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2013-09-16 19:00:24
competency three

competecy three
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    Medications that relieve pain without causing loss of consciousness
  2. PAIN
    -medical definition: pain is an unpleasant sensory or emotional experience related to tissue injury

    • -nursing definition: pain is whatever the experiencing person says it is, existing whenever he or she says it does.
    • -the Fifth Vital sign- always check pain
  3. Preception of pain
    Subjective and highly individualized
  4. Pain threshold
    Intensity at which the stimuli is judged as painful
  5. Pain tolerance
    Maximum degree of pain intensity a person is willing to endure - highly variable
  6. chronic pain (non malignant)
    persistant pain, can be difficult to treat
  7. Acute pain
    sudden onset, usually subsides after treatment, usually specific tissue injury
  8. cancer pain
    acute, chronic or both
  9. neuropathic pain
    • results from injury to inflammation or injury to nerve
    • feels like pins and needles, burning, triggered by light touch
  10. nociceptors
    sensory pain receptors
  11. somatic pain
    originates in muscles, ligaments and bones. refers to body
  12. superficial pain
    originates from the skin and mucous membranes, lower scale of intensity
  13. visceral pain
    originates from organs and smooth muscle
  14. vascular pain
    • interuption of blood flow to tissue, organs or nerves.
    • example: migraine
  15. referred pain
    pain felt in areas other than those stimulated
  16. phantom pain
    • pain percieved in an extremity that has been amputated.
    • normal feeling
  17. Pain transmission
    • *tissue injury causes the release of
    • -bradykinin
    • -histamine
    • *potassium iv potassium- leaking into        tissue cause pain
    • -prostaglandins
    • -serotonin
    • These substances stimulate the nerve endings, starting the pain process
  18. Gate control theory
    • -suggests that nervous e system adjusts or varies the transmission of painful stimuli
    • -suggests that pain impulses can be regulated or blocked by a gating mechanism in the dorsal horn of the spinal cord
    • *heat/cold or massage helps
  19. Endorphins & Enkephalins
    • -Produced by the body- considered the body's painkillers "runners high"
    • -natural pain killers
    • -neurohormones
  20. under treatment of pain
    • -client not acknowledging pain 
    • -inability to measure pain
    • -lack of assessment
    •   -rank pain 0-10 scale
    • -attitudes of health care team
    •   -don't believe client
    •   -concerns re: addiction & tolerance
    •   -inadequate does prescription
  21. Treatment of pain
    Non pharm & pharmacological measures
  22. NON OPIOID analgesics ( non narcotics)
    • -multi srtengths
    • -uses: mild to moderate pain
    •   *arthritis, HA, menstral cramps, inflammation, minor abrasions, muscular aches & pains
    • -other effects: 
    •         -antipyretic
    •         -anti platelet (aspirin)
    •         -anti inflammatory (NSAIDS only)
  23. Antipyretic
    fever reducer
  24. anti platelet (aspirin)
    blood thinner, prevents blood clots
  25. anti inflammatory (NSAIDS)
    decrease swelling
  26. Acetaminophen (Tylenol)
    • -mild to moderate pain
    • -Fever
    • -analgesic and antipyretic effects
    • -NO anti inflammatory effect
    • -available in oral & now injectable forms
  27. tylenol contradictions
    • -known drug allergy
    • -severe liver disease
    • -genetic disease (G6PD enzyme deficiency- no enzyme to break it down)
  28. tylenol side effects/Adverse effects
    • -generally well tolerated
    • -may experience: rash, nausea, vomiting
    • -less common: blood disorders (anemia), and nephrotoxicities- especially if taken outside the recommended dosage ranges
  29. tylenol Toxicities/Management of overdose
    • -Potentially lethal when over dosed (150 mg/kg or more a one time)
    • -tissue necrosis in liver (kills liver)
    • -long term ingestion of high doses causes nephrotoxicity
    • -treatment for toxicity: acetylcysteine
    • interactions: alcohol and other hepatoxic drugs
  30. potentially lethal over dose 150mg/kg or more) examples
    • 165 # pt = 75 kg
    • 75 x 150= 11250
    • 11250/325 (one tab)= 34.6 tabs (to kill)

    • child 22 # = 10 kg
    • 10x150 = 1500
    • 1500/325 =4.6 tabs (to kill)
  31. Tylenol patient teaching
    • -take as directed
    • -maximum dose per day?
    • -** 3250 mg **
    • -geriatric patients and people with liver problems- 2400 mg or less
    • Be aware of other meds that end in "cet"
    • -percocet, darvocet, lorcet, deocet, dolocet...
    • -other combo drugs: vicodin, tylox, wygesic
  32. Tramadol (Ultram)(other NONopioidanalgesic)
    • -moderate to severe pain
    • -SE: N7V, constipation, HA, anxiety, seizures
    • -pregnancy c
  33. nursing teaching
    • -pain tolerance
    • -not to exceed 4g/day
    • -check liver enzymes
    • -keep out of reach of children
    • effectiveness
  34. OPIODS (narcotics)
    • -pain relievers that contain opium
    • -or derived from opium poppy
    • -or chemically related to opium
    • -Act primarily in the CNS
  35. Controlled Substances Act
    -5 "schedule" categories- based on their potential for abuse
  36. 5 SCHEDULED categories
    • -schedule I- high potential for drug abuse. No accepted medical use...heroin,hallucinogens
    • -schedule II-high potential for drug abuse.accepted medical. Can lead to physical/psychological dependency...morphine
    • -schedule III-medically excepted drugs. May cause dependence. Less likely abused...codiene prep meds
    • -schedule IV-medically accepted. May cause dependence...lorazepam
    • -schedule V-medically accepted. Very limited potential for dependence... Opioid for cough
  37. Addiction (psychological & physical Dependence)
    - a pattern of compulsive drug use characterized by a continued crawving for an opioid and the need to use the opioid for effects other than pain relief

    ** physical dependence...taper off
  38. Indications
    • -relieve moderate to severe pain 
    •    -codiene- mild to moderate pain
    • -cough suppression
    • -relieve diarrhea
    • **no ceiling effect** (no limit on how high can go)
  39. contin
    continuous or long lasting- do not crush
  40. opiod examples (generic/(trade))
    • -morphine sulfate (roxanol)-effective against acute pain from mi,ca,dyspnea-po, iv, im, sq, sl, rectal (ms contin)
    • -hydromorphone (dilaudid)-stronger than morphine- po, iv, sc, im, rectal
    • -meperidine (demerol)-primarily effecive in gi procedures. Short term use 48-72 hrs- po, im, iv
    • -fentanyl (duragesic)po, iv, im, transdermal, lozenge (lollipop)- duragesic patch
    • -oxycodone- po
    •   *oxycontin
    •   *percocet= oxycodone+acetaminophen
    •   *percodan= oxycodone+aspirin
    • -hydrocodone- po
    •   *vicodin= hydrocodone+acetaminophen
    • -codiene sulfate- po, sq, im
    •   *tylenol #3=codiene+acetaminophin
  41. opiod side effects/adverse effects
    • -CNS depression**
    •   -respiratiory depression 1st thing seen. low resp rate
    •     -treatment-opiod antagonist
    •      ***naloxone(narcan)** (most common)(reassess after 1 hr)

    •       naltrexone (revia)
    •       nalmefene (revex)
    • -Orthostatic hypotension
    •   -risk for heart failure
  42. Opioid side effects/adverse effects
    • -**pupil constriction** 
    • -tachycardia
    • -drowsiness
    • -confusion
    • -euphoria
    • -gi side effects (common) n&v, constipation- should be assessed for & pattern
    • -urinary retention- risk for bladder infection
  43. Opioid contraindications
    • -drug allergy
    • -increased intracranial pressure
    • -severe asthma
    • -other respiratory insufficiency
    • -clients with very low bp (shock)
  44. Opioid interactions
    • -CNS depressants
    • -alcohol
    • -sedative-hypnotics
    • -muscle relaxants
    • -major tranquilizers
    • -antipsychotic agents
  45. Adjuvant analgesics
    meds used with other non opioid  or opioid med
  46. Methadone treatment program
    opioid less dependency used to replace abused opioid
  47. Opioid agonist antagonist
    opioid antagonist is used with opioid agonist to help decrease abuse
  48. Opioid antagonist
    blocks the receptor and displaces any opioid that would normally be at the receptor and inhibiting the opioid action
  49. Withdrawal symptoms
    • -Rebound pain, tachycardia, elevated bp, mental agitation, anxiety, irritability, chills, joint pain, lacrimation, rhinorrhea, diaphoresis, n&v, abdominal cramps, diarrhea
    • -occur within 24-48 hrs after stopped
  50. Opioid tolerance
    • -a common physiological result of chronic opioid treatment
    • -desensitizing...reduces effect of drug
    Respirations (VS), pain level, description, location, last dose
  52. nursing process: opioid analgesics
    assessment: perform thorough pain assessment including nature type, precipitating and relieving factors, remedies, other pain tx, fifth VS.

    dx and plan
  53. nursing process opioid analgesics: implement
    • -have rank pain
    • -patient teaching
    •   oral forms should be taken with food to minimize gastric upset
    • -ensure safety measures
    • -assess vs 
    •    Low BP or Low Respiration- hold dose and contact md
    •     may need to give opioid antagonist
    • -monitor other side effects- constipation ortho hypotension
    • -instruct pt to not take with other mds to otc preparation
    • -follow proper administration
    • -special populations -geriatrics pediatrics may need additional therapy
    • -adjuvant therapy-addiction concerns
    • *eval for effects f/u assessment
  54. migraine headaches characteristics
    • -unilateral(sometimes bilateral) throbbing pain disrupting adls
    • -other symptoms: aura, n&v, photophobia (sensitive to light)
    • -triggers: cheese, chocolate, red wine, hormones
    • -lasts for hours or days
    • - affects women 20-30's, decrease or absent during preg and menapause
  55. migraine headaches pathophysiology
    • -caused by inflammation and dilation of blood vessels
    • -imbalance of serotonin
  56. 2 types of migraines
    classic: associated with aura

    common: no aura
  57. migraine headache prevention
    • -beta adrenergic blockers
    •   'propranolol (Inderal)
    • -anticonvulsants
    •   'valproic acid (Depakote)
    •   'gabapentin (Neurontin)
    • -tricyclic antidepressants
    •   'amitriptyline (Elavil)
    • -triptans
  58. migraine headaches treatment
    • -analgesics
    •   'aspirin, acetaminophen
    •   'NSAIDs: ibuprofen, naproxen (aleve)
    • -opioid analgesics
    •   'meperidine (Demerol)
    •   'butorphanol nasal spray (stadol NS)
    • -erogot alkaloids
    •   'erogotamine tartrate (erogostat)
  59. anti migraine drugs: the "triptan" sisters- Treat Acute Attack
    • -almo triptan(axert)
    • -ele triptan (relpax)
    • -frova triptan (frova)
    • -nara triptan (amerge)
    • -riza triptan (maxalt)
    • -suma triptan (imitrex) 1st- most common
    • -zolmi triptan (zomig)
  60. triptans
    -action: causes vasoconstriction of cranial arteries

    -uses: treat migraine headaches

    -side effects: dizziness, tingling, numbness, warm sensation, drowsiness, seizures, muscle cramps, nausea,vomiting, diarrhea, **most serious: hypertension, dysrhythmias, thromboembolus, MI, stroke
  61. triptans nursing implications
    • teaching regarding:
    •  -dissolving wafers, nasal spray, self injectable forms (provide specific teaching)
    •  -avoid trigger foods
    •  -keep journal to monitor effects to therapy
    •  -may increase bp
    •  -do not take other triptans within 24 hr of sumatriptan- more side effects
  62. cluster headaches
    • -severe, unilateral, NON throbbing pain around eye
    • -1 or more attacks every day for several weeks
    • -more common in men
    • -treatment: similar to migraine headaches
  63. anti inflammatory drugs pathophysiology
    • -Inflammation
    •   'reaction to tissue injury & infection
    •   'caused by release of chemical mediators
    •   'leads to vascular response
    •   'fluid and WBCs migrate to injured site
    • -Chemical mediators
    •   'histamines
    •   'kinins
    •   'prostaglandins
  64. inflammation
    response to tissue injury and infection
  65. infection
    caused by microorganisms and results in inflammation
  66. Cardinal signs of inflammation
    • -redness
    • -swelling
    • -heat
    • -pain
    • -loss of function
  67. Cyclo oxygenase (COX)
    enzyme responsible for converting arachidonic acid into prostaglandins and their products
  68. SEE Pg 347  fig 25-1
  69. COX-1
    protects stomach lining & regulates blood platelets- dec fever promote platelet aggregation
  70. COX-2
    triggers inflammation & pain
  71. Anti inflammatory drug groups
    • -non steroidal anti-inflammatory drugs (NSAIDs)
    • -corticosteroids
    • -Disease modifying anti rheumatic drugs DMARDS
    • -anti gout drugs
  72. Non Steroidal Anti inflammatory drugs (NSAIDs)
    potent anti inflammatory effect not related to corticosteroidal
  73. anti inflammatory agents- Indications for use
    • -reduce inflammation and pain
    • -gout, inflammation, fever, platelet inhibition, rheumatoid & osteoarthritis
    • -Not recommended for fever or headaches
    •   'EXCEPT aspirin, ibuprofen
  74. First Generation NSAIDs (anti inflammatory)
    • -Salicylates: aspirin
    • -Parachlorobenzoic acid: indomethocin(Indocin), sulindac (clinoril)
    • -propionic acid derivatives:ibuprofen (advil),naproxen (Naprosyn)
    • -fenamates
    • -oxicams: piroxicam (feldene)
    • -phenylacetic acid derivatives: diclofenac sodium (voltaren), ketorolac (toradol)
  75. Second generation NSAIDs (
    -COX-2 inhibitors: celecoxib (Celebrex)- doesn't cause GI problems or bleeding
  76. Aspirin (ASA) (salicylates)
    • -action: anti inflammatory, antiplatelet, antipyretic, analgesic
    • ** know there are levels to draw-therapeutic serum salicylate level 10-30 mg/dl
    • -toxic serum salicylate level >30mg/dl
    NEVER say ASA daily 81 or 325 mg is for pain. its NOT it is for anti platelet effect
  78. Salicylates Drug interactions
    • -anticoagulants (Coumadin) increases anticoagulants
    • -hypoglycemia with oral hypoglycemic drugs
    • -increases gastric ulcer risk with glucocorticoids
  79. slaicylates lab interactions
    • -increase PT, INR, bleeding time, uric acid
    • -decrease potassium, cholesterol, T3 and T4 levels
  80. salicylates food interactions
    prunes, raisins, licorice, certain spices
  81. aspirin cautions
    • -do not take with other NSAIDs
    • -avoid during third trimester of pregnancy
    • - do not give to children with flu or virus symptoms (may cause potentially fatal reye syndrome
  82. aspirin side effects/adverse effects
    • -tinnitus- ringing in ears
    • -gastric distress (heartburn), peptic ulcer
    • -urticaria- hives
    • -life threatening: agranulocytosis, hemolytic anemia, anaphylaxis, thrombocytopenia, hepatotoxicity, bronchospasms, renal failure
  83. salicylates hypersensitivity
    tinnitus, dizziness, bronchospasms
  84. salicylism (mild)
    tinnitus, dizziness, headache, confusion, sweating, drowsy, thirst, nausea, vomiting, diarrhea
  85. severe salicylate poisoning
    convulsions, cardiovascular collapse, coma
  86. NSAIDs
    • -nonselective Cox inhibitors
    • -brand/trade names: ibuprofen (motrin, advil)
    • -drug interactions: increase effects of warfarin, phenytoin
    • side effects: gastric distress
    • Naproxen (Naprosyn)
  87. COX-2 inhibitors
    • -action: selectively inhibits COX-2 enzyme without inhibition of COX-1
    • -Use: decrease inflammation and pain
    • -drug agents: celecoxib (Celebrex)
    • -Similar agents: nabumetone(Relafen), meloxicam (Mobic) (some COX-1 inhibition)
  88. COX-2 inhibitors
    • -Caution: avoid during third trimester of pregnancy- premature closure
    • -side effects: mild headache, dizziness, nausea, diarrhea, sinusitis, peripheral edema, assess renal function and GI status
  89. NSAID patient teaching
    • -inform of drug and herbal interactions
    • -avoid alcohol
    • -inform surgeon and dentist before procedures of NSAID use
    • -avoid NSAIDs 1-2 days prior to menstruation
    • -do not take if pregnant
    • -inform of SE
    • -take with food decrease GI upset
  90. Disease Modifying Antrheumatic Drugs DMARDs
    • -gold drug therapy- used to be standard not so much now
    • -immunosuppressive agent
    • -immunomodulators
    • -antimalarials
  91. Gold Drug Therapy
    • -Auranofin (ridaura)
    • -Action:
    •   'stops progression of joint degeneration
    •   'decreases leukocytes migration
    •   'suppresses prostaglandin activity
    • -Use: rheumatoid arthritis
  92. Gold drug therapy** may take 3-6 mos to work
    Side Effects/adverse reactions
    • **may take 3-6 mos to work
    • 'anorexia, N&V, diarrhea, stomatitis, photosensitivity, metallic taste, uritica, severe rash,
    •  'cornel gold deposits, bradycardia, profound hypotension, hematuria, proteinuria
  93. gold drug therapy

    Life Threatening side effects
    nephrotoxicity, agranulocytosis, thrombocyopenia
  94. Gold drug therapy

    • -severe renal or hepatic disease
    • -pregnancy, blood dyscrasias, colitis
    • -systemic lupus erythematosis
  95. immunosuppressives
    used to treat refractory rheumatoid arthritis
  96. know about DMARD
    concern with immune suppressions & increase risk for serious infections & different cancers
  97. DMARDs nursing implications
    • -teaching
    • -assess for side effects/adverse reactions:
    •  'instruct patient regarding side effects
    •  'instruct patient to report symptoms of toxicity
  98. Immunomodulators
    treat moderate to severe rheumatoid arthritis disrupting inflammatory process and delaying disease progression
  99. immunomodulars: Tumor necrosis factor (TNF) blockers
    • -Entanercept (enbral) given SQ
    • -Infliximab (Remicade) given IV
    • -Adalimumab (Humira) given SQ
    • -Action: neutralize TNF, disrupt inflammatory process, delay disease progression
  100. immunomodulators: Infliximab (Remicade)
    • -side effects/adverse reactions: HA, dizziness, chills, hot flashes, depression, N&V, diarrhea, urinary frequency, hypotension, hypertension, altered liver enzymes, severe infections
    • -Contraindications: renal or hepatic disease, immunosuppression, infection
    • **predisposes the client to __________
  101. immunosuppressive agents
    • -used to treat RA unresponsive to anti inflammatory drugs
    • -ex: azathioprine (Imuran), Cyclophosphamide (Cytoxan), methotrexate
    • -many serious side effects
  102. Gout Pathophysiology
    • -inflammatory disease of joints, tendons
    • -usually occurs in great toe
    • -defect in purine metabolism leads to uric accumulation (purine containing foods, salmon, liver, sardines, alcohol
  103. anti gout drugs
    • -colchicine
    • -uric acid inhibitors (allopurinol)
    • -uricosurics- crystals
  104. Colchicine
    • -inhibit migration of leukocytes to inflamed site
    • -side effects: N&V, diarrhea, abdominal pain
    • -taken with food to avoid GI distress
    • -Contraindications: severe renal, cardiac, or GI distress
  105. Uric Acid Inhibitors
    • -Allopurinol (Zyloprim) Not an NSAID
    • -Action: decreases uric acid levels, used to prevent gout
    • -Nrsg interventions:
    •  'monitor CBC, liver enzymes, renal function
    •  'yearly eye exams for visual changes
    •  'client to avoid alcohol, caffeine, and thiazide diuretics that increase uric acid level
    • -increase fluid intake to increase uric acid excretion
  106. Uricosurics
    increase the rate of uric acid excretion by inhibiting its absorption
  107. uriosurics
    • -probenecid (Benemid)
    • -used for chronic gout NOT acute attacks
    • -Side effects: gastric irritation, take with food
    • -Nrsg intervention:
    •  'Increase fluid intake to increase uric acid excretion
    •  'not to be given with other highly protein bound drugs
  108. febuxostat (ulroic)-recognize
    side/adverse effects: upper respiratory tract infections, musculoskeletal, connective tissue or joint signs and symptoms, headache and diarrhea
  109. krytexxa (pegloticase) recognize
    -side/adverse effects: painful gout flare ups or reactions to injections, breathing problems, headaches and nausea
  110. anti gout drug teaching
    • -regular scheduled lab tests: assess kidney, liver function & CBC
    • -increase fluid intake
    • -report SE
    • -Dietary changes: low purine diet, alcohol, do not take large doses of vit c
  111. Epilepsy (Seizure Disorder)
    - abnormal electric discharges from cerebral neurons
  112. characteristics of a seizure
    • -loss of consciousness
    • -convulsive movements
  113. cause of seizure
    • -unknown
    • -secondary to trauma, anoxia, infection, stroke
    • -isolated seizures due to fever, electrolyte, or acid based imbalance
  114. grand mal (tonic-clonic)- generalized seizure
    -most common-generalized alternating muscle spasms and jerkiness
  115. petit mal (absence)-generalized seizure
    • -brief loss of consciousness (10 seconds or less)
    • -usually occurs in children
  116. Partial seizure
    • -Psychomotor
    •  'repetitive behavior-chewing or swallowing motions
    •  'behavior changes
    •  'motor seizures
  118. AKA Anti convulsants
    • -action-
    • -indications
    •  'control of seizure activity
    •  'status epilepticus
    •  'mood disorders (bipolar disorder--manic/depression)
    •  'neuropathic pain (migraines, diabetic, neuropathy)
  119. Antiepileptic Drugs Examples (all used for seizures, some ALSO used for other reasons)
    • -phenytoin (dilantin)
    • -carbamazepine ( tegretol)
    • -valpropic acid (depakote)-used for bipolar disorder
    • -clonazepam (klonopin)
    • -lamotrigine (Lamictal)-used for bipolar disease
    • -gabapentin (neurotin)- also used for neuropathic pain
    • -topiramate (topamax)
  120. therapeutic index
    safe & toxic plasma levels close
  121. Phenytoin (Dilantin)- inc protein bound
    • -contraindications: pregnancy (teratogenic)
    • -therapeutic serum level:10-20 mcg/ml
    • -side effects/adverse reactions: gingivitis, gingival hyperplasia, nystagmus- eyes jumpy indication of too much in system, diplopia, HA, dizziness, slurred speach, decreased coordination, alpecia, thrombocytopenia, steven-johnson syndrome

  122. valproic acid (Depakote)
    • -side/adverse effects: ataxia (common in elderly), thrombocytopenia, hepatotxicity
    • -interactions: barbiturates- additive effect (increase CNS depression)
  123. carbamazepine (tegretol)
    • -side/adverse effects: bone marrow suppression, dysrhymias
    • -interaction:all blood cells effected, several drugs when used in combination with this drug may lead to toxicity, other bone marrow depressants-additive effect
  124. Lamitrigine (lamictal)
    • -used a lot for bipolar disorders
    • -side/adverse effects: rash-common- hold med call md pt to be seen asap,
    • ataxia
    • -interactions: other anticonvulsants
  125. nrsg process-antiepileptics/anticonvulsants
    • -assessment: document type of seizure seen, assess liver function tests, CBC
    • -nrsg dx: risk for injury
    • -planning
    • -implementation
  126. anticonvulsants: general nrsg intervention
    • -warn client do NOT discontinue abruptly
    • -teach client to take drug at same time every day
    • -avoid certain herbs, alcohol, & other CNS depressants
    • -monitor serum drug levels & liver function tests
    • -safety: protect from environmental hazards, driving
  127. Dilantin Nrsg Interventions
    • -need frequent oral hygiene and dental check ups
    • -warn females taking oral contraceptives to use additional contraception
    • -monitor glucose level in diabetics
    • -warn of harmless pinkish red or brown urine
  128. anticonvulants evaluate
  129. Status epilepticus
    • -Benzodiazepines
    •  'diazepam (valium)- most common used to stop status epileptics
    •  'lorazepam (Ativan)
    •  'midazolam (versed)
    •  'followed by fosphenytoin--cerebyx (iv form of dilantin
  130. parkinsonism pathophysiology
    • -chronic neurologic disorder
    • -degeneration of dopaminergic neurons
    • -imbalance of the neurotransmitters
    •  'less dopamine
  131. parkinsonism characteristics
    • -tremors of the head and neck
    • -rigidity (increase muscle tone)
    • -bradykinesia (slow movement)
    • -postural changes-head and chest thrown forward
    • -shuffling walk
    • -lack of facial expression
    • -pillow rolling motion of hands
  132. parkinsonism treatment regimen
    • -dopaminergics: convert to dopamine
    • -dopamine agonists: stimulate dopamine receptors
    • -anticholinergics: block cholinergic receptors
    • -MAO-B inhibitors: inhibit MAO-B enzyme that interfere with dopamine
    • -COMT inhibitors: inhibit COMT enzyme that inactivates dopamine
  133. Dopaminergics
    • -Carbidopa-levadopa (sinemet)
    • -action: converted to dopamine-short duration of action, must be taken 3-4 times/day. extended release 2-4 times/day
    • -side effects: involuntary choreiform movements, N&V, urinary retention, fatigue, dry mouth, bluured vision, ortho hypotension, palpitations, dysrhythmias,dyskinesia, psychosis, severe depression
    • -drug interactions: phenytoin, benzodiazepines, anticholinergics
  134. antiparkinsonism drugs
    • -anticholinergics: benztropine (Cogentin), trihexyphenidyl HCL (artane)
    • -dopamine agonist: amantadine (symmetrel), bromocriptine (parlodel)
    • -COMT: entacapone (stalevo)
    • -others: seleginine (eldepryl), ropinirole (requip) also used for restless legs syndrome
  135. antiparkinsonism nrsg interventions
    • -monitor for ortho hypotension
    • -avoid excess vit B6
    • -warn of urine/sweat getting harmless brown discoloration
    • -assess symptom status and "on-off" phenomenon
    • -monitor blood cell counts, liver function & kidney function
    • -teaching re: anticholingerics effects with benztropine & trihexphenidyl
  136. Alzheimer's Disease Pathophysiology
    • -progressive, degenerative disease
    • -neuritic plaques form
    • -neurofibrillary tangles are in neurons
    • -cholinergic neurotransmitter abnormallity
  137. Alzheimer's Disease characteristics
    • -loss of memory, logical thinking,judgement
    • -time disorientation
    • -personality changes
    • -hyperactivity
    • -tendency to wander
    • -inability to express oneself
  138. meds used to treat Alzheimer's Disease
    • Acetycholinesterase inhibitors: Donepezil (Aricept), Rivastigmine (exelone), tacrine (cognex)
    • -use: mild to moderate Alzheimer's Disease
    • -goal: NOT a cure, improve memory, slow progression of disease
  139. side effects of meds used for AD
    headache, dizziness, dehydration dry mouth, blurred vision, depression, GI distress, insomnia, hypertension, hypotension, dysrhythmias, hepatotoxicity
  140. AD nrsg interventions
    • -monitor VS
    • -maintain consistency in care
    • -monitor behavior changes
    • -provide safety when wandering
    • -arise slowly to avoid dizziness
    • -monitor for GI bleed
  141. Multiple Sclerosis (MS) pathophysiology
    • -autoimmune disorder
    • -attacks myelin sheath of nerve fibers
    • -cause lesions or plaques
  142. MS characteristics
    • -remissions and exacerbations
    • -extremity weakness or spasticity
    •  'spasticity: muscular hyperactivity that cause contraction of the muscles.
    • -diplopia
  143. MS meds
    • -glucocorticoid (prednisone)
    • -biologic response modifiers (interferon-B)
    • -immunosuppressant
    •  'azathioprine (Imuran)
    •  'cyclophosphamide (Cytoxan)
    • -skeletal muscle relaxants
  144. skeletal muscle relaxants
    • -central acting
    •  'baclofen (lioresal)
    •  'tizanidine (Zanaflex) 
    •  'cyclobenzaprine (flexeril)
    •  'carisoprodol (soma)
    • -direct acting 
    •  'dantrolene (dantrium)
    • -use
    •  'suppress muscular hyperactivity
    •  'relax muscles in spasm
  145. skeletal muscle relaxants side effects
    drowsiness, sedation, dizziness- MOST COMMON WITH ALL, headaches, GI distress, drug dependence
  146. skeletal muscle relaxants Nrsg interventions
    • -take with food
    • -monitor liver function
    • -check VS
    • -do not allow to drive
    • -do not stop abruptly: discontinue over 1 week to avoid rebound spasms
    • -avoid alcohol and other depressants
  147. Myasthenia Gravis (MG) pathophysiology
    • -autoimmune disease
    • -lack of nerve impulses and muscle responses at myoneural junction
    • -lack of acetylcholine reaching cholinergic receptors
  148. MG characteristics
    • -muscular weakness and fatigue
    • -respiratory muscle paralysis, ptosis, difficulty chewing and swallowing
  149. Cholinesterase Inhibitors
    • -Neostigmine (prostigmin): short acting
    • -edrophonium (tensilon): ultra short acting (used for diagnosing MG)
    • -pyridostigmine (mestinon): intermediate acting
    • -action: transmission of neuromuscular impulses by preventing destruction of Ach
    • -use: control and treat MG
  150. Cholinesterase inhibitors overdosing & underdosing
    • -similar symptoms
    • -muscle weakness, dyspnea
    • -dysphasia, abdominal crapping
    • -drooling, increases tearing, sweating
    • -bradycardia
  151. cholinesterase inhibitors crisis'
     -myasthenia crisis: severe muscle weakness, improves after edrophonium

    -Cholinergic crisis: overdosed: severe muscle weakness
  152. cholinesterase inhibitors side effects
    • pupil consriction
    • GI distress, abd crapping
    • excess saliva, sweating
    • headache, dizziness, seizures
    • hypotension, bradycardia, dysrhythmias
    • bronchospasms, respiratory depression
  153. cholinesterase inhibitors nrsg interventions
    • administer doses on time
    • take drug before meals if possible
    • monitordrug effectiveness
    • have antidote available for cholinergic crisis:atropine