1. alzheimers disease
    • degerative disease of the CNS, occurs in cortex of brain
    • progressive deterioration
    • debilitating symptom of AD is demetia involves decrease in cognative function
    • decrease in acetylcholine
  2. S/S Alzheimers
    • Early phase- mild cognative decline:
    • increase forgetfulness
    • decrease performance in social setting
    • evidance of memory deficit when interviewed
    • anxiety

    • Early dementia phase- mildly severe cognative decline:
    • needs assist w/ ADL
    • cant recall important aspects of life
    • cant make choices
    • able to recall major facts
    • needs assistance 4 survival

    • late dementia phas- severe cognative decline:
    • incontinent
    • little verbal ability
    • no basic psychmotor skills
    • assisstance w/ ADL
  3. cholinesterase inhibitors
    action: increase level of Acetylcholin in CNS by inhibiting its breakdown & slowing neural distruction

    Uses: tx dementia from AD, not used in late stages of AD

    cont: renal & hepatic disease, bladder obstruction, seizures disorders, sick sinus syndrome, GI bleeding, asthma, & hx of ulcer disease b/c bleeding may occur

    • Inter:
    • anticholinergic (decrease body secretion)- decrease effectiveness of anticholinergic
    • NSAID(pain)- increase risk 4 GI bleeding
    • Theophyline(breathing problems)- increased risk 4 theophyline toxicity
  4. Herbal alert
    • Ginseng-improves energy & mental performance
    • AR: sleeplessness, nervousness, diarrhea when taken in lrg doses
    • shouldnt b taken w/ stimulants
    • cont: pt w/ high B/P

    • Ginkgo- improves memory & brain function, enhances circulation to heart, brain, limbs, & eyes
    • affects not visible till 4-24 wks of tx
    • AR: GI disturbance, headache, rash, when lrg doses AR are restlessness, nausea, vomiting, diarrhea
    • cont: pt. taking MAOI b/c of toxicity, & pt taking anticoagulants
  5. Donepezil (aricept)
    • Use: mild-moderate dementia due to AD
    • AR: headache, nausea, diarrhea, insomnia, muscle cramps, WT loss

    med given once @ bed time
  6. rivastigmine(exelon)
    • use: mild-moderate dementia of AD & parkinson's disease
    • available in transdermal patch, changed daily, b/c of dementia place in area where pt couldnt remove, preferred area is the back, same site shouldnt be used more than once q 2wks, nurse needs to teach pt/family about correct use of patch

    AR: lots of nausea, vomiting, diarrhea, dyspepsia, anorexia, insomnia, fatigue, dizziness, headache
  7. tacrine (cognex)
    • use: mild-moderate AD (dementia)
    • give 1hr before or 2hr after meals

    • AR: nausea, vomiting, diarrhea, dizziness, headache, elevated liver function, hepatotoxicity
    • pt should have bolld drawn
    • teaching on signs of liver dysfunction like yellow color to skin & eyes

    cont: pt w/ liver dysfunction

    • monitor ATL wkly from wk 4- 16, after wk 16 monitor q 3mon.
    • if levels high d/c meds, benefit of meds lost w/i 6 wk of d/c
  8. assessment
    • preadmission:
    • cognative & functional ability before & during therapy
    • cognative assessed w/ Folstein Mini- Mental exam, assessed on orientation, calculation, recall, & language, scoring done by comparing othe test
    • assess 4 aggitation & impulsive behavior & ability of ADL, e. of deviatrions poor eye contact, cant answer ?, monotone, inapprotiate laugh, sadness, crying,
    • medical & mental hx, family memeber also able to assisst w/ info, pt hostital records
    • pysical assessment: B/P in both arms when sitting, pulse, resp., wt, & functional ability
  9. educating pt/family
    • keep all appt.
    • report unusual changes or physical effect
    • take RX as directed
    • dont drive or perform hazardous task if drowsiness occurs
    • dont take OTC unless RX by DR
    • keep track of when drug taken, when early stage marking a calander/pill counter
    • notify DR if AR occurs- nausea, vomiting, diarrhea, difficulty sleeping, loss of appetite, dehydration, changes in neurologic function, yellowing of skin & eyes
    • notify if Hx of ulcer, feels faint, severe stomach pain, vomitus blood or material that looks like coffee grounds, bloody/black stool

    • remember that drugs dont cure but slow mental & physical degeneration, but med must be taking continualy
    • tacrinetherapy- ATL levels must b monitered
Card Set
ch 28