NUR426 - Neurogenic Disorders WEEK 2 .docx - NUR426 -...

NUR426 - Alzheimer’s Disease, Parkinson’s Disease/Seizures and Spasticity
September 7, 2021
WEEK 2
Alzheimer’s Disease – acetylcholine
 Form of dementia that is PROGRESSIVE
o Continue to get worse and can’t be cured
o Can stop progression/delay as much as possible
 Loss of neurons and deficiency in cholinergic function in cortex and basal forebrain
o Plaque made of protein build up and kill off neurons
o Neurons needed to send information in the brain using neurotransmitters
 Hallmark findings: neurotic plaques and neurofibrillary tangles
o Plaques made of amyloid protein
o Tangles made of fibrous proteins wound around each other/tangled and cause
damage to the brain
 Decrease in acetylcholine
o Helps with memory
 Overactivation of N-methyl-d-aspartate (NMDA) receptors by glutamate
Clinical Manifestations
 Affects memory, thinking, and behavior
 Progressive – Eventually can interfere with ability to complete activities of daily living 
inability to carry on conversation  inability to respond to environment
Alzheimer’s Disease: Drug Therapy
 Cholinesterase inhibitors
 NMDA antagonist / Glutamate regulators
Cholinesterase Inhibitors
 donepezil (Aricept)
 rivastigmate (Exelon)
 galantamine (Razadyne)
Cholinesterase Inhibitors Mechanism of Action
 Blocks the action of the enzyme cholinesterase
o Stops breakdown of acetylcholine (movement, behavior, memory
neurotransmitter) in the brain so more sticks around
o More of it gets to receptors that are still left so symptoms aren’t as bad
 Acetylcholinesterase is responsible for breaking down acetylcholine
 Acetylcholine
o In central nervous system responsible for memory, mood, and learning
o In peripheral nervous system responsible for skeletal muscle movement
o Goal is to increase communication between nerve cells

Cholinesterase Inhibitors Adverse Effects
 Adverse Effects
o Common
 Nausea, vomiting, loss of appetite, diarrhea
 GI DISTRUBANCES! (increased acid in stomach)
 Diarrhea causes concern for dehydration (fluid volume deficit/FVD)
 Vomiting causes concern for aspiration (sit them up)
o Less common
 urinary urgency, incontinence, bradycardia , dyspnea, headache, syncope ,
vertigo, depression, insomnia
 Bradycardia/syncope puts patient at risk for falls so it is best taken before
bed
o Contraindications/Cautions
 hypersensitivity, liver disease, GI obstruction, peptic ulcer disease,
bradycardia, heart block, hypotension, lung disease
 Liver disease can cause jaundice, liver function test elevated (AST/ALT,
bilirubin, ammonia)
Cholinesterase Inhibitors Nursing Implications
 Prevent interactions:
o Avoid anti cholinergic medications, including antihistamines, tolterodine
o NSAIDs may decrease effects and increase risk of GI bleeding and renal failure
 Administration:
o If using patch, make sure old patch is removed first- rotate the sites and clean the
area
 PATCH used with EXELON
o Usually given at bedtime due to falls, syncope, bradycardia
 Monitor for therapeutic effects:
o Varies person to person
o Cognition, Function, Behavior
o