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Disease Drugs Ex 2

Pharm Exam 2

QuestionAnswer
Goal: increase ability to perform ADL Effects: less bradykinesia, gait disturbance, and postural instability Types of drugs Dopaminergic(to raise dopamine) Anticholinergic(to decrease acetylcholine) Drug Therapy for Parkinsons Disease
Combined with carbidopa, Increases DA synthesis, Slow onset of action, Improves motor function, Max effect declines after 2 yrs, “Wearing off effect”, “On-off phenomenon”.AE's-GI:Nausea and Vomitting, Dyskinesias,CV: postural hypotension,dysrhythmias Dopaminergic Drugs: levodopa (For Parkinsons Disease)
Ideal goals: slow progression, prolong independence Reality No cure 25 – 30% respond to current drugs with slowed progression Classes of drugs in use Cholinesterase inhibitors NMDA receptor antagonist Drug Therapy for Alzheimers Disease
Action: raise ACh level by preventing breakdown by cholinesterase Current drugs: donepezil (Aricept), galantamine (Exelon), rivastigmine (Razadyne) Use All: mild to moderate AD Donepezil: severe AD also Cholinesterase Inhibitors (For treatment of AD)
Cholinergic side effects GI: nausea, vomiting, diarrhea CNS: dizziness, headache Resp: bronchoconstriction Key point Avoid other drugs that block cholinergic receptors Cholinesterase Inhibitors (For treatment of AD)
Prototype: memantine (Namenda) Use: moderate to severe AD Action: prevents influx of excess calcium into neuron Side effects CNS: dizziness, confusion GI: constipation NMDA Receptor Antagonist (For treatment of AD)
Goals of drug therapy:Modify disease process Treat acute relapse, Manage symptoms, Immunomodulators interferon beta preparations (Avonex, Rebif, Betaseron) Immunosuppressants mitoxantrone (Novantrone) Drugs used to treat Multiple Sclerosis (Disease-Modifying Therapy)
Goal of Rx:near/normal life w/reduction of seizures.Suppress discharge of neurons within seizure focus& prevent spread from focus.Suppress NA/cal influx. Antagonize/ Suppress glutamate(excitatory NT in CNS).Potentiate/Enhance GABA(inhibitory NT). Antiepileptic Drugs (AEDs)
Phenytoin(aka Dilantin is oldest)Action:limits/calms NA influx into hyper-active neurons.Narrow range(can easily be toxic or fall below)Adverse Effects-CNS:mild sedation,ataxia,diplopia,cognitive im-pairment,Gingiva:hyperplasia,Skin:rash, CV:dysrythmias Traditional AEDs
Numerous drug interactions Stimulates hepatic enzymes Phenytoin plasma level altered by many other drugs Ehnhancement/Additive effects with CNS depressants Phenytoin
oxcarbazepine (Trileptal)Action:stabilizes hyperexcitable neurons. AE's: CNS:dizziness,drowsiness, diplopia, ataxia,GI:nausea,vomiting Skin:serious reactions,Hyponatremia Multiorgan hypersensitivity reaction. Drug actions:induces enzymes;inhibits others Newer AEDs
lamotrigine (Lamictal) Action: decreases glutamate Adverse Effects Skin: life-threatening rashes, can be fatal CNS: dizziness, diplopia, headache GI: nausea, vomiting Drug interactions: many drugs increase or decrease half-life of lamotrigine Newer AEDs
Monitor plasma drug level Promote adherence Do not stop suddenly Monitor for depression, suicidal gestures Teratogenic (risk vs benefit) Vitamin K last weeks of pregnancy and to newborn Status epilepticus: tx with benzodiazepine AED Nursing Care: Key Points
Action Increased force of muscle contraction General muscarinic effects Mild CNS stimulation at therapeutic level Therapeutic uses Treat myasthenia gravis Reverse nondepolarizing neuromuscular blockade Reversible cholinesterase inhibitor: neostigmine (Treats Myasthenia Gravis)
Adverse effects Excessive muscarinic stimulation At toxic level: neuromuscular blockade Reversible cholinesterase inhibitor: neostigmine (Treats Myasthenia Gravis)
Created by: FLOYDJE
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