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MS
Chronic, progressive degenerative disorder of the CNS system
Autoimmune disease
Lack of coordination and movement
Shaking, tremors and muscular weakness
Nystagmus(rapid movement of eyes), urinary/bowel incontinence Motor/sensory impairment (hemiparesis/ataxia)
Treat with corticosteroids and immune suppressants
Alzheimer's
Rapid progression at a young age (genetics)
Sporadic- unknown, onset later, slower progression
Atropy of the brain
Reduction in neurotransmitter acetylcholine (Decrease in acetylcholine-memoryloss)
Treat with Donepezil (Aricept)
Acetylcholinesterase inhibitors
Treat mild to moderate Alzheimer's (early)
Improving cholinergic/parasympathetic function
SLUDGE> salivation; lacrimation; urination; diarrhea; GI distress; Emesis
May cause dizziness
Adverse effect: peptic ulcers
Notify HCP: ab pain, coffee ground emesis, nausea, diarrhea, change in color ofstool, & new symptoms
Tarcine (Cognex) heptatoxicity
Rivastigmine (Exelon) weight loss
Used in conjunction with acetylcholinesterase inhibitorsMemantine (Namenda): reduced glutamate, found in Alzheimer ptsAnti-inflammatory COX2 inhibitorsAnti-pyschotic agentsAnxiolytics (for anxiety & depression)
PARKINSON'S DISEASE
unknown cause
degenerative disease of basal ganglia & dopamine deficiency
hand tremors @ rest, muscle rigidity, bradykinesis (slow movement), loss of
balance (humped over), shuffling gait, dsyphagia, orthostatic hypotensionTreat with Dopaminergic & anti-cholinergics
Levodopa (Larodopa) Dopaminergic
converted to dopamine in the CNS
Carbidopa (Simemet) prevents peripheral destruction of levodopa
Use Sinemet conjunctively with Levodopa to reduce Levodopa dose
AD/SE: blurred vision; memory loss; hepatotoxicity; dark urine or sweat; gastricirritation; dizziness; dry mouth
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eat shortly after, but avoid high protein b/c it decrease absorption
Avoid taking multi vitamins
Notify HCP of urinary retention, involuntary movement; behavioral changes; severe N/V;
new skin lesions; spasmotic eye winking; protrusion of tongues (signs of toxicity)
Amantidine (Symmetrel) Dopaminergic
increase affect of dopamine in CNS
Benztroepine (Cogentin) Anti-cholinergic inhibits acetylcholine; blocks cholinergic
AD/SE: dry mouth; constipation; tachycardia; blurred vision; urinary retention
Caution w/ pts w/ narrow angle glaucoma; myathenia gravis, GI/GU tractobstruction, BPH
Avoid taking antacids or anti-diarrhea within 1-2 hrs of medsHELPFUL HINTS
Dry as a bone (dry mouth, constipation- increase fluids); Hot as a hare (avoidsunlight; sunglasses); Red as a beet (association with heart- tachycardia;palpitations); Mad as a hatter (behavioral changes depression); blind as a bat(blurred vision)
Myasthenia Gravis neuromuscular disease; weakness of voluntary muscle
loss of acetylcholine receptors
Sx: muscle weakness; diplopia
Treat with Anticholinesterase
Amyotrophic Lateral Sclerosis (ALS)
loss of motor neurons
Sx: muscle atrophy; hyperreflexia; spasticity;
Treatment is supportive care
SEIZURES
Acute: temporary condition irritation to the brain
Chronic: injury to the brain (seizure disorder/epilepsy)
Phases: aura (prior to seizure); ictus (seizure); Post ictal (following)
Types:
Partial/Focal a. simple abnormal sensation/localized motor activityb. complex pt is awake but unaware; involuntary
Generalized -a. absence (petit mal) last few seconds; see in children
b. atonic few seconds; falling for no reasonc. tonic-clonic aura; intense muscle contraction; loss of bowel/bladder control; shallowbreathing; disorientation/deep sleep after