Myasthenia gravis

Cholinesterase inhibitor

Pyridostigime(mestinon)

s/s ptosis,difficulty swallowing, and weak muscles

MOA: prevent ach inactivation=increased muscle strength

USE=symptomatic relief of muscle weakness

S/E increase Ach at muscarinic junctions, tremors,increase gi motility, inc secretions, muscle rigidity

Assess for difficulity swallowing,bradycardia, diaphoresis, and urinary urgency overdose can lead to respiratory failure

signs of relief are able to swallow better and raise eyelids

Tensilon test can check for overdose

Parkinsons disease

L.A.T.

Levodopa/Carbidopa (sinemet)

Amantadine (symmetrel)

Trihexyphenidyl (artane)

Levodopa/Carbidopa (Sinemet)

 Dopaminergic agents

Tremor at rest

Rigidity and bradykinesia

Akinesia absence of movement

Postural instability

S/S dementia,depression,impaired memory

Parkinsons Disease

anticholinergic agents

Amantadine (symmetrel)-antiviral

Promotes dopamine release and prevents reuptake. blockade of cholinergic receptors 2nd line drug

A/E CNS effects confusion, lightheadedness, anxiety will see response in about 2-3 days but will diminish in about 3-6 months with cholinergic blockade may cause atropine like effects BUDCAT blurry vision, urinary retention, and dry mouth.  DISCOLORATION OF SKIN LIVIDO RETICULARIS

Parkinsons Disease

Anticholinergic agents

Trihexphenidyl(Artane)

prevent activation of cholinergic receptors or blockade of muscaranic receptors

S/E atropine like effects BUDCAT blurred vision, urinary retention dry mouth, constipation, mydriasis

anti-epileptics

Phenytoin(dilantin)

Carbamazapine(tegretol)

Diazepam(valium)

Phenytoin(dilantin)

Traditional AED

MOA:stabilizes neuronal membranes therefore limiting seizure activity by selective inhibition of sodium channels

USES: all major seizures oral and IV but for emergency only half life 8 to 60 hours

A/E twitching eyes(nystagmus) sedation, ataxia(staggering gait) diplopia(double vision) GINGIVAL HYPERPLASIA, skin rash like stevens johnson syndrome, dysrhythmias UNUSUAL HAIR GROWTH can increase serum glucose levels

Phenytoin(dilantin)

Traditional AED

drug levels

Therapeutic level 10-20mcg/ml

toxic level 30-50mcg/ml

Carbaremazepine(Tegretol)

Antiepileptics

USE:epilepsy, bipolar disorder, trigeminal and glossopharyngeal neuralgias. not absence seizures,

A/E nystagmus, ataxia, Hematologic effects Leukopenia, anemia, thrombocytopenia

Monitor serum sodium and edema because of hypoosmolarity

Rash and photosensitivity

Grapefruitjuice effect decreases effect of contraceptives and warfarin must test asan patient genetics

Tonic Clonic seizures lasting 20 -30 min

treatment of choice

Insomnia

Local anesthetics

Procaine(novocaine)

Lidocaine(xylocaine)

block conduction in motor nerves as well as sensory nerves

Injection only(novocaine)

Preparations Cream,ointment,jelly,solution (lidocaine)

MOA: block sodium channels

supress pain without generalized CNS depression. often used with epinephrine to decrease local blood flow and thereby delaying systemic absorption. prolongs anesthesia and reduces risk for toxicity. A/e excitation followed by depression, bradycardia and heart block

can cross placenta

used for induction and maintenance of anesthesia.

A/E resp.depression, hypotension. HIgh risk for bacterial infection dure to mixture supplied in. discard after 6 hours

used in induction in pts greater than 3 years of age

used in maintanance of general anesthesia in pts greater than 2 months of age

used in ICU or places with mechanical ventilation and intubation ready

Benzodiazepines

end in pam lam

temazepam(restoril) sedative/hypnotic

Diazepam (valium) anticonvulsant

Analgesics- Opoid agonists

Strong

Morphine(duramorph) Morphine IV

Morphine(MS Contin)

Fentanyl(wildnil)

Meperidine(Demerol)

Analgesics-opoid agonists

Moderate

Codeine

Lortab(vicodan)

Oxycodone(percocet)

Propoxyphene(Darvocet-N)

Naloxone (narcan)

opoid antagonist

opoid agonists

MOA: reduce pain by bindig to poiate receptor sites in the peripheral nervous system and CNS. mimics the effects of endorphins (bodys naturally occuring opiates for pain relief)

Therapeutic effects analgesia and sedation, cough suppression, dilate blood vessels

A/E respiratory depression constipation, hypotension. monitor for oversedation, seizures, dizziness, nightmares, bradycardia, shock, cardiac arrest, thrombocytopenia, and respiratory depression, pinpoint pupils and coma.