Nuedexta® for Pseudobulbar Affect in an ALS Patient Pseudobulbar Affect (PBA) is a neurological condition that causes the patient to experience inappropriate and uncontrollable laughing and crying, which is an exaggeration of the emotions experienced or, in some instances, totally unrelated to the patient’s emotions. Episodes, which can last from seconds to several minutes, are often mistaken for mood disorders and can be disruptive to daily living (Mayo, 2017). Approximately 43 to 49 percent of ALS patients suffer from PBA (BCM, 2017). The target for change in this single subject design research was the number of episodes of PBA experienced by the participating ALS patient. The goal was to reduce the number of episodes with an intervention …show more content…
The observation points, days of the week, are marked on the x axis and the frequency of PBA episodes is plotted on the y axis. The visual analysis of this graph shows that the medication, Nuedexta®, reduced the number of PBA episodes for this patient. During the baseline period, episodes of PBA were stable as evidenced by the flat baseline trend. The patient was experiencing between 7 – 9 episodes of PBA daily prior to the introduction of the initial dose of Nuedexta®. When Nuedexta® was introduced once a day for 7 days during the initial intervention (B), PBA episodes decreased with the patient experiencing between 5 - 7 episodes per day. The patient’s PBA episodes dropped to between 2 – 4 episodes per day when Nuedexta® was increased to twice a day during intervention (C). The research suggests that the administration of Nuedexta® every 12 hours should be continued for this patient. Intervention C is the recommended dosage for Nuedexta®. Optimum results for this medication are generally achieved by week 12 (Avanir, 2017). Based on the level of improvement the patient has experienced after 3 weeks, Nuedexta® should be continued at the recommended
It is truly remarkable how Randy Pausch and Morrie Schwartz stories are so similar but yet so different. They both seem to have an outlook on life in a positive way, not sad or demeaning. The only crippling difference is the fact that Morrie was at the age that wasn’t abnormal to be sick and Randy was just dealt the cards for a short life. One of Professor Randy Pausch’s many quotes during The Last Lecture makes a similar point between his experience and Morrie’s when he says, “…it’s hard to raise awareness of pancreatic cancer – people who get it don’t live long enough.” ALS is such a rehabilitating disease that scientist have issues pinpointing the causes to even get close to a cure, which didn’t hinder either of their strive to keep going as far as they could.
There is no cure for ALS at this time and treatment is focused on management of the symptoms, involving a combination of physical therapy, occupational therapy, and speech, respiratory, and nutritional therapies. Moderate exercise may help maintain muscle strength and function. Drugs can also treat excessive saliva and drooling, and speech therapy can help compensate for loss of muscular control of the mouth. As the disease progresses and muscular degeneration spreads throughout the body, various devices may provide support, such as ankle braces, neck collars, reclining chairs, wheelchairs, and hospital beds. Respiratory support and feeding tubes are required when the person loses cont...
"Dementia: Hope Through Research." National Institute of Neurological Disorders and Stroke (NINDS). National Institute of Neurological Disroders and Stroke, 23 Mar. 2011. Web. 29 Nov. 2011. .
-Began using a twin shell electric furnace to increase production and lower costs and increase market share
PBA is also known as Pseudobulbar Affect is a neurological condition that occurs in the brain, which has many symptoms that can be misdiagnosed, unfortunately it is incurable but there are medicines that can help. PBA is a condition which affects about 2 million people in America, some people do not even know they have it. The prefix pseudo means false,and the suffix bulbar refers to the brain stem, the word affect describes the person’s emotions. The symptoms of PBA are uncontrollable laughter and/ or crying. One of the diseases that can be misdiagnosed with PBA is depression. People with PBA act as if they have depression because of frequency of crying, they do not because there are certain factors that can distinguish people with PBA and a person without PBA.
Amyotrophic lateral sclerosis, or ALS, is a degenerative disease affecting the human nervous system. It is a deadly disease that cripples and kills its victims due to a breakdown in the body’s motor neurons. Motor neurons are nerve cells in the brainstem and spinal cord that control muscle contractions. In ALS, these neurons deteriorate to a point that all movement, including breathing, halts. Muscle weakness first develops in the muscles of body parts distant from the brain, such as the hands, and subsequently spreads through other muscle groups closer to the brain. Such early symptoms as this, however, can hardly be noticed.
Due to the intense nature of the physical symptoms of PD and its impact of one’s life, various researchers has identified different contributory factors of this disorder. Some studies indicated hyperventilation, over activity in the noradrenergic neurotransmitter system, interceptive classical conditioning, anxiety sensitivity, catastrophic misinterpretation of bodily sensations and safety behaviors are potential factors of PD (Davey, 2014). While, other researchers have stated PD is possibly caused by genetic predisposition, abnormalities in serotonin, and early developmental factors (Sansone et al., 1998). As the etiology of PD remains unknown and further studies are being conducted, it is agreed upon the mental health community that biological, psychological and cognitive factors contribute to the etiology and maintenance of PD.
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
In addition to the importance of knowing the effects of substrates on a given phenotype, it is also important to note the effects of inducers and inhibitors of CYP enzymes. Medications that are either inhibitors or inducers of a CYP enzyme can change a person’s given phenotype by increasing or decreasing the protein’s metabolic capabilities. For example, a PM for CYP2D6 who receives an inhibitor of 2D6, such as the antiarrhythmic quinidine, will have greatly increased metabolism of dextromethorphan, a substrate of 2D6. Interestingly, this mechanism is used in the treatment of pseudobulbar affect, a symptom associated with numerous neurological conditions. In treating this disorder, the therapeutic agent dextromethorphan, often used as a cough suppressant, is paired with the inhibiting quinidine to allow for greater amounts of dextromethorphan to build up within the body. Pseudobulbar affect (also known as PBA) has gained more attention in recent years, in part due to the memorable commercials for the
Research is showing that the numbers of proton pump inhibitors (PPIs) are being over prescribed during hospital stays and subsequently on discharge. There are studies published that show there are opportunities for substantial cost savings in relation to PPI prescription if there were some clinical guidelines used across the board nationwide. In addition to the costs, there are also risks for devastating side effects of continued use. There is a need to have a more defined reason for the administration and continuation of PPI’s.
Furosemide is available in tablets, sublingual tablets, oral suspension, and intravenously. (2) The recommended schedule dose for adults for an initial dose is 20 to 80mg. (3) The same dose as well as higher doses may be administered 6 to 8 hours following the previous dose if needed. (2) When titrating doses it may be raised by 20 to 40mg but not within 6 to 8 hours after the initial dose, and this may continue until the desi...
This is a neurodegenerative disease, meaning it results in progressive loss or death of neurons. It often starts off with effecting simple motor skills like writing and holding things, after a few months usually patients start losing the ability to walk, talk, or move any of their limbs. Although the brain trauma is what causes it, ALS has little-no-effect on the brain. This fatal disease is typically diagnosed around age 60 and most patients are given about 3-5 years to live after being diagnosed. It has been found that 10% of cases are shown as genetic. It was brought to attention that athletes were beginning to get diagnosed with ALS at a younger age than most. After extensive research in the early 2000’s, Brain Analyst, Dr. Mckee ran tests and finally came to the conclusion that the toxic proteins in the brains of ALS patients were coming from repeated blows to the head. It was then made evident why so many athletes in contact sports such as football, soccer, boxing, etc… were being diagnosed at such a young age and more frequently than
The purpose of this paper is to analyze, diagnose, and to determine a proper treatment plan to work toward the beneficial prognosis for the individual indicated within the case study.
According to the National Fire Protection Association (NFPA), a fire is any process of uncontrollable combustion or burning. A structural fire, refers to any fire occurring in or on a structure, including, if this is limited to the contents. Fire spread rapidly, causing economic losses, injury and even death. The majority of the injuries or deaths caused by fire, occur in the home, either in properties of one, two or multiple families, especially while people are sleeping. In addition, the risk of injury or death does not have a uniform distribution between populations. This varies between age groups, race, religion, cause of the fire and size of the community (Ahrens, 2014).