

Double vision, a common symptom in MG.

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Dysphagia (MG)

Difficulty chewing and swallowing, seen in MG.

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Dysarthria (MG)

Slurred speech, a characteristic of MG.

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Myasthenic Crisis

Severe, generalized muscle weakness including respiratory muscles, caused by inadequate medication or infection.

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Dopaminergics

Drugs that affect dopamine levels or dopamine receptors in the body.

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Levodopa

A precursor to dopamine that can cross the blood-brain barrier; converted to dopamine in the brain.

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Dopa Decarboxylase

Enzyme that converts levodopa to dopamine, found both in the brain and periphery.

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Carbidopa

Inhibits dopa decarboxylase in the periphery, preventing levodopa from being converted to dopamine before it reaches the brain.

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Carbidopa-Levodopa

A combination drug containing both carbidopa and levodopa.

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Levodopa Side Effects

Side effects include nausea, vomiting, dyskinesia, orthostatic hypotension, cardiac dysrhythmias, and psychosis

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Apomorphine

A dopamine agonist derived from morphine, used for acute treatment of 'off' episodes in advanced Parkinson's disease.

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"Off" Episodes

Return of Parkinson's symptoms due to wearing off of medication effects.

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Neostigmine

Rapid-acting AChE inhibitor used to relieve myasthenic crisis by increasing acetylcholine levels at the neuromuscular junction.

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Cholinergic Crisis

Acute exacerbation of myasthenia gravis symptoms due to overdosage of AChE inhibitors.

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Neuromuscular Blockade (in Cholinergic Crisis)

Continuous depolarization of postsynaptic membranes which creates a neuromuscular blockade.

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Miosis

Abnormal constriction of the pupils.

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Fasciculations

Involuntary muscle twitching.

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Pyridostigmine

An intermediate-acting AChE inhibitor used to treat myasthenia gravis. It enhances nerve impulse transmission.

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Medications Exacerbating Myasthenia Gravis

Drugs that can worsen myasthenia gravis symptoms.

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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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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.

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