Module 12: Drugs for Neuromuscular Disease

Neuromuscular junction

It refers to the synaptic connection between the terminal end of a motor nerve and a muscle that serves as the site of transmission for an action potential.

Neuromuscular transmission

This process involves the triggering of acetylcholine by nerve impulses that enable the CNS to control the movement of the muscles.

Dopamine

It refers to a neurotransmitter that is secreted by the neurons of substantia nigra and is considered both excitatory and inhibitory.

Acetylcholine

It refers to a chemical messenger that sends signals from the brain to the body, leading to voluntary control of muscles, making it a major part of the somatic nervous system.

Hippocampus and cerebral cortex

Acetylcholine is an important transmitter in which two anatomical structures?

Acetylcholinesterase

It refers to a cholinergic enzyme used to hydrolyze acetylcholine into choline and acetate.

Myasthenia Gravis

What chronic, autoimmune neuromuscular disorder is characterized by weakness in the skeletal muscles?

Neostigmine (Bloxiverz, Prostigmine)

What drug is used for MG and is considered the prototype, decreasing the breakdown of acetylcholine and producing skeletal muscle stimulation?

Tensilon Test

What test is used to diagnose MG?

Handwriting gets smaller over time

What is an early symptom of PD?

Parkinson’s Disease

It is a neurological disorder characterized by shuffling gait, tremors, pill-rolling, postural instability, rigidity, and bradykinesia due to a decrease in dopamine.

Levodopa

It refers to the cornerstone of PD treatment and is a precursor of dopamine.

N/V and orthostatic hypotension

What are the most common side effects of Levodopa?

True

True or False: One of the adverse effects of Levodopa is gambling and alcohol abuse.

Carbidopa

What is combined with levodopa to produce Sinemet?

Sinemet

What drug is the most effective form of therapy for PD due to its potency?

Amantadine (Symmetrel)

What drug was approved in 1980 as an antiparkinson drug as it was believed to release dopamine and norepinephrine from central neurons?

Bromocriptine (Parlodel)

What drug activates postsynaptic dopamine receptors in the corpus striatum and is considered an ergot derivative?

Selegiline HCl (Eldepryl)

What drug inhibits MAOs and increases dopamine, which is then used for newly diagnosed Parkinson’s disease?

Liver failure

What is the adverse effect of COMT inhibitors?

Vitamin B6

Clients taking levodopa should avoid foods & medications containing substantial amounts of ___.

Dizziness and risk for falls

For what should clients receiving dopaminergic agents be closely monitored?

Tyramine

Patients taking MAO inhibitors should avoid food rich in __ as it may cause hypertensive crisis.

Alzheimer’s Disease

It refers to an incurable dementia illness characterized by progressive neurodegenerative conditions marked by cognitive dysfunction.

Donezepil, Memantine, Galantamine, and Rivastigmine

What are the four Alzheimer agents?

Multiple Sclerosis

It refers to a chronic inflammatory autoimmune disease that damages the myelin sheath of neurons, causing a wide variety of sensory, motor, and cognitive deficits.

Dysarthria, Nystagmus, and Intention Tremor

What s/sx belong to the Charcot’s Triad?

Bone marrow suppressant and liver injury

What are the drug interactions for Betaseron?

Immunomodulators (Betaseron)

These are drugs that can decrease the frequency and severity of MS attacks, decrease the number and size of visible lesions, and have adverse effects such as myelosuppression, depression, and hepatotoxicity.

Allopurinol

What drug, when taken with immunosuppressants, increases the risk for toxicity?

Cyclophosphamide (Cytoxan)

What drug is used for the treatment of malignancies and is used by physicians in selected cases of progressive or worsening MS?

Baclofen (Lioresal)

This drug helps relieve spasms related to multiple sclerosis and spinal cord injuries by acting within the spinal cord to suppress hyperactive reflexes involved in the regulation of muscle movement.

Dantrolene (Dantrium)

This drug is helpful in relieving spasticity and act directly on the skeletal muscle so that it is less able to contract.

Before meals

When is it recommended to administer Neostigmine, as its peak effect occurs at this time?

Pyridostigmine Bromide

What drug, also known as Mestinon, is used for the management of myasthenia gravis and reaches its peak effect at 3-6 hours?

True

True or False: A patient taking Mestinon should be advised to take ER tablets whole.

Edrophonium Chloride (Tensilon)

What drug is injected via IV during a diagnostic test for myasthenia gravis?

Positive

A temporary boost in strength during a Tensilon test indicates a __ result.

False

True or False: Patients taking Levodopa are advised to increase their protein intake.

2 hours upon awakening

Bromocriptine (Parlodel) should be taken with food and __.

Uncontrolled hypertension

Bromocriptine (Parlodel) is contraindicated for patients with __.

Entacapone (Comtan) and Tolcapone (Tasmar)

What are the two drugs classified under COMT Inhibitors?

True

True or False: Cholinesterase inhibitors should continue as long as clinically indicated/tolerable/benefits disappear.

Donepezil (Aricept)

Which Alzheimer's agent is administered at bedtime through orally disintegrating tablets (ODT) on the tongue, followed by water?

Memantine (Namenda)

Which Alzheimer's agent is administered with or without food through extended-release tablets?

Galantamine (Razadyne)

Which Alzheimer's agent is administered with morning and evening meals, specifically for IR tablets?

Rivastigmine (Exelon)

Which Alzheimer’s agent is administered with morning and evening meals and is also available in transdermal patches applied once daily?

Bone marrow suppression

What adverse effect is associated with taking immunosuppressants?