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