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Neuromuscular Disorders
-Four types of NM disorders
-1. Parkinson's Disease: Chronic Disease that effects the __________ motor tract (which controls ________, ________& _________ characterized by three major features: rigidity, __________ & __________.
Neuromuscular Disorders
- -Four types of NM disorders
- -1. Parkinson's Disease: Chronic Disease that effects the extrapyramidal motor tract (which controls posture, balance & locomotion characterized by three major features: rigidity, bradykinesias & tremors.
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Neuromuscular Disorders
-2. Myasthenia Gravis: Lack of __________ impulses & __________responses at myoneural junctions causing muscle __________ and, at worst, __________ failure & arrest. Due to decreased secretion of __________ or loss of acetylcholine due to an increase in the enzyme __________. Also due to antibodies that __________ the acetylcholine receptor site post synapse.
Neuromuscular Disorders
-2. Myasthenia Gravis: Lack of nerve impulses & muscle responses at myoneural junctions causing muscle weakness and, at worst, respiratory failure & arrest. Due to decreased secretion of acetylcholine or loss of acetylcholine due to an increase in the enzyme cholinesterase. Also due to antibodies that block the acetylcholine receptor site post synapse.
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Neuromuscular Disorders
-3. Multiple Sclerosis a disease of lesions on the myelin sheaths called __________
-4. Alzheimer's Disease - a disease of neuritic plaques thought to be due to degeneration of cholinergic neurons and a deficiency in __________
Neuromuscular Disorders
- -3. Multiple Sclerosis a disease of lesions on the myelin sheaths called plaques
- -4. Alzheimer's Disease - a disease of neuritic plaques thought to be due to degeneration of cholinergic neurons and a deficiency in acetylcholine
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Neuromuscular Disorder
-Muscle Spasms are due to a variety of _________. Can be reduced by the use of skeletal muscle _________
Neuromuscular Disorder
-Muscle Spasms are due to a variety of causes. Can be reduced by the use of skeletal muscle relaxants.
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Parkinsonism
-__________ drugs are used to reduce muscle rigidity and some of the tremors but have no effect on __________
-The anticholinergics are parasympatholytics that inhibit the release of __________.
-__________, __________, __________ & __________.
Parkinsonism
- -Anticholinergic drugs are used to reduce muscle rigidity and some of the tremors but have no effect on bradykinesia
- -The anticholinergics are parasympatholytics that inhibit the release of acetylcholine.
- -Artane, Cogentin, Parsidol & Norflex.
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Parkinsonism
-Dopaminergics: Dopamine can not cross the _____________. ___________ is a precursor of Dopamine and it can cross the ________ In the brain, ________ is converted to Dopamine. 99% of ________ is converted to Dopamine in ________ tissue before reaching the brain.
-________ has a short half-life and must be taken frequently
-After ____ years of treatment patients experience on/off ________ and may need a dopamine ________ or ________inhibitor to decrease the "off" time and therefore decrease ________.
Parkinsonism
- -Dopaminergics: Dopamine can not cross the Blood Brain Barrier. Levodopa is a precursor of Dopamine and it can cross the BBB. In the brain, Levodopa is converted to Dopamine. 99% of Levodopa is converted to Dopamine in peripheral tissue before reaching the brain.
- -Levodopa has a short half-life and must be taken frequently
- -After 5 years of treatment patients experience on/off fluctuations and may need a dopamine antagonist or COMT inhibitor to decrease the "off" time and therefore decrease symptoms.
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Parkinsonism
-Dopamine Agonists: _________ dopamine receptors. _________ (amantadine hydrochloride) is an antiviral that acts on _________ receptors
-_________ is also used to act directly on CNS _________ receptors.
Parkinsonism
- -Dopamine Agonists: Stimulate dopamine receptors. Symmetrel (amantadine hydrochloride) is an antiviral that acts on dopamine receptors
- -Parlodel is also used to act directly on CNS dopamine receptors.
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Parkinsonism
-_________ inhibitors to prevent or slow the breakdown of ________
-________ inhibitors increase the amount of ________ in the brain by inhibiting the inactivation of ________.
Parkinsonism
- -MAO-B inhibitors to prevent or slow the breakdown of dopamine
- -COMT inhibitors increase the amount of Levodopa in the brain by inhibiting the inactivation of Levodopa.
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Myasthenia Gravis
-Autoimmune disorder in which __________ does not read the post- ______ receptor sites.
-Antibodies attack the __________ sites
-Drug used to treat MG include __________.
Myasthenia Gravis
- -Autoimmune disorder in which acetylcholine does not read the post- synaptic receptor sites.
- -Antibodies attack the receptors sites
- -Drug used to treat MG include cholinesterase.
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Myasthenia Gravis
-Crises:
-1. _______ crisis: too little drug, too little acetylcholine, too little activity--> very weak patient (needs airway control then more drug)
-2. _______ crisis: too much drug, too much acetylcholine, too much activity-->
-very weak patient with severe _______ cramping (needs airway control then overdose _______ )
Myasthenia Gravis
- -Crises:
- -1. Myasthenic crisis: too little drug, too little acetylcholine, too little activity--> very weak patient (needs airway control then more drug)
- -2. Cholinergic crisis: too much drug, too much acetylcholine, too much activity-->
- -very weak patient with severe abdominal cramping (needs airway control then overdose antidote)
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Myasthenia Gravis
-Drugs used for the treatment of MG
-_________-cholinesterase inhibitor
-immunosuppressant _________
-_________
Myasthenia Gravis
- -Drugs used for the treatment of MG
- -Mestinon-cholinesterase inhibitor
- -immunosuppressant Imuran
- -Prednisone
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Multiple Sclerosis
-Autoimmune disease that affects _______sheaths causing ______ to form
-There is currently no _____ and no _____ drug therapy.
-______are still being tried.
-Drug therapy is aimed at phases of the disease including ______ attack, ______ & ______ & ______ progressive.
Multiple Sclerosis
- -Autoimmune disease that affects myelin sheaths causing plaques to form
- -There is currently no cure and no satisfactory drug therapy.
- -Protocols are still being tried.
- -Drug therapy is aimed at phases of the disease including Acute attack, remission & exacerbation & chronic progressive.
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Alzheimer's Disease
-________ dementia
-Numerous changes related to multiple therapies about what causes Alzheimer's including:
-1. ________ found with twists inside the neurons.
-2. Accumulation of ________
-3. ________ that promotes the formation of neuritic plaques bindings ________ in the plaques
-4. Degeneration of ________ neurons and deficiency in ________.
Alzheimer's Disease
- -Incurable dementia
- -Numerous changes related to multiple therapies about what causes Alzheimer's including:
- -1. Neurofibrillary found with twists inside the neurons.
- -2. Accumulation of amyloid
- -3. Apolipoprotein that promotes the formation of neuritic plaques bindings amyloid in the plaques
- -4. Degeneration of cholinergic neurons and deficiency in acetylcholine.
- -5. Neuritic plaques that forms outside the neurons and inside the cerebral cortex.
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Alzheimer's Disease
-no known _________ to cure the disease
-FDA approved four medications to treat Alzheimer's including:
-1. _________to treat memory loss
-2. _________ inhibitors including:
-A. _________ (tacrine)
-B. _________ (donepezil)
-C. _________ (rivastigmine)
-These drugs increase _________ function by increasing the levels of _________.
Alzheimer's Disease
- -no known medications to cure the disease
- -FDA approved four medications to treat Alzheimer's including:
- -1. Hydergine to treat memory loss
- -2. Cholinesterase inhibitors including:
- -A. Cognex (tacrine)
- -B. Aricept (donepezil)
- -C. Exelon (rivastigmine)
- -These drugs increase cognitive function by increasing the levels of acetylcholine.
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Alzheimer's Disease
-Several drug for treating Alzheimer's are under investigation including the non-______ ant-inflammatories ______ , ______ channel blocker, ______ inhibitors, CNS stimulants like ______ , ______ inhibitors & vitamin__.
Alzheimer's Disease
-Several drug for treating Alzheimer's are under investigation including the non-steroidal ant-inflammatories Indocin, Calcium channel blocker, MAO-B inhibitors, CNS stimulants like Ritalin, ACE inhibitors & vitamin E.
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Central Acting Muscle Relaxants
-____________ result from increased muscle tone from ___________ neurons caused by increased stimulation of cerebral neurons or lack of inhibition in the ___________ in the skeletal muscle.
-These drugs _________ neurons activity in the spinal cord or brain and act directly on ___________ muscles.
Central Acting Muscle Relaxants
- -Spasticity result from increased muscle tone from hyperexcitable neurons caused by increased stimulation of cerebral neurons or lack of inhibition in the spinal cord in the skeletal muscle.
- -These drugs depress neurons activity in the spinal cord or brain and act directly on skeletal muscles.
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Spasticity
-Centrally acting muscle relaxants acts on the ______ cord
-Such drugs include:
-______(Baclofen), ______ (Dantrium) &
-______ (Zanaflex)
-Centrally acting muscle relaxants can --> drowsiness, lightheadedness, ______.
Spasticity
- -Centrally acting muscle relaxants acts on the spinal cord
- -Such drugs include:
- -Iioresal (Baclofen), dantrolene (Dantrium) &
- -Tizanidine (Zanaflex)
- -Centrally acting muscle relaxants can --> drowsiness, lightheadedness, headaches.
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Muscle Spasm
-These are drug that are used for muscle spasm to _______ pain and _______ range of motion.
-These drugs have a _______ effect and therefore should not be taken with CNS _______ like _______, _______, or _______.
-This group of drug include:
-_______, _______, _______ & _______.
Muscle Spasm
- -These are drug that are used for muscle spasm to decrease pain and increase range of motion.
- -These drugs have a sedative effect and therefore should not be taken with CNS depressant like barbiturates, narcotics, or alcohol.
- -This group of drug include:
- -Soma, Flexeril, Robaxin & Norflex.
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