Medications for MS Immunomodulator Modify the disease progression and prevent relapse • Interferon B-1a (Rebif, Plegridy and Interferon b-1a (Avonex – IM weekly) • Interferon B-1b (Betasron – given weekly SQ, Extavia) • Glatiramer Acetate (Copaxone) **Rotate injection sites Immunosuppressant Decrease the frequency of relapse • Azathioprine (Imuran) • Cyclosporine (Sandimmune) **Avoid Pregnancy and Infections Antispasmodics Decrease muscle spasms • Dantrolene (Dantrium) • Tizanidine (Zanaflex) • Baclofen (Liorsal) • Diazepam (Valium) ** Increase weakness, safety, liver toxicity, never stop abruptly Corticosteriods Decrease Inflammation, in acute exacerbation • Prednisone ** Increase risk for infection and volemia, hypokalemia, hypernatremia, increase glucose, risk for GI bleeding Do NOT stop abruptly Restrict sodium
Parkinson’s Disease • Chronic, progress neurodegenerative disorder • Lack of Dopamine which is essential for normal functioning of the extrapyramidal motor system, including control of posture, support and voluntary motion. • Lewy bodies, unusual clumps of protein, are found in the brains of patients with Parkinson Disease • Men more than women • Increase incidence with age • Exposure to toxins/viruses (manganese dust, carbon monoxide)
How to diagnosis Parkinson’s Disease • There is NO specific diagnostic test that exists for Parkinson’s Disease • Diagnosis is based on patients history and clinical features. • Clinical diagnosis require presence of TRAP and asymmetric onset • Confirmation of PD is a positive response to antiparkinsons drugs (levodopa or dopamine agonist) • MRI and CT do not show a specific pathologic finding but rule out stroke or brain tumor
Clinical Manifestations of PD • Onset of Parkinson Disease is gradual and insidious with an ongoing progression • Only one side of body may be involved initially • In the beginning stages, only a mild tremor, a slight limp, or a decreased arm swinging may be evident. • Later in the disease, the patient may have shuffling, propulsive gait with arms flexed, and slow loss of postural reflexes • Up to 90% of patient speech abnormalities (hypokinetic dysarthria) • Mask like face T remors (described as “pin rolling”) R igidity (cogwheel rigidity – jerky quality) A kinesia (absences of voluntary muscle movement) P ostural instability (unable to stop themselves going forward) – pull test
Signs & Symptoms Resting Tremors Stage I – unilateral tremors of one limb pill rolling – hand writing, decrease arm swinging Stage II – bilateral limb involvement walking and balance Stage III – decrease tremors, increase akinesia, increase rigidity, decrease in ADL’s function Stage IV – unable to stand/walk, total care, dementia
Complications of Parkinson’s Disease • As the disease progresses, complications increase • Worsening of dyskinesia (spontaneous involuntary movements), weakness, neurologic problems (dementia), and neuropsychiatric problems (depression, hallucinations, psychosis) • As swallowing becomes more difficult (dysphagia), malnutrition or aspiration may result.
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