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MS

Chronic, progressive degenerative disorder of the CNS system

Autoimmune disease

Lack of coordination and movement

Shaking, tremors and muscular weakness

Nystagmus(rapid movement of eyes), urinary/bowel incontinence Motor/sensory impairment (hemiparesis/ataxia)

Treat with corticosteroids and immune suppressants

Alzheimer's

Rapid progression at a young age (genetics)

Sporadic- unknown, onset later, slower progression

Atropy of the brain

Reduction in neurotransmitter acetylcholine (Decrease in acetylcholine-memoryloss)

Treat with Donepezil (Aricept)

Acetylcholinesterase inhibitors

Treat mild to moderate Alzheimer's (early)

Improving cholinergic/parasympathetic function

SLUDGE> salivation; lacrimation; urination; diarrhea; GI distress; Emesis

May cause dizziness

Adverse effect: peptic ulcers

Notify HCP: ab pain, coffee ground emesis, nausea, diarrhea, change in color ofstool, & new symptoms

Tarcine (Cognex) heptatoxicity

Rivastigmine (Exelon) weight loss

Used in conjunction with acetylcholinesterase inhibitorsMemantine (Namenda): reduced glutamate, found in Alzheimer ptsAnti-inflammatory COX2 inhibitorsAnti-pyschotic agentsAnxiolytics (for anxiety & depression)

PARKINSON'S DISEASE

unknown cause

degenerative disease of basal ganglia & dopamine deficiency

hand tremors @ rest, muscle rigidity, bradykinesis (slow movement), loss of

balance (humped over), shuffling gait, dsyphagia, orthostatic hypotensionTreat with Dopaminergic & anti-cholinergics

Levodopa (Larodopa) Dopaminergic

converted to dopamine in the CNS

Carbidopa (Simemet) prevents peripheral destruction of levodopa

Use Sinemet conjunctively with Levodopa to reduce Levodopa dose

AD/SE: blurred vision; memory loss; hepatotoxicity; dark urine or sweat; gastricirritation; dizziness; dry mouth

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eat shortly after, but avoid high protein b/c it decrease absorption

Avoid taking multi vitamins

Notify HCP of urinary retention, involuntary movement; behavioral changes; severe N/V;

new skin lesions; spasmotic eye winking; protrusion of tongues (signs of toxicity)

Amantidine (Symmetrel) Dopaminergic

increase affect of dopamine in CNS

Benztroepine (Cogentin) Anti-cholinergic inhibits acetylcholine; blocks cholinergic

AD/SE: dry mouth; constipation; tachycardia; blurred vision; urinary retention

Caution w/ pts w/ narrow angle glaucoma; myathenia gravis, GI/GU tractobstruction, BPH

Avoid taking antacids or anti-diarrhea within 1-2 hrs of medsHELPFUL HINTS

Dry as a bone (dry mouth, constipation- increase fluids); Hot as a hare (avoidsunlight; sunglasses); Red as a beet (association with heart- tachycardia;palpitations); Mad as a hatter (behavioral changes depression); blind as a bat(blurred vision)

Myasthenia Gravis neuromuscular disease; weakness of voluntary muscle

loss of acetylcholine receptors

Sx: muscle weakness; diplopia

Treat with Anticholinesterase

Amyotrophic Lateral Sclerosis (ALS)

loss of motor neurons

Sx: muscle atrophy; hyperreflexia; spasticity;

Treatment is supportive care

SEIZURES

Acute: temporary condition irritation to the brain

Chronic: injury to the brain (seizure disorder/epilepsy)

Phases: aura (prior to seizure); ictus (seizure); Post ictal (following)

Types:

Partial/Focal a. simple abnormal sensation/localized motor activityb. complex pt is awake but unaware; involuntary

Generalized -a. absence (petit mal) last few seconds; see in children

b. atonic few seconds; falling for no reasonc. tonic-clonic aura; intense muscle contraction; loss of bowel/bladder control; shallowbreathing; disorientation/deep sleep after