1. Drugs for Degenerative Diseases and Muscles12
Drugs for Degenerative Diseases and Muscles

2. Directory
Classroom Response System
Lecture Note Presentation

3. Question 1
Drug therapy for the patient with Parkinson’s disease focuses on:

4. Question 1 Choices Increasing cholinergic stimulation within the brain
Restoring acetylcholine and blocking dopamine within the brain
Restoring dopamine function and blocking acetylcholine within the brain
Destroying dopamine receptors within the brain

5. Question 1 Answer Increasing cholinergic stimulation within the brain
Restoring acetylcholine and blocking dopamine within the brain
Restoring dopamine function and blocking acetylcholine within the brain
Destroying dopamine receptors within the brain

6. Question 2
An interferon is prescribed for a patient with MS. The nurse should include which of the following points when teaching the patient about drug therapy?

7. Question 2 Choices
Report flulike symptoms to the health care provider.
Expect urine to be orange.
Report the development of diarrhea.
The symptoms will get better over a period of a year.

8. Question 2 Answer Report flulike symptoms to the health care provider.
Expect urine to be orange.
Report the development of diarrhea.
The symptoms will get better over a period of a year.

9. Question 3
The patient on haloperidol (Haldol) is experiencing tardive dyskinesia. Which of the following drugs would the nurse anticipate being ordered?

10. Question 3 Choices Levodopa Risperidone (Risperdal)
Benztropine (Cogentin)
Chlorpromazine (Thorazine)

11. Question 3 Answer Levodopa Risperidone (Risperdal)
Benztropine (Cogentin)
Chlorpromazine (Thorazine)

12. Question 4
The patient with Alzheimer’s disease has been started on rivastigmine (Exelon). The nurse assesses the patient for:

13. Question 4 Choices Liver toxicity Weight loss Renal failure
Extrapyramidal adverse effects

14. Question 4 Answer Liver toxicity Weight loss Renal failure
Extrapyramidal adverse effects

15. Learning Outcomes
Identify the most common degenerative diseases of the CNS.
Describe symptoms of Parkinson’s disease, Alzheimer’s disease, multiple sclerosis and spasticity.
Explain the neurochemical basis of central degenerative diseases and muscle spasms.

16. Learning Outcomes
Explain the goals of pharmacotherapy and categorize drugs used in the treatment of degenerative diseases based on their classification and drug action.
Describe the pharmacologic management of muscle spasms.

17. Learning Outcomes
Discuss nonpharmacologic therapies used to treat muscle spasms and spasticity.
Discuss the pharmacology of neuromuscular blocking agents.

18. Learning Outcomes
Compare and contrast the roles of the following drug categories in treating muscle spasms and spasticity: centrally acting skeletal muscle relaxants and direct-acting antispasmodics.
For each of the drug classes, know representative drugs, and explain their mechanisms of action, primary actions, and important adverse effects.

19. Medications are unable to cure most degenerative diseases of the CNS.
Core Concept 12.1
Medications are unable to cure most degenerative diseases of the CNS.

20. Neurologic Degenerative Disease
Cause unknown
Progress from hardly noticeable signs and symptoms early in the disease to serious neurologic and cognitive deficits.
Difficult to diagnose in early stages
Pharmacotherapy provides only minimal benefit except for Parkinson’s disease

21. Neurologic Degenerative Disease
Currently, medication is unable to cure any of the major neurodegenerative diseases.

23. Core Concept 12.2
Parkinson’s disease is progressive, with the occurrence of full symptoms taking many years.

24. Symptoms Tremors Muscle rigidity
Hands and head develop a palsy-like motion or shakiness when at rest
pill-rolling
Muscle rigidity
Stiffness resemble arthritis
Difficulty bending over or moving limbs.
Masked face.

25. Symptoms Muscle rigidity Bradykinesia. Most noticeable
Difficulty chewing, swallowing, or speaking
Difficulty initiating movement and controlling fine muscle movements.
Walking often becomes difficult, shuffling gait

26. Symptoms
Postural instability.
Stooped posture
Frequent falls

27. Concept Review 12.1
Parkinson’s disease primarily affects which body functions? What are the four major symptoms of this disorder?

28. Core Concept 12.3
Parkinsonism drugs focus in the brain by restoring the balance between dopamine and acetylcholine.

29. Goal of Pharmacotherapy
Increase the ability of the patient to perform normal daily activities such as eating, walking, dressing, and bathing
Restore the balance of dopamine and acetylcholine within the corpus striatum of the brain.
These drugs include dopaminergic agents and anticholinergics (cholinergic blockers).

30. Figure 12. 1 Dopamine cannot cross the blood-brain barrier
Figure Dopamine cannot cross the blood-brain barrier. Levodopa, its precursor, can. Once levodopa crosses the blood-brain barrier and enters nerurons, it is converted into dopamine, which normally inhibits firing of the next neuron. Natural acetylcholine in the brain stimulates the same postsynapticneuron. Thus, to restore normal neuronal activity, drug therapy attempts to either (a) restore dopamine inhibitory action, or (b) block acetylcholine (cholinergic) stimulatory activity.

32. Table 12.2 (continued) Dopaminergic Drugs Used for Parkinsonism

34. Concept Review 12.2
Anti-Parkinson’s drugs attempt to restore the balance of which two major central neurotransmitters?

35. Core Concept 12.4
Alzheimer’s patients experience a dramatic loss of ability to perform tasks that require acetylcholine as the central neurotransmitter.

36. Symptoms of AD Impaired memory and judgment
Confusion or disorientation
Inability to recognize family or friends
Aggressive behavior
Depression
Psychoses, including paranoia and delusions
Anxiety

37. Alzheimer’s disease is treated with acetylcholinesterase inhibitors.
Core Concept 12.5
Alzheimer’s disease is treated with acetylcholinesterase inhibitors.

38. Concept Review 12.3
Alzheimer’s disease is a dysfunction of which brain neurotransmitters? How do drugs for Alzheimer’s disease restore neurotransmitter function and improve symptoms of dementia?

39. Figure Alzheimer’s medications work by intensifying the effect of acetylcholine at the receptor.

41. Core Concept 12.6
Symptoms of multiple sclerosis result from demyelination of central nerve fibers

42. Demyelination
Myelin - fatty material that acts as a protective insulator of nerve fibers
Causes
Damage & inflammation
Leaves multiple areas of hard scarred tissue (plaques) along the covering of nerve cells

43. Demyelination
Axons are gradually destroyed, disrupting the ability of the nerves to conduct electrical impulses to and from the brain.

44. Symptoms Fatigue Heat sensitivity Pain
Spasticity (muscle cramps and spasms)
Cognitive problems
Balance and coordination problems
Bowel and bladder symptoms
Course of MS is unpredictable

45. Core Concept 12.7
Drugs for multiple sclerosis reduce immune attacks in the brain and treat unfavorable symptoms

46. Strategies for Treating MS
One approach attempts to reduce inflammation and prevent attacks on the nervous system.
The other strategy emphasizes treatments to relieve symptoms.

48. Core Concept 12.8
Muscle spasms are caused by injury, overmedication, hypocalcemia, and debilitating disorders.

49. Muscle Spasm
Tonic spasm single, prolonged contraction is called, whereas multiple,
Clonic spasms rapidly repeated contractions are called .

50. Core Concept 12.9
Muscle spasms may be treated with nonpharmacologic or pharmacologic therapies.

51. Nonpharmacologic Measures
Immobilization of the affected muscle
Application of heat or cold
Hydrotherapy
Ultrasound
Supervised exercises
Massage and/or manipulation

52. Pharmacotherapy Combinations of analgesics Anti-inflammatory agents
Centrally acting skeletal muscle

53. Therapeutic Goals Minimize pain and discomfort
Increase range of motion
Improve the patient’s ability to function independently.

54. Concept Review 12.4
Give several reasons why muscle spasms develop. What is the main goal of therapy for muscle spasms?

55. Core Concept 12.10
Many muscle relaxants treat muscle spasms by inhibiting upper motor neuron activity, causing sedation, or altering simple reflexes.

56. Antispasmodics Relieve symptoms of muscular stiffness and rigidity
Treat muscle spasms at the level of the CNS.

58. Table 12.6 (continued) Centrally Acting Antispasmodic Drugs

59. Core Concept 12.11
Effective treatment for spasticity includes both physical therapy and medications.

60. Spasticity Muscle groups remain in a continuous state of contraction,
Usually as a result of damage to the CNS.
Signs and symptoms
Mild to severe pain,
Exaggerated deep tendon reflexe
Muscle spasms
Scissoring (involuntary crossing of the legs)
Fixed joints.

61. Core Concept 12.12
Some drugs for spasticity provide relief by acting directly on muscle tissue, interfering with the release of calcium ions.

62. Effective Drugs Central Acting Direct-acting drug Baclofen (Lioresal)
Diazepam (Valium)
Direct-acting drug
Dantrolene (Dantrium).

63. Figure (a) Drugs affecting the neuromuscular junction may block either the release of acetylcholine at the synaptic terminal or the action of acetylcholine at its receptor (located on the surface of muscle fibers). (b) Drugs also block the release of calcium ions from muscle tissue, preventing the muscle fibers from contracting.

65. Core Concept 12.13
Neuromuscular blocking agents block the effect of acetylcholine at the receptor.

66. Neuromuscular Blocking Agents
Bind to nicotinic receptors located on the surface of skeletal muscle fiber
Nicotinic blocking agents
Interfere with the binding of acetylcholine
Preventing voluntary muscle contraction
Cholinergic

67. Major Categories Nondepolarizing Blockers Depolarizing blockers
Compete with acetylcholine for the receptor
Interfere with the binding of acetylcholine
Muscles remain relaxed.
Depolarizing blockers
Bind to the acetylcholine receptor
Produce a state of continuous depolarization.