Medications for MS Immunomodulator Modify the disease progression and prevent

Medications for ms immunomodulator modify the disease

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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
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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)
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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
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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
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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
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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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