Symptoms And Treatment Of Pseudocholinesterase Deficiency Syndrome

Treatment for epilepsy is often focused on controlling the seizures with the least amount of medication as possible. Antiepileptic drugs (AEDs) are the class used to accomplish this. Some of the AEDs that are used most often are Clonazepam, Diazepam, Divalproex, Gabapentin, and Phenytoin. The most common side effects of these medications include nausea, vomiting, sedation, fatigue, and lethargy. (Kwan,1; Benbadis, 3-5; Huethers,637)

The dosage was to high for the patient because the chart started going over the regular normal level

Sympathomimetics are medications that mimic the effects of neurotransmitter substances of the sympathetic nervous system (Karch, 2013, p.930). These medications stimulate the ‘fight or flight’ response and can cause the bronchi to dilate with increased rate and depth of respiration. Thus, these drugs are used to treat lower respiratory tract disorders. Anticholinergics are medications that block the action of acetylcholine on the parasympathetic nervous system. These medications are used to treat lower respiratory disorder because they can dilate the bronchi and reduce

Malignant Hyperthermia is primarily thought to be an autosomal dominant genetic disorder that causes a hypermetabolic state after administration of volatile anesthetics. When a patient is under anesthesia, the muscles are usually relaxed, but when a patient is experiencing Malignant Hyperthermia crisis, certain IV anesthesia causes the opposite effect. Most inhaled anesthetics other than nitrous oxide, cause or trigger Malignant Hyperthermia. More specifically, the anesthetic agents: Halothane, Chloroform, and Succinylcholine. The genic condition of Malignant Hyperthermia only becomes apparent when a patient is exposed to certain anesthetics such as halothane, which causes muscle rigidity.

by Nurse J. After five minutes, the diazepam had no effect so Dr.T ordered two milligrams of hydromorphone IVP given at 4:15 in the afternoon. The patient received another two milligrams of hydromorphone IVP and five milligrams diazepam IVP at 4:20 p.m. because Dr.T was not satisfied with the patient’s level of sedation. When the patient appeared to be sedated at 4:25 in the afternoon, the reduction of his left hip took place. At 4:35 p.m., Mr. B’s BP is 110/62 and his oxygen saturation is 92%. The “conscious sedation” policy was not followed. He did not have supplemental oxygen and his ECG and RR were not monitored. Then, Mr.B’s oxygen saturation dropped to 85%. The LPN adjusted the alarm and repeated the BP reading. Nurse J and the LPN were very busy taking care of the other patients during this time. At 4:43 p.m., Mr. B was not breathing, had no pulse, BP is 58/30 and oxygen saturation is 79%. The stat code was called.

The patient was sedated with diazepam and hydromorphone, appeared to be sedated, and a successful reduction took place. After the procedure, the

When substances like Acetylcholine (Ach) and norepinephrine which are small- molecular neurotransmitters are released into the body they bind to receptors on tissue or neurons through our ANS and PNS system. Ach is released by many PNS neurons and some CNS neurons. In the PNS Ach is an excitatory neurotransmitter at some synapses, such as the neuromuscular junction where it binds to ionotropic receptors which open cation channels. Ach can also be an inhibitory neurotransmitter at other synapses, where it binds to metabotropic receptors while opening potassium channels. The enzyme acetylcholinesterase (AchE) inactivates Ach by splitting into acetate and choline fragments. Norepinephrine (NE) is a biogenic amine; most biogenic amines may cause

Patients can become hypertensive during induction, positioning, or tumor resection (12). Chronic catecholamine excess causes volume contraction and patients can become severely hypotensive, as in this case, if adequate volume resuscitation is not performed (12). It is prudent to evaluate for adverse events following hypertensive and hypotensive episodes. Serial neurological evaluations, CT brain, electrocardiograms, or serial cardiac enzymes may be warranted. Complications of surgery are primarily due to severe preoperative hypertension, high secretion tumors, or repeat intervention for recurrence (13). In one study, adverse perioperative events occurred in 32 percent of cases (14). The most common adverse event was sustained hypertension in 25 percent of the patients. There were no perioperative deaths, myocardial infarctions, or cerebrovascular events. Despite premedication of most patients with phenoxybenzamine and a beta-blocker, varying degrees of intraoperative hemodynamic lability occurred

Cholinesterases are a group of enzymes present in mammals which breakdown certain neurotransmitters by hydrolyzing the ester bonds within a molecule (Rang & Dale, 2007). There are two major types of enzymes, acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Though similar in structure, they differ in distribution, function and substrate specificity.

Status epilepticus are seizures lasting >20 minutes, or repeated seizures without regaining consciousness [71]. Physicians should be particularly careful with it, since the background may be other than epilepsy. Infection, haemorrhage, trauma, hypoxia, ischemic or haemorrhagic stroke, hypoglycaemia, hyponatremia, drug toxicity and alcohol withdraw should be ruled out. In any of the above, the provoking cause should be treated. If the cause is epilepsy, the treatment of choice is benzodiazepines and the second choice is phenytoin/ fosphenytoin, but with caution as rapid infusion may induce cardiovascular problems. For resistance in those two drugs, the Neurocritical Care Society’s Status Epilepticus Guideline

Malignant hypothermia is a disease, caused by a bad reaction of anesthetics. This disease causes an immensely rapid temperature rise and extreme muscle contractions. MH (malignant hypothermia) is passed down through families and inherited by one parent carrying it giving it to the child. “Malignant hyperthermia occurs in 1 in 5,000 to 50,000 instances in which people are given anesthetic gases” (NIH, 2007). Most people aren’t aware that they are prone to this disease/reaction because they have never been under anesthesia drugs, or have never received surgery.

Cholinesterase inhibitors are used to breakdown the acetylcholine, which is a neurotransmitter that is connected to memory, by blocking the enzyme acetylcholinesterase. The donepezil, rivastigmine, and the galantamine are three commonly prescribed cholinesterase inhibitors. The known side effects are nausea, vomiting, diarrhea, upset stomach, and dizziness (Wattmo, Londos, & Minthon, 2014). To block the NDMA receptors, the memantine is prescribed to improve cognition and regulate the glutamate that acts as a neurotransmitter in the brain around the learning and memory area. Excessive glutamate could cause damaged, killed nerves. Common side effects of memantine consist of dizziness, confusion, and headaches (Koch, Szecsey, & Haen, 2004). Additional medication can be prescribed to patients with symptoms such as depression, psychosis, disturbed sleep, and apathy. Howes (2014) supported the commonly used drug treatments as he compared AD to the issues of the cardiovascular disease. The reduced blood flow to the brain, the reduction of oxygen, clogged arteries and vessels could damage the brain cells, making the Alzheimer’s disease worse. The treatment of AD reduces some of the effects of the cardiovascular (Howes,

Overdosing with a cholinesterase inhibitor such as neostigmine can cause excessive muscarinic stimulation and respiratory depression. By taking atropine sulfate which can be beneficial in reducing excessive muscarinic stimulation and also can suppress the bronchial secretions as a result of cholinesterase inhibitor neostigmine.

As shown in the table 2 the EC50 values of acetylcholine, calculated from the dose-response curve, significantly differ from each other. In fact, in endothelium denuded rings acetylcholine caused no relaxation at all. Moreover, the prolonged exposure to increasing concentrations had given some constriction.

Cholinesterase inhibitors – These boost levels of acetylcholine in the brain of AD patients, who show reduced levels, and increase cell-to-cell communication. They can also improve neuropsychiatric symptoms, such as agitation or depression. Commonly prescribed cholinesterase inhibitors include Donepezil (Aricept), Galantamine (Razadyne) And Rivastigmine (Exelon). Side effects include diarrhea, nausea, loss of appetite and disturbed sleep. In people with cardiac conduction disorders, serious side effects may include a slow heart rate and heart