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Fall Pharmacology > Alzheimer's and Parkinson's > Flashcards

Alzheimer's and Parkinson's Flashcards

1
Q

Anticholinesterases include

A

Rivastigmine (Exelon)
Donepezil (Aricept)
Galantamine (Razadyne)

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2
Q

MOA of anticholinesterases

A

decrease amount of acetylcholine breaking down in cleft

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3
Q

What drugs should anticholinesterases not be given with?

A

anticholinergics

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4
Q

ADRs of anticholinesterases

A 
Nausea
Insomnia
HA
Blurred vision
Symptomatic bradycardia
Syncope
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5
Q

Which anticholinestease is approved for dementia of Alzheimer’s disease AND dementia with Parkinsons?

A

Rivastigmine (Exelon)

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6
Q

Dose a anticholinesterase for the treatment of mild to moderate, or severe dementia of Alzheime’s type

A

Donepezil 10mg once a day in the EVENING

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7
Q

Anticholinesterases may be avoided in pts with

A

cardiovascular disease

peptic ulcer disease

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8
Q

NMDA receptors include

A

Memantine (Namenda)

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9
Q

When does Namenda dose need to be adjusted?

A 
Renal impairment (<30)
no hepatic adjustment required
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10
Q

ADRs of NMDA

A

ataxia, hypokinesia
emotion agitation, confusion, dizzy, depression, fatigue
constipation

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11
Q

Dose an nmda receptor antagonist

A

Namenda 10mg one tablet twice a day

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12
Q

How do you pick drug regimen for dementia?

A

Clinical judgement

  • anticholinesterase alone or
  • anticholinesterase + memantine (Namenda)
Others often thrown into mix: (BUT THEY DONT DEFINETIVLEY WORK)
NSAIDs
estrogen tx
antioxidant vitamins
statins
nutraceuticals
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13
Q

Patients with Parkinson’s have decreased levels of

A

Dopamine

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14
Q

Patients with Alzheimer’s dementia have decreased levels of

A

Acetylcholine

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15
Q

When should you initiate medical therapy for Parkinsons?

A

Debatable!

not disease modifying

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16
Q

Disrupt withdrawal of Levodopa can lead to

A

neuroleptic malignant syndrome (NMS)

17
Q

Dopamine precursors include

A

Levodopa/Carbidopa (Sinemet)

18
Q

ADRs of levodopa

A

Nausea
Somnolence, dizzy, HA
Elderly- may have confusion, hallucinations, delusions, agitation, psychosis
Possible neurotoxicity?

19
Q

Dose a dopamine precursor

A

Levodopa/carbidopa (variable) every 8 hours

20
Q

Dopamine agonists include

A

Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)

21
Q

MOA of dopamine agonists

A

direct action at dopamine receptor sites

22
Q

Are dopamine agonists better than dopamine precursors?

A

Possibly more s/e

also has withdrawal syndrome

23
Q

ADRs of dopamine agonists

A 
Postural hypotension
hallucinations
nausea
somnolence
worsen dyskinesias
induce compulsive behavior (gambling)
24
Q

Dose a dopamine agonist

A

Requip XL 12mg two tablet one a day

25
Q

MAO-B inhibitors for Parkinson’s include

A

Rasagline (Azilect)

Selegeline (Eldepryl)

26
Q

What drugs should MAO-B inhibitors be avoided with

A

tramadol, methadone, cyclobenzaprine, St. John’s wort

27
Q

ADRs of MAO-B inhibitors

A

Insomina, nervousness, confusion
nausea
orthostatic hypotension

CA risk? (probably not)

28
Q

Dose a MAO-B inhibitor

A

Azilect 1mg once daily

29
Q

Dose an add on therapy for the treatment of Parkinson’s that works well with rigidity symptoms and is pretty well tolerated

A

Amantadine 100mg twice a day

30
Q

Anticholinergics for Parkinson’s include

A

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

31
Q

MOA of anticholinergics

A

Decrease acetylcholine by blocking receptor

32
Q

Anticholinergics in Parkinsons is good for

A

Slow, resting tremor

Monotherapy in patients less than 70 years of age, with no significant akinesia, or gait disturbances

33
Q

ADRs of anticholinergics

A

Tachycardia (not good for cardiac conditions)
Constipation, urinary retention
Hypotension
CNS effects: disorientation, hallucinations, toxic psychosis

34
Q

Dose an anticholinergic

A

Trihexyphenidyl 2mg three time a day

35
Q

Comt inhibitors include

A

Tolcapone (Tasmar)

Entacapone (Comtan)

36
Q

Uses for comt inhibitors

A

add on tx to levodopa/carbidopa

assists when motor fluctuations/ “off” periods

37
Q

ADRs of comt inhibitors

A

heightened rxns from levodopa/carbidoap

hepatotoxicity

38
Q

What should be considered for dyskineisas in Parkinson’s?

A

amantadine

39
Q

Are any treatments for Parkinson’s neuroprotective?

A

No

Fall Pharmacology (13 decks)

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