42 Neuro Drugs pt 2

Question 1

Hungtintons is a result of a severe loss of which neurons?

B/c they are lost, what kind of input is lost?

Answer 1

GABA neurons in basal ganglia

Lose the inhibition of dopamine input. too much dopamine…(target drug therapy)

Question 2

What drug treats Huntingtons?

Answer 2

Tetrabenazine
-Suppresses involuntary jerky movements

Used in other hyperkinetic mvmts
- tourette’s, tardive dyskinesia, hemiballismus(random limb movements)

Question 3

How does Tetrabenazine work?

Answer 3

Its a Huntington drug that depletes monoamine

Inhibits vesicle Monoamine transporter

• No DA taken up into synaptic vessels
• Increase DA metabolism in the neuron
• Decrease DA levels and DA transmission

Question 4

What are the SEs of Tetrabenazine?
What can it cause?
Contraindications?

Answer 4

Worsening or triggering depression, suicidal thoughts
also insomnia, drowsiness

Contra: MAO Inhibitors

Question 5

What are other treatments for Huntington movement disorders?

Answer 5

Antipsychotic drugs
- Their SE is suppressing movements, but may worsen involuntary contractions and rigidity

Benzodiazepines such as:
-Diazepam, clonazepam

AntiParks drugs for the hypokinesia and rigidity, esp in juvenile cases

Question 6

What are the drugs for cognitive symptoms of Alzheimers?

Answer 6

Cholinesterase Inhibitors (partially correct the Ach defect)
Memantine

Question 7

What are the cholinesterase Inhibitors for mild to moderate Alzheimers?

Answer 7

Donepezil
- also for severe AD

Rivastigmine (sounds like physostigmine which is Ach restoring)
- also for dementia in Parks, available as a patch

Galantamine

Question 8

How can cholinesterase Inhibitors benefit Alzheimers patients?

Answer 8

Improve memory, awareness, ability to function

Benefit is gradual, not dramatic but may slow the progression of symptoms
-give out early for better results, but as disease progresses, Ach is running out so there an AchE Inhibitor won’t even work

Question 9

What are the common and less common SEs of AchE Inhibitors?

Answer 9

Common:
N/V, diarrhea
Anorexia
Myalgia
Dizziness

Less common (more serious)
Slow irregular HR
dysuria
HypoTN
Abd Pain, Melena
Sz

Question 10

Drug Interactions with AchE Inhibitors?

Answer 10

NSAIDS
-even more GI bleeding (remember AChE I’s cause melena)

Cholinergic Agonists (ie bethanechol) OR OTHER AChE Inhibitors (ie Donepezil)
 - May increase SEs

Cholinergic Antagonists (ie scopalamine)
 - decreases Ach effects

Question 11

What is Memantine?
How is it compared to Ache Inhibotors

SEs?

Answer 11

It is a drug used for moderate to severe Alzheimers that is a NONCOMPETITIVE antagonist for NMDA glutamate receptors

glutamate normally helps in learning and memory

• dysfunction–>Alzheimers?
• high levels also overstimulate and kill neurons

Better tolerated than AchE Inhibitors

SEs: Dizzy, HA, constipation confusion

Question 12

Combo therapy for Alzheimers?

Answer 12

Glutamate and Ach Pathway

Question 13

Treatments for psychosis and agitation in Alzheimers?

Answer 13

Anti-pyschotic meds

- BZDs (lorazepam, oxazepam, diazepam, clonazepam)

Question 14

Treatments for depression in Alzheimers?

Answer 14

Anti-depressants

• TCAs, SSRIs, MAOIs
• Electroconvulsive Therapy

Question 15

Treatment for sleep disturbances in Alzheimers?

Answer 15

Trazodone, Zolpidem, Zaleplon

BZDs, diphenhydramine