Patho/Risks
If you were describing MG, MS, and Parkinson's in 3 words or less each how would you?
MG - muscle weakness, achetylcholine
MS - Autoimmune, myelin damage
parkinson - dopamine, achetylcholine imbalance
5 D's of MG!
BONUS 50, name new other s/s of MG
diplopia, dysphagia, dysphonia, dyspnea, dysarthria
BONUS ptosis, mask-like face
Components of eyecare for MG and MS?
tape eyes closed at night, can use ointment/drops
list at least 3 things about Potassium (Oral or IV)
Nursing monitoring/considerations: NEVER GIVE IV PUSH, always on pump, no more than 10-20 Meq/hr, establish renal function prior, continuously monitor cardiac monitor, can burn upon admin of IV
what is albuterol for? Pt. edu?
Albuterol (Proventil)
risk factors for MG vs MS
MG: autoimmunity, female, thymus gland abnormalities, env
MS: 20-40, female, white, genes, obesity, smoking, low Vit D, Epstein Barr
What S/S do MS and Parkinson's have in common?
tremors, slurred speech, muscle weakness, dysphagia
*these can occur at different stages for MG
How do you diagnose MG, MS, and Parkinson's?
MG: Antibody tests, CT, Ice pack test, EMG, Rx trial (Mestinon)
MS: hx, LP, CT, MRI, EMG, EEG
Parkinson's: 2/4 cardinal signs, PET, SPET, DaT
What is pyridostigmine bromide? What is it used for and MOA?
BONUS: what is the main adverse effect we're worried about? is there an antidote?
Mestinon!
tell me everything you know about Nitroglycerin
risk factors for parkinson's?
BONUS: What are the cardinal s/s for parkinson's?
Risk Factors: genes, env, antipsychotics, head trauma, atherosclerosis
Cardinal S/S: tremors, rigidity, bradykinesia, postural changes
what is uthoff's phenomenon triggered by and s/s? which disorder is it associated with?
associated with MS
triggered by extreme heat/cold (i.e. hairdryers, saunas, weather, hot tubs, etc.)
s/s nuchal rigidity
Difference between Cholinergic and Myasthenic Crisis?
Cholinergic: SLUD- Salivation, lacrimation, urination, defecation; GI cramps, emesis, bradycardia, constricted pupils, exacerbation of s/s with tensilon test, weak muscles and fasciculations
Myasthenic: decreased cholinergic receptors, respiratory distress, normal secretions, tachycardia, weak muscles, tensilon test relieves s/s, pupils normal or dilated
differentiate heparin and Warfarin
name at least 4 differences
Heparin:
Warfarin:
50 points for every thing you can tell me about Alteplase/tenecteplase
How does MS work? (patho)
make sure to mention which cells are involved!
T cells and lymphocytes cross BBB and other agents damage myelination resulting in neuromuscular changes
what are the "special" s/s for MG, parkinson's, and MS?
MG: : ptosis, 5 D's (diplopia, dysphagia, dysphonia, dyspnea, dysarthria) only intentional tremors
MS: nystagmus, uthoff’s phenomenon, ataxia
Parkinson's: resting and intentional tremors, rigidity, bradykinesia, postural changes, stiffness, depression, akinesia, shuffling gait
Are there any surgical/procedural options for MS, MG, or Parkinson's?
MS: stem cell transplant
MG: thymus removal, plasmapheresis
Parkinson's: DBS (neurostimulator implant), sterotaxic pallidotomy
What medications do you use for MS, MG, and Parkinson's?
MS: monoclonal antibodies, interferon-beta meds, methylprednisone, baclofen/dantrolene
MG: Mestinon, immunosuppressants
Parkinson's: Levodopa-Carbidopa, neuroprotectants, other dopinergics
Carbadopa-levodopa, tell me everything about it
ALSO why don't we want to use spasmolytics for parkinson's tx?
We don't use spasmolytics like dantrolene or baclofen because parkinson's patients usually rely on some spasticity for posture
Achetylcholine is involved in Parkinson's and Myathenia Gravis. How is their patho different?
MG: autoimmune disorder in which antibodies attack acetylcholine resulting in muscle weakness from diminished communication between nerves and muscles. Strength restored with rest. S/S begin at eyes
Parkinson's: dopamine receptors are inhibited leading to imbalance between dopamine and Ach, communication between brain and body slower = person unable to control or initiate movements normally
Write out all s/s for MG, MS, and parkinson's
BONUS 200 if you can list the early and late s/s of parkinson's
BONUS 500 if you can do MS and parkinson's early, progressive (if applicable) and late stages, AND identify where s/s first appear in MG
MG: ptosis, diplopia, dysphagia, dysphonia, dyspnea, mask-like face
First: Eyes
MS:intentional tremor, nystagmus/diplopia, slurred speech, uthoff’s phenomenon, ataxia, muscle weakness/spasticity
Early: diplopia, blurry vision, nystagmus, fatigue, muscle weakness
Progressive: bladder/bowel dysfunction, emotional and personality changes, slurred speech, intention tremors, ataxia
Late: severe fatigue, cognitive impairment, muscle spaticity
Parkinson's: (Cardinal) resting/intentional tremors, rigidity, bradykinesia, postural changes, SMART: shuffling gait, mask-like, akinesia, rigidity, tremors
Early: stiffness, resting tremors, bradykinesia
Late: slurred speech, dysphagia, rigidity, drooling, depression
Patient education for all 3, LETS GOOOOO
MS: mgmt. of s/s: avoid strenuous activity, avoid extreme heat/cold, C&DB, eye care
MG: eye care, avoid novocaine, s/s cholinergic crisis vs myasthenic crisis
Parkinson's: monitor aspiration and fall risks, semi-solid foods, no thin liquids, monitor protein if on Levodopa, encourage independence and mobility, monitor weight, prevent constipation
TELL ME EVERYTHING YOU KNOW ABOUT DIGOXIN
WE NEED AT LEAST 5 THINGS
Digoxin
Name at least 3 characteristics of the following meds:
extra 50 pts for any additional characteristic!
ACE inhibitors
metoprolol
omeprazole
furosemide
Ace inhibitors (Captopril)
Metoprolol:
omeprazole:
furosemide