Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
parkinsons
pn 141 test 3 book burke: pg 952
| Question | Answer |
|---|---|
| what is it | a chronic progressive, degenerative neurologic disease thatalters motor coordination |
| at what age are most people dx | after 40 yo |
| who does it affect most | men more than wm, caucasion, >40 yo |
| cause | unknown |
| secondary parkinsonism: cause | by repeated head trauma, encephalitis, or exposure to carbon monoxide or cyanide poisoning |
| what drugs can induce it; when do the symtoms dissapear | phenothiazines, haldol, methyldopa (aldomet); when drug is stopped |
| it results from a deficiency of what | dopamine |
| dopamine: where is it produced in the body | in the substantia nigra of the midbrain |
| what happens to neurons in the cerebral cortex; what happens to the # of dopamine receptors | the neurons atrophy; and the dopamine receptors decrease |
| dopamine: what is this neurotransmitter responsible for | voluntary motor function |
| the balance of what two neurotransmitters are upset | dopamine and acetylcholine |
| what happens to acetylcholine when dopamine levels drop | acetylcholine is no longer inhibited |
| when acetylcholine is no longer inhibited what does that cause | constant excitement of the motor neurons |
| what is the basis for the manis of PD | constant excitement of the motor neurons |
| dopamine is what type of neurontransmitter | an inhibitory one |
| acetylcholine is what type of neurontransmitter | an excitatory neurotransmitter |
| are the manis subtle or obvious | subtle |
| what might s/s be mistaken for | normal s/s of aging |
| what is the onset | gradual, disease prgresses slowly |
| s/s : what are the 3 cardinal s/s of it | 1) tremor, 2) rigidity 3) bradykinesia |
| s/s: what is bradykinesia | slowed voluntary movements and speech |
| s/s: what is the classic "pill-rolling" tremor | it occurs when the thumb and fingers move like they are rolling a pill |
| s/s: when do the tremors dissappear | during sleep |
| s/s: what are they | tremor that moves from one arm to both arms & may involve lips,jaw,head & lower extremitiesrigidity of neck,shoulders and trunk,bradykinesia(inability to initiate voluntary movements,slurred speech,low amplitude,decreased blinking,masklike face) drooling, |
| are there any specific tests to Dx | no |
| Dx: what is it based on | the pt's hx and presence of two of the three cardinal s/s |
| dx: what may a pet scan show | decreased levels of levodopa |
| what is levadopa | a precursor to dopamine |
| why do interventions vary | depends on the extent of the pt's manifestations and disability |
| what is the goal of Tx | to retain the highest function level of function for as long as possible |
| meds: does drug therapy cure it | no, but it is used to control s/s |
| meds: what are the four different classes of meds used | dopaminergics, dopamine agonists, anticholinergics, monoamine oxidase inhibitors (MAOIs) |
| meds: how are meds chosen | based on the pt s/s, individual responses, and length of effectiveness |
| meds: over time what happens when using levodopa and dopaminerigc | they lose their effectiveness, and side effects increase |
| meds: what med is added to levodopa to increase its effectiveness | dopamine agonists |
| meds: what is the newer class of drugs used ; what do they go | catechol-O-methyltransferase (COMT) inhibitors; they reduce s/s caused by the wearing off of sinemet |
| surgery: what are the two primary ones done | pallidotomy and stereotaxic thalamotomy |
| surgery: what anesthesia is used | local |
| surgery: pallidotomy- what is done | part of the globus pallidus (basal ganglia located in teh cerebral cortex that is responsible for skilled movement) is destroyed to control rigidity and tremors |
| surgery: stereotaxic thalamotomy- what is it | destroysf part of the thalamus to reduce tremors, it is reserved for younger ppl with extreme unilateral tremor |
| electrical stimulation: what is done | deep brain stimulation involves surgically implanting a batteryoperated neurostimulator device,an insulated wire is placed in teh thalamus & connects to a pulse generater, which is placed under the skin by the clavicle. it sends electrical impulses |
| electrical stimulation: what does it block | the signals that cause PD tremors |
| what does massage therapy do | it decreases the muscle stiffness and achingthat accompanies PD |
| complications | skin beakdowns, incontinence or immobility, falls, joint contractures |
| what is a neurotransmitter | a biochemical messenger at nerve endings that stimulate an action or non-action |
| examples of neurotransmitters | dopamine, acetylcholine, norepinephrine, epinephrine |
| what neurotransmitter is there a deficiency of | dopamine |
| what does parkinsens effect | mental processes. emotions, voluntary movements |
| a decrease in dopamine = a loss of controlled _________ | motor functions |
| when are trmeors most pronounced | during activity |
| meds: what are the four main ones given | dopaminerigcs, antichlinergics, antidepressants, dopamine agonists |
| meds: dopaminerigcs- names | symmetrel (amantadine), sinemet (carbidopa/levadopa), levadopa, lodosyn (carbidopa), parlodel "snap tabs" (bromocriptine) |
| meds: dopaminerigcs- what is the action of these durgs | it is levadopa, a found in plants and animals that is converted into dopamine by the body, this form is able to cross the blood brain barrier, only in small quantities,it is usually combined with another drug to allow more to reach the brain |
| meds: dopaminerigcs- use | parkinsons |
| meds: dopaminerigcs- adverse reactions | as medications effectiveness lessens adverse reacions include dry mouth, difficulty swallowing, N/V, abd. pain, HA, choreiform movement and dystonic movements |
| meds: dopaminerigcs- what is the most serious adverse reaction | choreiform movement & dystonic movements |
| what med gives the adverse effect of choreiform movement & dystonic movements | levadopa (dopaminerigcs) |
| what are choreiform movement | involuntary muscular twitching of the limbs or facial muscles |
| what are dystonic movement | musclular spasms most often effecting the tongue jaw eyes and neck |
| what is the blood brain barrier | a meshwork of tighlty packed cells in the walls of the brain's capillaries that screen out certain substances it inhibits certain molecules, some drugs cannot pass through it |
| blood brain barrier: what is the issue with levadopa | it can only cross the barrier in small amounts, leaving too much of the drug in the PNS and causing large amounts of adverse reactions |
| meds: when levadopa is combined with _________ it allows more of it to cross the blood brain barrier | carbidopa |
| meds: dopaminerigcs- what one is an antimalarial | symmterel (amantadine) |
| meds: dopaminerigcs- what one is the most popluar | sinemet (carbidopa/levadopa) |
| meds: dopaminerigcs- what adverse effect is a big issue | the swallowing, b/c they may already have swallowing issues |
| meds: dopaminerigcs- with what disorders should pt not be taking these meds | glaucoma, |
| meds: dopaminerigcs- why should fluids be increased | b/c of dry mouth |
| meds: dopaminerigcs- if the choreiform movement & dystonic movements occur what should be done | with hold next dose of med and inform md that the dose needs to be lowered |
| meds: dopaminerigcs- what happens if dosage is stopped abruptly | a neuroleptic malignant like syndrome may occur (musclular rigidity, elevated body temps, mental changes) |
| meds: anticholinergics- action | aCh, a neurotransmitter is produced in exces in parkinsons, these drugs block aCh in the CNS enhancing dopamine transmission |
| meds: anticholinergics- these meds are less effective than what med | levadopa |
| meds: anticholinergics- they have less adverse effects than what meds | levadopa |
| meds: anticholinergics- names | cogentin (benztropine), benadryl |
| meds: anticholinergics- why is benadryl given | it is used in the elderly b/c they produce fewer side effects |
| meds: anticholinergics-cogentin (benztropine): adverse effects | dry muouth, blurred vision, dizzines, N, skin rash, urinary retention, confusion |
| meds: anticholinergics- are they dosed in high or low dosages | low |
| meds: anticholinergics- who should not take this med | glaucoma, peptic ulcer, cardiac issue (with caution) |
| meds: COMT inhibitors: names | tasmar (tolcapone), comtan (entacopone) |
| meds: COMT inhibitors: they are used as helpers to what med | sinemet a dopaminerigcs |
| meds: COMT inhibitors: what is their action | thought to prolong the effect of levadopa by bloacking the enzyme COMT (COMT eleiminates dopamine), so it should increase plasma levadopa |
| meds: COMT inhibitors: use | adjunct to levadopa/cardidopa |
| meds: COMT inhibitors: what adverse reaction are they associated with | liverissues |
| meds: COMT inhibitors: what one has the most adverse effect to the liver, it is reserved for those where no other tx is owrking | tasmar (tolcapone), |
| meds: COMT inhibitors:adverse effects | dizziness, N, anorexia, ortho hypo, sleep disorders, GI upset, liver issure |
| meds: COMT inhibitors: who are they contraindicated in | ppl with liver dysfunctions |
| meds: COMT inhibitors: what should be monitored regularily while on tasmar (tolcapone), | liver functions |
| meds: COMT inhibitors: s/s of liver failure | N, fatigue, lethargy, anorexia, jaundice, dark urine, pruritus, RUQ tenderness |
| dopamine receptor agonists: action | exact action unknown, thought that they act directly on postsynaptic dopamine receptors of nerve cells in the brain. they mimick the effects of dopamine in the brain |
| dopamine receptor agonists: names | mirapex (pramispexole), requip (ropinirole) |
| dopamine receptor agonists: what other therapy must be initiated with these meds | antiemetic |
| dopamine receptor agonists: adverse reactions | N/V, dizzines, somnleness, confusion, sleep disorders,HA |
| surgery: pallidotomy- whatis done; why | part of the globus pallidus is destroyed to control rigidity and tremors |
| surgery: thalamotomy- whatis done; why | destruction of part of the thalmus to reduce tremors, reserved for young ppl |
| why is there a risk for aspiration | it is hard to eat and drink when you are trmeoring |
| what are the risks for injury | aspiration, fall, swallowing, side effects of medds |
Created by:
jmkettel
Popular Nursing sets