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2 Pharm Unit > 29 Neurodegenerative diseases > Flashcards

29 Neurodegenerative diseases Flashcards

1
Q

Neuro-degenerative diseases are characterized by?

A

premature, primary death of specific nerve cells

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2
Q

T/F For Neuro degenerative diseases, drugs are curative and help to prevent further degeneration?

A

False. Drugs generally only help with symptoms and quality of life. Some drugs may help retard degeneration only.

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3
Q

An example of a hypokinetic ND disease is?

A

parkinsons disease

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4
Q

An example of a hyperkinetic ND disease is?

A

Huntingtons disease

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5
Q

Both parkinsons and Huntingtons have malfunctions involving what?

A

The extrapyramidal system. (primarily substantia nigra and striatum)

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6
Q

which type of neurons are degenerative in huntingtons disease?

A

striatal neurons only.

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7
Q

Which ND disease is characterized by degeneration of motor neurons in the spinal cord and cerebral cortex?

A

ALS

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8
Q

Which ND disease is characterized by degeneration to the hippocampus and cerebral cortex?

A

I forgot…..Oh Alzheimers.

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9
Q

T/F Parkinsons disease can be attributed partially to pesticides and insecticides?

A

true to some degree

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10
Q

Blocking NMDA is a good treatment for?

A

Alzheimers disease

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11
Q

superoxide dismutase does what?

A

O2 radical to H2O2

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12
Q

If you exhaust your antioxidant stores what generally happens inside the cell?

A

1) DNA damage
2) Protein damage
3) Lipid peroxidation of membranes

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13
Q

What is the fourth most common ND disease among the elderly? What is its incidence rate among those over 65?

A

Parkinsons disease

1:100

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14
Q

Name some of the characteristics of parkinsons disease (5 major ones)?

A

1) bradykinesia
2) tremors
3) abnormal posture
4) shuffling gait
5) impaired speech

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15
Q

what degenerates in parkinsons disease?

A

The nigrostriatal pathway. These neurons project to the putamen and caudate nucleus.

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16
Q

How many of the neurons in the nigrostriatal pathway have to be destroyed before you see parkinsonian signs?

A

over 80%

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17
Q

What do you see remaining in the living neurons of parkinsons patients? What is it made of?

A

1) Lewy bodies

2) alpha synuclein

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18
Q

What are 4 things that resemble parkinsons disease due to the parkinsonian movements?

A

1) encephalitis lethargica
2) small strokes
3) traumatic brain injury
4) anti-psychotic drugs

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19
Q

(Review basal ganglia pathway) If you inhibit the Globus pallidum externa, will this help or worsen parkinsons disease symptoms?

A

It will worsen the symptoms because the sub thalamic nucleus can be activated which activates the globus pallidus interna. The GP interna inhibits the thalamus, therefore not allowing normal movements.

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20
Q

How dopamine/epi form?

A

Tyrosine—>DOPA—>Dopamine—>Norepinephrine—> Epinephrine.

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21
Q

what breaks down dopamine?

A

COMT =Dopamine to 3-methoxytyramine

MAO= 3 methoxytyramine to HVA

22
Q

What is so significant of L-DOPA?

A

It acts as a precursor for dopamine and is able to cross the BBB.

23
Q

What percentage of L-DOPA reaches the brain?

A

only 1-3%

24
Q

Why do you see a lot of side effects when using levadopa?

A

because of the conversion of dopamine to Norepi.

25
Q

what are some of the signs/symptoms of using levadopa?

A

1) anorexia
2) nausea
3) tachycardia
4) hypotension
5) anxiety, depression, psychosis

26
Q

what is the drug of choice for treatment of parkinsons patients with symptoms?

A

Levodopa and carbidopa combination

27
Q

What does carbidopa do?

A

prevents the metabolism of L-Dopa to Dopamine in the periphery before it reaches the brain.

28
Q

What does entacapone do?

A

inhibits COMT

29
Q

why does it matter if L-DOPA is converted to dopamine in the periphery?

A

because dopamine cannot cross the BBB

30
Q

Selegiline and Rasagiline are both inhibitors of MAO b. What is the biggest difference between these two drugs?

A

Selegiline is metabolized into methamphetamine and amphetamine products and rasagiline is not.

31
Q

Bromocriptine acts a?

A

dopamine receptor agonist:
D2 agonist
D1 partial agonist.

32
Q

Ropinirole and pramipexole are both dopamine agonists that act on which receptors?

A

D2 and D3 receptors (agonists)

33
Q

when should you not give a patient dopamine agonists?

A

in patients with heart and mental problems.

causes arrhythmias, hypotension, confusion, etc

34
Q

what is apomorphine? when do you give it? How is it given?

A

1) Dopamine receptor agonist
2) advanced patients with “off disease”
3) given be sub Q injections only.

35
Q

why would you give a parkinsons patient Benztropine or trihexyphenidyl?

A

They are muscarinic antagonists that help reduce tremor and rigidity. This occurs because with parkinsons disease, loss of the nigrostriatal neurons leads to increased firing of the striatal cholinergic inter-neurons and over stimulation of the muscarinic receptors.

36
Q

What is amantadine? What are some side effects?

A

1) Block NMDA (glutamate) receptors and cholinergic muscarinic receptors.
2) Rash on lower extremities, worsening of CHF, and glaucoma.

37
Q

what is the most common cause of dementia in adults?

A

Alzheimers disease

38
Q

what are 2 major signs/symptoms of alzheimers? what are 2 major histological findings?

A

memory loss
language deterioration
amyloid plaques with NF tangles
loss of neurons in the cerebral cortex and hippocampus

39
Q

which two pathways are majorly affected by the brain?

A

1) nucleus basalis cholinergic pathway

2) septohippocampal cholinergic pathway

40
Q

what are the 3 major things that predispose you to getting alzheimers?

A

1) age
2) gender (2x more women)
3) Genes

41
Q

T/F 6% of the age group 65-85 have alzheimers, and 45% of the over 85 have alzheimers?

A

true

42
Q

10% of the Alzheimers cases are inherited. Which 4 genes are primarily responsable for alzheimers?

A

APP (amyloid precursor protein gene)
PS1 & PS2 (presenilin gene, 1 being worse)
APOe4 (Apolipoprotein E gene)

43
Q

Which gene is the primary genetic risk factor for late onset AD?

A

Apolipoprotein E

44
Q

T/F There is no cure and no way to slow the progression of alzheimers?

A

True. You can only treat the symptoms.

45
Q

what affect does a NMDA receptor inhibitor have?

A

It decreases glutamate activation.

46
Q

Doneprazil, galantamine, tacrine, and rivastigmine are all ACh esterase inhibitors. How long do each of these act?

A

1) 70 hours
2) 7 hours
3) 3 hours
4) 1.5 hours
respectively

47
Q

what degrades rivastigmine?

A

plasma cholinesterase

48
Q

what degrades donepezil, galantamine, and tacrine?

A

CYP3A4 and CYP2D6

49
Q

ACh inhibitors are relatively safe except for tacrine which causes?

A

hepatotoxicity

50
Q

Memantine is a drug that does what?

A

NMDA receptor antagonist. This protects neurons from Ca+ overload that can lead to neuronal death.

2 Pharm Unit (17 decks)

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