NURS Exam 3 Prep - The Nervous System Drugs for Degenerative Diseases of the Nervous System and Drugs for Muscle Spasms and Spasticity

What leads to dementia?

cellular degeneration and abnormalities of brain tissue

What leads to Parkinson’s disease?

damage to dopamine producing area of the brain (substantia nigra)

What leads to multiple sclerosis?

demyelination in the CNS

What is ischemia?

loss of normal blood flow within the brain 

What leads to ischemia?

narrowing or blockage of blood vessels (ischemic stroke) 

What are the 4 major degenerative neurological disorders?

alzheimer’s disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis, parkinson’s disease

What is amyotropic lateral sclerosis (ALS)?

a degenerative disease of motor neurons resulting in progressive weakness and atrophy of skeletal muscles

What does it mean to be degenerative?

a disease in which the function or structure of affected tissues or organs changes for the wrose over time

What is sclerosis?

abnormal hardening of body tissue 

Whaat is amyotrophic?

the loss of signals neurons normally send to muscle cells

What does parkinson’s disease result from?

progressive loss of dopamine in the CNS (substantia nigra/corpus striatum)

What are manifestations of parkinson’s disease?

tremors, muscle rigidity, bradykinesia, postural instability, affective flattening

What are tremors?

particularly of the hands/head; pill rolling tremor at rest 

What is muscle rigidity?

stiffness, may appear like arthritis

What is bradykinesia?

slowing of movement, difficulty chewing/swalloing/speaking; shuffling gait

What is postural instability?

stooped posture with balance issues

What is affective flattening?

loss of facial expression, masked face

What symptoms do patients with parkinson’s disease exhibit?

anxiety/depression, sleep disturbance, dementia, disturbances of the ANS

What are disturbances of the ANS?

urinary retention, constipation, sexual dysfunction 

Who does Parkinson’s affect more?

men; starts usually after age 50, genetics plays a role, perhaps an environmental toxin

What is secondary Parkinsonism?

symptoms of parkinson’s disease due to other causes

What are causes of secondary parkinsonism?

head trauma, brain infection/tumor, neurotoxin exposure, or antipsychotic drugs (EPS)

What are the classes of medication use to treat parkinson’s disease?

dopamine agonist, MAO-B inhibitors, anticholinergic medications 

What dopamine agonist treats parkinson’s disease?

levodopa-carbidopa

What are common side effects of levodopa-carbidopa?

weight loss, GI upset, constipation, orthostatic hypotension, dizziness, choreiform movements

What are serious adverse events of levodopa-carbidopa?

MI, NMS, EPS, suicidality, agranulocytosis, liver damage

What MAO-B inhibitors and other enzyme inhibiting drugs treat parkinson’s disease?

entacapone, selegiline

What are common side effects of entacapone and rasagiline?

nausea & vomiting, HA, joint/muscle pain, constipation, dry mouth, confusion

What are serious adverse events of entacapone and rasagiline?

hallucinations, hepatotoxicity, seizures, numbness

What anticholinergic medications treat parkinson’s disease?

benztropine

What are common side effects of benztropine?

sedation, constipation, dry mouth 

What are serious adverse events of benztropine?

paralytic ileus, CV arrest, balance disturbance, hallucinations

What is dementia?

a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes, and impaired reasoning

By the age of 85 how many people have alzheimer’s disease?

half of the population

What is alzheimer’s disease responsible for?

70% of all dementias 

What forms during brain damage?

amyloid plaques and neurofibrillary tangles

What can medications for alzheimer’s disease result in?

slow progression of the disease if started early in the course of the illness

What are available alzheimer’s disease treatments?

cholinesterase inhibitors and glutaminergic inhibitors

What are cholinesterase inhibitors?

intensify the effect of acetylcholine

What cholinesterase inhibitors treat alezheimer’s disease?

donepezil, galantamine, rivastigamine

What are common side effects of donepezil, galantamine, and rivastigmine?

HA, dizziness, insomnia, N & V, diarrhea, loss of appetite, muscle cramps

What are serious adverse events of donepezil, galantamine, rivastigmine?

liver and kidney toxicity, heart block, anorexia

What are glutaminergic inhibitors?

reduces high levels of glutamate 

What are common side effects of glutaminergic inhibitors used to treat alzheimers?

dizziness, HA, GI upset, confusion

What are serious adverse events of glutaminergic inhibitors used to treat alzheimer’s?

Steven Johnson Syndrome

What is multiple sclerosis?

chronic inflammatory/autoimmune disorder; antibodies damage myelin (proteins and phospholipids that ocat and insulate nerve fibers)

Who is diagnosed with multiple sclerosis?

in young adulthood; women are affected slightly mroe often than men 

What are the forms of multiple sclerosis?

relapsing-remitting, progressive-relapsing, secondary-progressive, primary-progressive

What is relapsing-remitting MS?

(most common) characterized by acute exacerbations with full recovery

What is progressive-relapsing MS?

(least common) characterized by progressive disability with clear, acute relapses

What is secondary-progressive MS?

starts as relapsing-remitting followed by progressive disability 

What is primary-progressive MS?

characterized by progression of diability from onset

What are treatments for relapsing forms of MS?

immune modulators (glatiramer) and corticosteroids

What are common side effects of immune modulators?

dizziness, HA, GI upset, flu-like symptoms

What are serious adverse events of immune modulators?

seizures, liver toxicity, SJS, teratogenicity 

What are treatmetns for progressive forms of MS?

immunosuppressants

What are common side effects of immunosuppressants?

N & V, fever, increased risk of infection

What are serious adverse events of immunosuppressants,

cardiotoxicity and meylosupression

Which neurological disorders originate outside the CNS?

ALS, myasthenia gravis, peripheral neuropathies

What is ALS?

considered a degenerative motor neuron disease

What is affected in ALS?

both upper and lower motor neurons 

What is myasthenia gravis?

occurs at neuromuscular junctions; autoimmune antibodies form against post synaptic acetylcholine receptors

What do peripheral neuropathies result in?

sensory dysfunctions; related to diabetes

What are causes of peripheral neuropathy?

trauma and injury

What is asymmetric progressive weakness?

clinical signs include flaccid weakness with muscle atrophy, spastic weakness with hyperreflexia, muscles of the legs and oropharynx affected 

What are FDA approved medications to treat ALS?

edaravone, riluzole

How is riluzole taken?

daily by mouth

What is riluzone?

works by decreasing glutamate in the CNS and extends survival patients with ALS

What are serious adverse events of riluzole?

seizures 

What are common side affects of riluzole?

headache, dizziness, confusion, anxiety, hypotensions, and edema

When is edaravone taken?

intravenously in cycles of 10-14 days with a 2-week drug holiday between infusions

What is edaravone?

slows the decline in daily functioning in patients with ALS

What are common side effects of edaravone?

bruising, headache, and mobility difficulties

What is dysphagia?

difficulty swallowing 

What is odynophagia?

pain on swallowing; breach in mucosal integrity by trauma, infection, and inflammation

What is the rule of an upper endoscopy?

rule out mucosal abnormalities such as strictures, webs, maligancies, infections, and eosinophilic esophagitis

What is a full-column barium swallow?

may reveal muscular rings, which are often missed on endoscopy

What does dysphagia result from?

dysfunction of the esophageal body, bolus becomes “stuck”  or “hung up” on the way donw 

What are associated symptoms of dysphagia?

regurgitation and chest pain

What is dysphagia considered?

mechanical

What factor is associated with dysphagia?

poor oral bolus preparation and control, difficulty in intitiating a swallow, nasal and oral regurgitation, aspiration and coughing with swallowing, food sticking at the level of the throat

What can dysphagia result from?

generalized neuromuscular disorder such as prior CVA, MS, Parkinon’s disease 

What is dysphagia called when due to a neuromuscular disorder?

functional

What is dysarthria?

slow, slurred speech

What is dysphonia?

disorder of the voice

What are the major complications of oropharngeal dysphagia?

fatal pulmonary aspiration and pneumonia, malnutrition, and weight loss 

What is barium study and esophageal manometry?

measures the strength & muscle coordination of swallowing

What are treatments of dysphagia?

speech and swallow therapist, radiologist, gastroenterologsit, otolaryngologist, and neurologist

What do deglutitionists assess?

the risk of aspiration, certain rehabilitative exercisees to strengthen swallowing muscles may be helpful 

What is an alternative to oral feeding?

percutaneous endoscopic gastrostomy (PEG) tube (G-tube or J-tube) 

What are muscle spasms?

involuntary contractions of a skeletal muscle or group of skeletal muscles

What is a spasm associated with?

overuse or injury to a skeletal muscle

What is muscle spasticity?

refers to a condition in which muscle groups remain in a continous state of contraction

What is spasticity associated with?

disorders affecting motor areas of the cerebral cortex

What are other causes of muscle spasms?

medication, epilepsy, electrolyte disturbance/dehyrdation, neurological disorders, impaired circulation 

What medications affect muscle spasms?

antipsychotic medications/drugs for high cholesterol (statins)

What neurological disorders affect muscle spasms?

cerebral palsy, spinal cord injury, stroke (CVA), other neurodegenerative diseases

What are muscle relaxers?

drugs which inhibit mono and polsynapses in the spine (spinal reflexes)

Which drugs inhibit mono and polysynapses in the spine (spinal reflexes)?

baclofen/lioresal, chlorszoxazone

Which drugs act as central nervous system depressants?

carisoprodol, metaxalone, methocarbamon, benzodiazepines