Need help to reply three post.

DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.

1- Each reply should be at least 200 words.

2- One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA style needs to be followed.

4- Each response should have reference at the end

5- Reference should be within last 5 years

Need help to reply three post.

DO NOT JUST REPEAT SAME INFORMATION, DO NOT JUST SAY I AGREE OR THINGS LIKE THAT. YOU NEED TO ADD NEW INFORMATION TO DISCUSSION.

1-

Each reply should be at least 200 words.

2- One scholarly reference ( NO MAYO CLINIC/ AHA)

3- APA style needs to be followed.

4- Each response should have reference at the end

5- Reference should be within last 5 years

DQ-1

Eczemais a common, chronic inflammatory skin condition characterized by dry, itchy skin. Individuals with eczema have a dysfunctional skin barrier which can be due to genetics where there is a mutation in the gene filaggrin (Nemeth & Evans, 2019). Filaggrin is an important component for skin cell maturity and is responsible for making the tough, flat corneocytes; however, patients with a filaggrin mutation will have an inconsistent organization of the skin cells allowing water to leak through the skin barrier which will dehydrate the skin leading to skin irritation (Nemeth & Evans, 2019). Also, patients with eczema have decreased amounts of bet-defensins in the skin which are vital peptides that fight off bacteria, viruses, and fungi. Therefore, patients with eczema are easily irritated by environmental factors and are more susceptible to infections.

First-line therapy for eczema includes hydration via over the counter skin moisturizers that are fragrance-free, ointments, anti-inflammatory medications, and antihistamines. Topical corticosteroids can be utilized for acute symptoms and should only be used a few times a week as long-term use can result in skin atrophy, striae, acne, and rebound dermatitis (Nemeth & Evans, 2019). Second-line therapy includes immunomodulators, such as pimecrolimus and tacrolimus, phototherapy, immunosuppressants, oral steroids, and alitretinoin. Pimecrolimus is a topical immunomodulator applied twice daily on the affected area and can be used as a long-term treatment. Compared to topical corticosteroids, pimecrolimus is more beneficial on sensitive and/or think skin and has positive effects on epidermal integrity (Jovanovic, 2019). However, patients may experience burning, soreness, stinging, and pruritus for the first few treatment days (Jovanovic, 2019). Adverse reactions include skin papilloma, skin infections, acne vulgaris, hypersensitivity, herpes simplex dermatitis (“Pimecrolimus,” 2019). Additionally, there are theoretical risks that pimecrolimus may be associated with skin malignancy and lymphoma, but the FDA agency indicated the safety of its use including in patients as young as 3 months old and for long-term management (Jovanovic, 2019). However, black box warning still indicates that pimecrolimus should not be used in children <2 years of age. It is also contraindicated in patients with erythroderma, skin diseases that may potentially increase systemic absorption such as Netherton’s syndrome, and in immunocompromised patients (“Pimecrolimus,” 2019). Drug interactions include CYP3A4 inhibitors as it may decrease the metabolism of pimecrolimus and immunosuppressants which may enhance adverse effects and toxicity.

References

Jovanovic, M. (2019). Safety of pimecrolimus and tacrolimus in the topical therapy of atopic dermatitis. Medicinski Pregled, 5–6, 139-142. doi:10.2298/MPNS1906139J

Nemeth, V., & Evans, J. (2019). Eczema. StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK538209/

Pimecrolimus. (2019). Retrieved from https://www.drugs.com/ppa/pimecrolimus.html

DQ-2

Psoriasis is a skin disease that is multi factorial in nature and involves the body’s immune response system (Kalb, 2019). Psoriasis is unique in the aspect that it has a typical red waxy scaly skin characteristic (Kalb, 2019). Psoriasis is usually apaprant at the elbows, knees, scalp, nails, and gluteal cleft (Kalb, 2019). The diagnosis of psoriasis is based on a skin biopsy to confirm the diagnosis (Kalb, 2019).

The pathology of psoriasis is characterized by systemic and local inflammation from deficits and defects in T regulatory cells and an upregulation of Th-1 and Th-17 cells, antigen-presenting cells- and cytokines (Kalb, 2019). Treatment focuses on suppressing interlukin 12, 23, and 17 to stop the inflammatory process that causes the presentation of psoriasis (Kalb, 2019). For example a treatment option is brodalumbwhich is given as a three weekly doses for induction, followed by every other week thereafter (Kalb, 2019).

Some adverse reactions of brodalumb is injection site reaction, a 1-2% chance of a cutaneous candida infection, inflammatory bowel disease exacerbation, depression, and suicidal ideation (Kalb, 2019). The depression and suicidal ideation could be a combination of self-esteem issues but could be agitated or exacerbated by brodalumb (Kalb, 2019).

Another interesting fact is that anti-IL-17 and anti-IL-23 classes have an insert warning that states that there is an infection risk from long term usage that suppresses the immune system and that there is an increased cancer risk (Kalb, 2019).

Some interactions of brodalumb include avoiding live vaccines due to the immunosuppressant nature of brodalumb and also avoiding grapefruit juice (Siliq, 2017). Brodalumb is also noted to have a narrow therapeutic index requiring monitoring of the immune system and dose adjustments as necessary (Siliq, 2017).

References:

Kalb, R. E. (2019). Overcoming Challenges in the Management of Psoriasis: Treatment Advances to Improve Standard of Care. Journal of Managed Care Medicine, 22(4), 63–66.

Siliq. (2017). MPR Monthly Prescribing Reference, 8, 3.Retrived from: https://search-ebscohost .com.lopes.idm.oclc.org/login.aspx?direct=true&db=edsgao&AN=edsgcl.510111204&site=eds-live&scope=site

DQ-3

Eczema is a chronic skin disorder that affects all ages and often begins in infancy and can resolve during puberty, but often returns after that (Woo & Osborn, 2019, pg. 958). The exact cause is unknown but patients normally have a high IgE antibody levels and have high correlation with developing asthma, allergies, or hay fever later on in life. Depending on the severity of eczema there are over-the-counter medications, prescription topical medications, phototherapy, immunosuppressants, medications, and other natural treatments for eczema.

Eczema is usually a rash that develops anywhere on the face, trunk, scalp, or extremities that causes mild to severe itching. Patches of skin become inflamed, red, cracked and rough during times of flare up and can be triggered by a variety of things. Eczema is an IgE hypersensitivity reaction and involves a complex immunologic cascade involving defects in the cell-mediated immune response, IgE dyregulation, and disruption in the epidermal barrier (Piliang & Schneider, 2019).

Treatment includes hydrating the skin, topical corticosteroids, antipruitics, emollients, phototherapy, and avoiding triggers. Patients can take vitamin D, probiotics, use oatmeal baths, lotions/creams as nonpharmacological treatments. They should take a 20 minute bath, pat the skin dry and apply emollients such as eucerin or aquaphor to the skin to lock in the moisture. Oatmeal baths help with the itching and hydrate the skin as well. Topical medications can be used such as Protopic (tacrolimus) that is a macrolide immunosuppressant that is applied to the skin twice a day. It is not indicated for children under 2 years old and should be used short term with breaks in between if needed (Protopic, 2019). It is not a first line therapy and should be used if the topical steroids fail. Long-term safety has not been established and the causal relationship has not been established for skin malignancy but has been reported. It comes in a 0.03% for pediatric and a 0.1% for adults or kids 16 and over. They need to avoid light therapy, tanning beds, and sun exposure while using it. There has not been studies with drug interactions with this but CYP3A4 inhibitors such as erythromycin, ketoconazole, fluconazole, calcium channel blockers, and cimetidine should be used with caution.

Piliang, M., & Schneider, S. (2019, July 3). Atopic Dermatitis. Retrieved February 27, 2020, from http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/atopic-dermatitis/default.htm

Protopic – FDA prescribing information, side effects and uses. (2019, April 1). Retrieved February 27, 2020, from https://www.drugs.com/pro/protopic.html

Woo, T. M. & Osborn, K. (2019). Dermatological Conditions. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (pp. 957-989). Philadelphia, PA: F. A. Davis Company.

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Running Header:

PARKINSON’S DISEASE

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PARKINSON’S DISEASE

PARKINSON’S DISEASE

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Parkinson’s disease refers to a continuous disarray of the sensory system. This condition is caused by the genes or environmental factors. There are certain genes that tend to increase the risk of contracting this condition and some environmental factors though their chances are small. This disorder majorly affects motion or movement. It does this by altering the neurocytes that are found in the black substance. The neurons are responsible for the transfer of nerve impulses from the corpus collosum to the middle of the brain particularly the black substance. These neurocytes are responsible for the voluntary movement of the body. This disorder is majorly experienced by elderly people. In most cases it is causes by excessive usage of medications and the environmental factors (Ahlskog, 2018). The Parkinson’s disease has the following signs and symptoms;

· Tremor- A patient suffering from this condition will experience body shaking, and in most cases, it happens at the hands. In this case the handshakes while still at rest.

· Slow movements- this condition slows down the patient’s movements such that doing simple tasks becomes a challenge. It leads to a lot of time consuming.

· Muscles become rigid- it makes muscles from different parts of the body become stiff. This causes pain to the patient and reduces his or her movements.

· Imbalance- One may experience impaired posture and balance. One finds it very difficult to stand upright and sometimes he or she may fall.

· Impairment of automatic movements- Actions like blinking, smiling and swinging of hands by default become a challenge. One is not able to automatically perform these functions effectively.

· Change of speech-This condition affects and alters the patient’s nature and way of speaking. The patient may start speaking slowly, softly or even quickly. The speech may become a monotone rather that with its normal inflections.

· Changes in writing- A Parkinson’s patient may find it very difficult to write and in most cases the handwriting becomes very small. Tremor may also cause the handwriting to be shoddy and one’s hand will not be stable and still while writing.

Prescription

Parkinson’s disease cannot be cured. Medications are often used to mitigate the symptoms of this disease. Sometimes, medical practitioners recommend change of lifestyle especially bodily exercise. To improve on one’s speech, it is recommended to seek speech pathologist. The following medications could be very useful to a patient suffering from Parkinson’s disease;

· Carbidopa- It is the best medication for this condition. It is an enzymatic substance which gets into the brain and changes into Intropin. L-dopa is used together with carbidopa which prevents L-dopa from being converted into Intropin before reaching the brain. It also reduces the aftermath of L-dopa such as nausea. After several years of usage of this drug, it will start to have less impact on your body. One will also start incurring involuntary movements if taken in large doses hence the need for regular control from time to time by the doctor (Mayo Clinic, 2020).

· Carbidopa-Levodopa infusion- it is given via a tube that delivers the medication straight into the small intestine in the form of a gel. This medication is for patients whose disease is more advanced, though they respond to Carbidopa-Levodopa, the response is not stable. S small surgery is needed to install the tube. Having this tube exposes one to infections or sometimes the tube may fall out (Mayo Clinic, 2020).

· Dopamine agonist-this medication remains the same but it borrows the brain outcome of dopamine. They are not as strong as Levodopa but they can be used together with it to smoothen the results of L-dopa. Samples of dopamine agonists are ropinirole, pramipexole etc. The side effects of this medication are similar to those of carbidopa-Levodopa but they extend to hallucinations and sleepiness (Mayo Clinic, 2020).

· MAO B inhibitors- They inhibit the brain enzyme, monoamine oxidase B, helping in the prevention of breakdown of the brain dopamine. They include selegiline, Rasagiline and safinamide. Its side effects include nausea and insomnia. If this medication is used together with Carbidopa-Levodopa, chances of hallucinations will increase (Mayo Clinic, 2020).

· COMT inhibitors- This medication lengthens the effect of Levodopa by standing in the way of an enzyme that that causes breakdown of dopamine. An example of this inhibitor is the entacapone. Side effect of these inhibitors includes diarrhea and involuntary movements. Tolcapone is also a COMT inhibitor but it is hardly prescribed because of its serious effects on the liver (Mayo Clinic, 2020).

· Anticholinergics- They has been in use for quite a number of years and they are used to control Parkinson’s disease tremor. One example of this medication is benztropine. Its side effects include confusion, dry mouth, memory loss and constipation (Mayo Clinic, 2020).

· Amantadine- It offers short time relief. They may be given together with carbidopa-Levodopa to control the involuntary movements caused by carbidopa-Levodopa. Its side effects include hallucinations and ankle swelling (Mayo Clinic, 2020).

Adverse effects and drug-drug interaction

Sometimes, a drug may be used to treat one disease but end up causing another disease if not carefully taken. It may be a drug for one disease but when used inappropriately, it may become a virus or bacteria that will cause a different disease. When it comes to depression, there are drugs that can treat it but may end up causing Parkinson’s disease. Treatment of Alzheimer’s could also lead to Parkinson’s disease symptoms. Sleepiness and hallucinations are the most common symptoms of Parkinson’s disease. In drug-drug interaction, warfarin has a severe effect as it causes insolubility of the drug and ends up reducing the interaction of the drug with the plasma serum (Katzenschlager et.al, 2018).

Pediatrics and geriatrics

It has been noted that there are many changes that occur in the life of a child up to puberty. This has led to the need for pediatric groupings. There are still a lot to discover in the psychological development and it can only be achieved if these findings are brought about according to the groups. Children and adults have different reactions or responses to treatments. For example, phenobarbitones are very critical and important in the treatment of cerebral malaria amongst adults. But the same medication, if administered to children, then it is likely to cause mortality. The same way corticosteroid can be used by adults with meningitis, but not with children with the same condition. There is no adequate guideline that has been put in place to cater for the analysis of these age groups and the psychological experiences involved at each group.

Geriatrics is not only for the old as the case may be inferred by the majority of the people; it could also be very important and vital for persons who are below the age of sixty. It is not only geriatricians who can offer geriatrics care; anyone can connect these seniors to a healthcare that is meant for the aging minds and bodies. Breast feeding mothers must have a controlled dosage of Parkinson’s disease medication if at all they are suffering from the disease. Medications like ropinirole have adverse effects on children as they may cause mood swings and malfunctioning of the body parts. Elderly patients should do slow bodily exercises to improve their body movements. Geriatrics comes in hand in improving the dopamine levels in the body of an elderly patient (Katzenschlager et.al, 2018).

References

Mayo Clinic. (2020). The Parkinson’s Disease. Retrieved from

https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/diagnosis-treatment/drc-20376062

.

Ahlskog, J. E. (2018, March). Aerobic exercise: evidence for a direct brain effect to slow

Parkinson disease progression. In Mayo Clinic Proceedings (Vol. 93, No. 3, pp. 360-372). Elsevier. Retrieved from

https://mail.google.com/mail/u/0/#inbox/FMfcgxwGDWvBxdQgtkVStCGSBRhgqzMT?projector=1&messagePartId=0.1

.

Katzenschlager, R., Poewe, W., Rascol, O., Trenkwalder, C., Deuschl, G., Chaudhuri, K. R., … & Staines, H. (2018). Apomorphine subcutaneous infusion in patients with Parkinson’s disease with persistent motor fluctuations (TOLEDO): a multicenter, double-blind, randomized, placebo-

controlled trial. The Lancet Neurology, 17(9), 749-759. Retrieved from

https://www.sciencedirect.com/science/article/abs/pii/S1474442218302394

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Submission Ide: 88c19114-7d71-4703-b679-22f6c2ee5804

79% SIMILARITY SCORE 4   CITATION ITEMS 66   GRAMMAR ISSUES 0   FEEDBACK COMMENT

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Muhammad Aftkhar

Parkinsonism- Pharmaceutical Treatment Plan x

Summary

 1140 Words  

1
Running Header: PARKINSON’S DISEASE

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PARKINSON’S DISEASE

Parkinson’s disease

Parkinson’s disease is a neuro de-generative disease that occurs and depletes the neurons

present in substansia nigra. These neurons are involved in the transmission of nerve impulses

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PARKINSON’S DISEASE

MUHAMMAD AFTKHAR

NUR 635 (GCU)

Mar 4th, 2020

https://www.researchgate.net/profile/Charles_Davie/publication/5454757_A_review_of_Parkinson’s_disease/links/5866522a08ae8fce490ee2e6/A-review-of-Parkinsons-disease

https://www.researchgate.net/profile/Charles_Davie/publication/5454757_A_review_of_Parkinson’s_disease/links/5866522a08ae8fce490ee2e6/A-review-of-Parkinsons-disease

https://www.sciencedirect.com/science/article/abs/pii/S1474442218302394

https://www.sciencedirect.com/science/article/abs/pii/S1043661818321078

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140171/

from corpus collosum to the susbtansia nigra part of the mid brain. These are the character

playing neurons in managing voluntary motor movements in the body. It mostly occurs in elderly

patients describe by involuntary movements and multi-dimensional brain functioning. The part

of this disease may occur due to the effective and excessive use of medications indulging in bi

polar or Alzheimer’s disease (Davie, 2008). The decline of dopamine in par compacta

deteriorates the normal functioning of the brain in controlling motor activities.

Prescription medication

The prescribed medications used for Parkinson’s disease includes the use of Levodopa

directly with replenishes the pool for dopamine neurotransmitter. This drug can’t be given in a

single dose rather without carbidopa (LODOSYN) the levodopa will break down into dopamine

and then to epinephrine in the body’s periphery. This will create severe symptomatic side effects

like an increase in heart rate and sympathetic system dominancy. Dopa-decarboxylase enzyme

breaks down the levodopa in the periphery so along with levodopa carbidopa is given. This

inhibits the dopa-decarboxylase enzyme and allows levodopa to travel into the blood brain

barrier easily.

For the calculations of drug regimen there must be precautionary measures for kidney

and liver sensitive enzyme dependent patients. LFT and RFT’s for sensitive patients are done to

ensure the correct for dose adjustments not lying in range affecting kidneys and liver function.

Below are some of the medications for Parkinson’s disease.

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PARKINSON’S DISEASE

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a. Agonist of dopamine: – Use of ergot containing drugs like bromocriptine, ropinirole

(Requip) and pramipexole (Mirapex). Requip works by increasing dopamine levels in the

brain. They are used for the patch medication there are some drugs given in patch

because elder patients sometimes can’t swallow capsules or tablets may be due to fear so

Neupro is given as a patch that contains rotigotine in it as active ingredient. Yet another

way to administer medication through injectable which involves Apokyn has

apomorphine as an active participate of treatment (Xu et.al, 2019).

b. MOA inhibitors: – These are the enzymes that break down the dopamine in the

periphery of neuron in synaptic cleft. For observing the action they are blocked by these

MOA inhibitors (mono amine oxidase inhibitors) including Zelapar, Eldepryl residing

selegiline in it.

c. COMT inhibitors: – These are the reuptake channels and enzymatic control of dopamine

from the synaptic cleft. If they are blocked then there will no uptake of dopamine in the

neuron and there will be much more dopamine to perform its function and meet the other

synaptic surface of a leading neuron. Comtan containing entacapone is used to replenish

dopamine concentration in synaptic cleft and Tasmar as Tolcapone.

d. Anti-cholinergic: – The use of these mnedications is to control the frequency of tremors

and muscles movement which results in the deprivation of energy and loss of nutrients

from cells resulting in weakening of muscle. Cogentin containing benztropine is the

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PARKINSON’S DISEASE

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chiefly used drug in regimens prescribed by doctors ( Richardson et.al, 2018) .

e. Non- prescribed drug treatment: – Many ways are there for those patients who wanted

to mend their way in treating of Parkinson disease. Most effective practices are exercise,

proper muscle movements and massage therapy, speech and locomotors junction therapy.

Some of the occupational therapy sessions with therapist recommendations are beneficial

for Parkinsonism. Use of motivated speeches and psychological sessions will bring

patients from holding the strong grip over their disease and will think less about it.

Singing could also do a great job in managing the Parkinson disease symptoms. It will

help the patient to improve on his or her voice which will result to improved social

interactions. Aqua therapy can also help the patient in terms of removing the worry or

fear of falling as he or she will be swimming and moving in water freely. Acupuncture

will reduce the pain and muscle stiffness in the patient’s body ( Giugni & Okun, 2014).

Adverse effects and drug –drug interaction

Most probably the use of drugs for one ailment may cause damage to other parts of the

body if it left unaware or unattended. Especially in the case of depression therapy and

medication, some of the drugs are related to the origin of Parkinson disease. Alzheimer’s is a

psychotic disorder that may lead to Parkinsonism symptoms during its treatment. Dementia and

sleeplessness are the most effective adverse effects of drugs used in Parkinson’s disease.

Hallucinations and delusions are also common as these drugs are used as adjunct therapy for

depression ( Katzenschlager et.al, 2018) .

Warfarin has a severe drug-drug interaction with ropinirole and this causes an

anticoagulant effect in the blood which forms less solubility of drug and interaction mode of the

drug in serum plasma is decreased. Medications use for liver functioning and kidney assistance

like thiazide diuretics and loop diuretic used in hypertensive patients will get affected by

ropinirole. Gastric drugs for ulcerations and bleeding in the small intestine may be enhanced by

the use of levodopa. It will bind to complexes formed by aluminum hydroxide in gastric track

thus inhibits the efficacy of the drug and formulate ulceration.

Pediatrics and geriatrics

Use of a controlled amount of drug regimens in the clinical setup there must be an

important note for breast feeding mothers to restrict the required dose for Parkinson’s disease.

Related to pediatrics calculated initiated amount of dosage regimen is selected. As ropinirole has

severe dementia effect in children. In children, sudden mood swings and motor impartment

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PARKINSON’S DISEASE

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during exercise and running is seen. But improved therapy sessions have presented the group of

medications in one role (Katzenschlager et.al, 2018). Rather put elder patients in that category

that deals with the slow and shaking movement of facial muscles and hands, pill rolling

movement and improved muscle rigidity is seen. Geriatrics has an affective therapeutic goal in

improving dopamine level in the body.

References

Davie, C. A. (2008). A review of Parkinson’s disease. British medical bulletin, 86(1), 109-127.

Retrieved from:

https://www.researchgate.net/profile/Charles_Davie/publication/5454757_A_review_of_Parkins

on’s_disease/links/5866522a08ae8fce490ee2e6/A-review-of-Parkinsons-disease

Katzenschlager, R., Poewe, W., Rascol, O., Trenkwalder, C., Deuschl, G., Chaudhuri, K. R., …

& Staines, H. (2018). Apomorphine subcutaneous infusion in patients with Parkinson’s disease

with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-

controlled trial. The Lancet Neurology, 17(9), 749-759. Retrieved from

https://www.sciencedirect.com/science/article/abs/pii/S1474442218302394

Richardson, K., Fox, C., Maidment, I., Steel, N., Loke, Y. K., Arthur, A., … & Campbell, N. L.

(2018). Anticholinergic drugs and risk of dementia: case-control study. bmj, 361, k1315.

Xu, W., Reith, M. E., Liu-Chen, L. Y., & Kortagere, S. (2019). Biased signaling agonist of

dopamine D3 receptor induces receptor internalization independent of β-arrestin recruitment.

Pharmacological research, 143, 48-57. Retrieved from

https://www.sciencedirect.com/science/article/abs/pii/S1043661818321078

Giugni, J. C., & Okun, M. S. (2014). Treatment of advanced Parkinson’s disease. Current

opinion in neurology, 27(4), 450. Retrieved from:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140171/