alz/pd Flashcards
what happens to the brain with alz
shrinks and lose of neurons
how can we help with symptoms of alz
- decrease cholinergic transmission (hippocampus and frontal cortex)
- stop bad amyloid plaques (A-beta)
- so neurofibrillary tangles
in alz we use this class of meds
Cholinesterase inhibitors
give examples of alz drugs and name class again
Donepezil (aricept)
Rivastigmine (excelon)
Galantamine (Razadyne)
these are cholinesterase inhibitors
how do cholinesterase inhibitors work
prevent acH breakdown
anesthesia effects of cholinesterase inhibitors— use for what medical problem
prolongs sux
relative resistance to non-depolarizing muscle relaxors
ALZ
how else can we decrease cholinergic transmission in alz- think receptor
use a NMDA Receptor antagonist— blocks channel
Memantine (namenda) works how
special considerations
binds to NMDA recptor and blocks channel—
be careful with bircarb bc decrease clearance with increased urine pH
what is the bad enzyme for amyloid plaques
beta secretase—- works on the APP
what is the gene for amyolid plaques
APOE gene
2 better than 4
s/s of parkinson’s
where and what is the problem with PA
pill rolling, tremor, shuffle gait
basal ganglia and substantia niagra— decreased DA
Strategies to help PA
increase DA in brain- dopamine agents
anticholinergic agents
Dopamine does not cross the BBB so we have to give
Ldopa
what other med should PA start out with
Carbidopa (peripheral decarboxylase inhibitor)— helps not breakdown Ldopa outside of the brain
last ditch drug for PA
entacupone—– (COMT inhibitor)
LDOPA avoid _______ class of drugs and anesthesia considerations
non- selective MAOIs (HTN crisis) MAOI-b ok
drugs that increase DA at synapse
- Selegiline–
- Amatadine—
dopamine agonists
pramipexole and ropinirole
- specific D2/3 and less s/e (but have hallucinations/compulsive behaviors)
anticholinergic med for PA
benztropine
anesthetic considerations with Ldopa and carbidopa
must give every 6-12 hrs and 20 min prep – to avoid sudden loss of effectiveness and neuromuscular fx/ respiratory failure
- Selegiline anesthesia considerations–
- do not give ephedrine or meperide
- caution with vaso active drugs
pronounced effect of NMB, sedatives and diuretics
- Amatadine anesthesia considerations—-
eval anticholinergic s/e. R/o HF
s/e of Ldopa and carbidopa
s/e dysthrythmia, adrenergic stimulation, orthostatic hypotention, go
anesthesia considerations for anticholinergic med
assess fro anticholinerct s/e (esp HR)
avoid drugs that impact cholinergic tone or increase s/e HR! (if poss)
