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medications administered for chronic Neurologic Disorders are used to___symptoms and___quality of life.
manage improve
chronic Neurologic disorders include:
myasthenia gravis
Parkinson's disease
seizures disorder myasthenia gravis: causes weakness of voluntary skeletal muscles.
medication for chronic Neurologic disorders are classified as:
cholinesterase inhibitors anti Parkinson's antiepileptics
cholinesterase inhibitors
select prototype medication: neostigmine (prostigmin) other medication: ambenonium (mytelase) physostigmine (antilirium) edrophonium (tensilon)
cholinesterase inhibitors prevent the enzyme___from inactivating___thereby increasing the amount of ACh available at receptor sites. transmission of nerve impulses is increased at all sites responding to ACh as a transmitter.
cholinesterase(ChE) acetylcholine(ACh)
neostigmine (prostigmin) ambenonium (mytelase) physostigmine (antilirium)
treatment of myastthenia gravis
edrophonium (tensilon)
diagnosis of myasthenia gravis
neostigmine (prostigmin) physostigmine (antilirium) edrophonium (tensilon)
reversal of nondepolarizing neuromuscular blocking agents.
complications of cholinesterase inhibitors
select prototype medication: neostigmine (prostigmin) other medication: ambenonium (mytelase) physostigmine (antilirium) edrophonium (tensilon)
excessive muscarine stimulation as evidenced by:
GI motility increased GI secretions bradycardia urinary urgency
these side effects can be treated with___.
atropine
cholinergic crisis:
excessive muscarinic stimulation and respiratory depression from neuromuscular blockade.
muscarinic effects can be treated with___. provide respiratory support through mechanical ventilation and oxygen.
atropine
contraindications/precautions
cholinestirase inhibitors
cholinesterase inhibitors are pregnancy risk category___.
c
cholinesterase inhibitors are contraindicated in clients with:
obstruction of GI and GU system.
use neostigmine(prostigmin) cautiously in clients with:
seizure disorders
hyperthyroidism
peptic ulcer disease
asthma
bradycardia
hypotension
cholinesterase inhibitors interactions
medication and food interaction
___counteracts the effects of___.
atropine neostigmine (prostigmine)
atropine is used to treat neostigmine toxicity.
monitor the client closely and provide mechanical ventilation until the client has regained full muscle function.
___reverses neuromuscular blockade caused by neuromuscular blocking agents after surgical procedures and overdose.
neostigmine (prostigmin)
continue.. nursing intervention..
monitor the client for return of respiratory function. support respiratory function as necessary. if used to treat overdose, provide mechanical ventilation until the client has regained full muscle function.
___increases neuromuscular blockade. avoid concurrent use.
succinylcholine
advise clients that dosage is very individualized. start at___, and is titrated until desired muscle function is achieved.
very low doses
encourage clients to participate in self dosage adjustments. this can be accomplished by having the client:
keep records of medication administration and effects. recognize signs of inadequate dosing, such as difficulty swallowing and signs of overmedication, such as urinary urgency. modify dosage based on response.
antiparkinsons medication.
select prototype medication: dopaminergics: levodopa (dopar, larodopa) or levodopa plus carbidopa (sinemet). dopamine agonists: pramipexole (mirapex). centrally acting anticholinergics: benztropine (cogentin). dopamine releaser (antiviral): amantadine (symmetrel).
antiparkinsons medication continued:
other medication: dopamine agonists: ropinirole (requip), bromocriptine (parlodel). centrally acting anticholinergics: trihexyphenidyl (artane).
antiparkinsons medication do NOT HALT the progression of ___.
Parkinson's disease.
however, antiparkinsons medication offers symptomatic relief from dyskinesias(___)and an increase in the ability to perform ADLs by maintaining the balance between___&___in the extrapyramidal nervous system.
(bradykinesia, resting tremors, and muscle rigidity) dopamine acetylcholine
dopaminergics:
levodopa carbidopa
___crosses the blood brain barrier and is taken up by___nerve terminals and converted to___. this newly synthesized DA is released into the synaptic space and causes stimulation of DA receptors.
levodopa dopaminergic dopamine DA
___is used to augment levodopa by decreasing the amount of levodopa that is converted to DA in the intestine and periphery. this results in greater amounts of levodopa reaching the CNS.
carbidopa (sinemet)
dopamine agonists:
pramipexole (mirapex)
dopamine agonists agents act directly on___.
DA receptors.
centrally acting anticholinergics:
benxotropine (cogentin)
centrally acting anticholinergics agents block___at muscarinic receptors, which assist in maintaining balance between___&___in the brain.
acetylcholine dopamine acetylcholine
dopamine releaser (antiviral):
amantadine (symmetrel)
antivirals stimulate___release, preventing dopamine reuptake, and may block cholinergic and glutamate receptors.
DA(dopamine)
___may be used as a first line medication for PD treatment.
levodopa
___is used as monotherapy in early stage PD and used in conjunction with___in late stage PD. it is used more often in younger clients who are better able to tolerate day time drowsiness and postural hypotension.
pramipexole (mirapex) levodopa
Dopaminergics side effects
levodopa (usually dose dependant)
nausea, vomiting, drowsiness
administer with food, and in small doses and at the start of treatment.
dyskinesias (head bobbing, tics, grimacing, tremors)
decrease dosage. the decrease may result in resumption of PD symptoms.
orthostatic hypotension
monitor blood pressure. lie or sit. get up slowly.
cardiovascular effects from beta1 stimulation(tachycardia, palpitations, irregular heartbeat).
monitor vitals. monitor ECG. notify provider. use cautiously in those who have cardiovascular disorders.
psychosis (visual hallucinations, nightmares)
administer antipsychotic medication as prescribed.
discoloration of sweat and urine.
advice clients that this is a harmless side effect.
activation of malignant melanoma.
avoid use of medication in clients who have skin lesions that have not been diagnosed.
dopamine agonists side effects
pramipexole (mirapex)
sudden inability to stay awake.
notify provider immediately if this occurs.
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