alz/pd

Question 1

what happens to the brain with alz

Answer 1

shrinks and lose of neurons

Question 2

how can we help with symptoms of alz

Answer 2

• decrease cholinergic transmission (hippocampus and frontal cortex)
• stop bad amyloid plaques (A-beta)
• so neurofibrillary tangles

Question 3

in alz we use this class of meds

Answer 3

Cholinesterase inhibitors

Question 4

give examples of alz drugs and name class again

Answer 4

Donepezil (aricept)
Rivastigmine (excelon)
Galantamine (Razadyne)

these are cholinesterase inhibitors

Question 5

how do cholinesterase inhibitors work

Answer 5

prevent acH breakdown

Question 6

anesthesia effects of cholinesterase inhibitors— use for what medical problem

Answer 6

prolongs sux
relative resistance to non-depolarizing muscle relaxors

ALZ

Question 7

how else can we decrease cholinergic transmission in alz- think receptor

Answer 7

use a NMDA Receptor antagonist— blocks channel

Question 8

Memantine (namenda) works how

special considerations

Answer 8

binds to NMDA recptor and blocks channel—

be careful with bircarb bc decrease clearance with increased urine pH

Question 9

what is the bad enzyme for amyloid plaques

Answer 9

beta secretase—- works on the APP

Question 10

what is the gene for amyolid plaques

Answer 10

APOE gene

2 better than 4

Question 11

s/s of parkinson’s

where and what is the problem with PA

Answer 11

pill rolling, tremor, shuffle gait

basal ganglia and substantia niagra— decreased DA

Question 12

Strategies to help PA

Answer 12

increase DA in brain- dopamine agents

anticholinergic agents

Question 13

Dopamine does not cross the BBB so we have to give

Answer 13

Ldopa

Question 14

what other med should PA start out with

Answer 14

Carbidopa (peripheral decarboxylase inhibitor)— helps not breakdown Ldopa outside of the brain

Question 15

last ditch drug for PA

Answer 15

entacupone—– (COMT inhibitor)

Question 16

LDOPA avoid _______ class of drugs and anesthesia considerations

Answer 16

non- selective MAOIs (HTN crisis) MAOI-b ok

Question 17

drugs that increase DA at synapse

Answer 17

• Selegiline–

- Amatadine—

Question 18

dopamine agonists

Answer 18

pramipexole and ropinirole

- specific D2/3 and less s/e (but have hallucinations/compulsive behaviors)

Question 19

anticholinergic med for PA

Answer 19

benztropine

Question 20

anesthetic considerations with Ldopa and carbidopa

Answer 20

must give every 6-12 hrs and 20 min prep – to avoid sudden loss of effectiveness and neuromuscular fx/ respiratory failure

Question 21

• Selegiline anesthesia considerations–

Answer 21

• do not give ephedrine or meperide
• caution with vaso active drugs
  pronounced effect of NMB, sedatives and diuretics

Question 22

• Amatadine anesthesia considerations—-

Answer 22

eval anticholinergic s/e. R/o HF

Question 23

s/e of Ldopa and carbidopa

Answer 23

s/e dysthrythmia, adrenergic stimulation, orthostatic hypotention, go

Question 24

anesthesia considerations for anticholinergic med

Answer 24

assess fro anticholinerct s/e (esp HR)

avoid drugs that impact cholinergic tone or increase s/e HR! (if poss)

Question 25

Carbadopa is a

Answer 25

peripheral decarboxylase inhibitor