Transcript
DRUGS AFFECTING NEUROMUSCULAR SYSTEMCh 28-30
INTRODUCTION (P 247)
Musculoskeletal system= bones, joints, muscles that provide movement
Degenerative diseases covered in this unit Alzheimer’s Parkinson’s Gout
CHOLINESTERASE INHIBITORSChapter 28
ALZHEIMER’S
Progressive disease Deterioration of emotional, physical &
cognitive functions 9th leading cause of death over 65 No known cure Can slow process with Cholinesterase
inhibitors
PARKINSON’S
Affects messages sent from CNS (brain, spinal cord) to muscles
Caused by imbalance of dopamine & acetylcholine in the CNS
S/S: trembling, rigidity, problem with balance & walking
No cure Can treat with antiparkinson drugs
SEIZURES
Convulsion caused by periodic disturbance of electrical activity in the brain
Several types Ch 30 discusses anti-convulsant medications
CHOLINESTERASE INHIBITORS
Alzheimer’s causes nerves to degenerate into plaques and tangled nerve bundles
Causes decrease in cognitive function (dementia)
Cholinesterase inhibitors are used to treat
CHOLINESTERASE INHIBITORS (CON’T)
Action: Lessens dementia and enhances cognition in Alzheimer’s patients.
Use: early & moderate stages of dementia associated with Alzheimer’s disease
Side Effects: GI (n/v/d) Headache
CHOLINESTERASE INHIBITORS (CON’T)
Drug names: Aricept (donepezil) Namenda (memantine) Exelon (rivastigmine)
NURSING DIAGNOSES
Nutrition less than requirements r/t GI side effects
Risk for Injury r/t dizziness
NURSING PROCESS
Assessments: Cognition & function Mini-mental exam Baseline assessment Ongoing assessments
INTERVENTIONS
Monitor weight Calm meal times Frequent smaller meals Assistive devices to minimize falls
TEACHING
Take drug exactly as directed Do not drive if drowsiness occurs Notify MD if adverse reactions occur Liver function studies monitored with tacrine (Cognex) administration d/t hepatotoxicity
ANTIPARKINSON DRUGSChapter 29
PARKINSONISM
Group of symptoms involving motor movement Characterized by Extrapyramidal s/s:
Bradykinesia (slow movement) Tremors Rigidity Disease is progressive Drugs to treat called antiparkinsonism drugs
DRUGS TO TREAT PARKINSON’S
Dopaminergic : affect dopamine in the brain
Action: enhance dopamine in the brain to lessen the symptoms of parkinson’s disease
Use: Treat parkinson’s and drug induced extrapyramidal syndrome
SIDE EFFECTS
Dry mouth GI distress headache dizziness
DOPAMINERGIC DRUG NAMES
Symmetrel (amantadine) Parlodel (bromocriptine) Lodosyn (carbidopa) Sinemet (carbidopa/levodopa)
CHOLINERGIC BLOCKERS FOR PARKINSON’S
Action: enhance dopamine transmission
Use: adjunctive therapy to treat parkinson’s treatment of extrapyramidal disorders
Side Effects: dry mouth, dizziness, GI upset
CHOLINERGIC BLOCKERS FOR PARKINSON’S
Contraindicated in glaucoma Drug names:
Cogentin (benztropine)
OTHER ANTI-PARKINSON DRUGS
COMT inhibitors Comtan (entacapone) Tasmar (tolcapone)
Dopamine agonists Mirapex (pramipexole)
Combination drugs Stalevo (carbidopa, levodopa, entacapone)
NURSING PROCESS
Nursing diagnoses Imbalanced nutrition (less than requirements) Constipation R /O injury r/t dizziness Impaired mobility
INTERVENTIONS
Provide for adequate nutrition Prevention of constipation Safety Concerns—minimize r/o falls
ANTICONVULSANTSCh 30
ANTICONVULSANTS
Seizure: periodic disturbance of the brain’s electrical activity
Epilepsy: condition of recurrent seizures Many types
Partial Motor Generalized absence
Status Epilepticus: continual seizure activity with no interruptions
Lorazepam (ativan) drug of choice for this
ANTICONVULSANTS CON’T
Action: Depress abnormal electrical activity in the brain
Control but do not cure seizures Use: to prevent seizures treat neuropathic pain
Bipolar disorders some anxiety disorders
ANTICONVULSANTS (CON’T)
Side effects: Gingival hyperplasia (overgrowth of gums) Drowsiness Headache Sleepiness Nystagmus (involuntary movement of the eye) Ataxia (loss of control of voluntary movements) GI upset
ANTICONVULSANTS (CON’T)
Use cautiously in liver or kidney disease Baseline assessment (V/S), LOC etc May require frequent adjustments
DRUGS
Drug Names: Dilantin (phenytoin) Depakote, Depakene (valproic acid) Zarontin (ethosuximide) Clonazepam (Klonopin) Valium (diazepam) Ativan (lorazepam) Luminal (phenobarbital) Tegretol (carbamazepine) Neurontin (gabapentin)
NURSING PROCESS
Nursing Diagnoses: r/o impaired oral mucous membranes r/t
overgrowth of gums R/O Injury r/t drowsiness, ataxia
INTERVENTIONS
Ongoing assessments Do not omit increase or decrease doses Do not d/c abruptly Avoid alcohol Medical ID bracelet
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