Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Pharmacology > Alzheimer's/Parkinsons > Flashcards

Alzheimer's/Parkinsons Flashcards

1
Q

pathologic changes in Alzheimer disease

A

formation of neurofibrillary tangles and plaques, cortical atrophy, and neuronal (Cholinergic and glutamatergic) destruction and loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

drug therapy choices for cognitive symptoms of AD

A

cholinesterase inhibitors and memantine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

cholinesterase inhibitor drugs

A

donepezil (Aricept)
rivastigmine (Exelon)
galantamine (Razadyne)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

when would you switch agents in the cholinesterase inhibitor class of AD

A

if no effects is seen in 3-6mo or if patient experiences adverse effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

which cholinesterase inhibitor is approved for mild-mod AD and mild-mod Parkinson’s dementia

A

rivastigmine (Exelon)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

titration of cholinesterase inhibitor drugs

A

recommended to titrate up to maximum tolerated dosage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which patients would you be cautious in prescribing cholinesterase inhibitors for AD

A

hx peptic ulcer disease and who currently take NSAIDs, hx or current seizure disorder
donepezil also causes insomnia and nightmares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

contraindications for cholinesterase inhibitors for AD

A 
anorexia
neuroleptic malignant syndrome
bradycardia
peptic ulcer disease
conduction abnormalities
asthma/COPD
seizure disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

dos food effect the onset of action or absorption of memantine

A

no

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

agents for noncognitive symptoms of AD

A

antipsychotic drugs
benzodiazepines
antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

typical antipsychotics used to manage agitation/psychosis in patients with AD

A

Risperidone (Risperdal)

olanzapine (Zyprexa)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

typical BZDs used to manage anxiety or episodic agitation in AD

A

lorazepam (Ativan)

alprazolam (Xanax)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

1st line therapy for AD

A

usually, donepezil but any cholinesterase inhibitor may be used. Severe AD may be offered Memantine as well

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2nd line therapy for AD

A

different cholinesterase inhibitor

some providers may add vitamin E

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

following up with AD patients

A

q3-6mo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

response to antipsychotics in AD

A

usually seen in the first day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what if marked decline in cognitive function is noted in the first 3-6 weeks after dc’ing cholinesterase inhibitors

A

consider restarting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

patient education of donepezil

A

may be taken without regard to food

take in morning if it causes insomnia or nightmares

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

patient education on galantamine (Razadyne)

A

give without regard to food and should be slowly titrated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

patient education on vitamin E for AD

A

report unusual bruising, blood in urine/stool, bleeding gums as it predisposes to bleeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

mech of action of vitmamin E for AD

A

an antioxidant that can stabilize free radicals and the damage they produce

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

herbal agnets used in tx of AD

A

ginko biloba (may interact with warfarin or ASA increasing risk of bleeding)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

medications that may cause drug induced parkinsonism (DIP)

A

agents that deplete or antagonize dopamine (first-generation “typical” antipsychotics or neuroleptic drugs)

24
Q

which antipsychotics are associated with lower rates of DIP

A

clozapine and quetiapine

25
Q

other drugs that may cause DIP

A

metoclopramide, valproic acid, methyldopa, prochlorperazine

26
Q

caffeine and PD (parkinson’s disease)

A

may be protective to dopaminergic neurons

high intake is associate with lower PD risk in women taking HRT

27
Q

hallmark motor symptoms of PD

A

slowing movement (bradykinesia)
resting postural tremor
cogwheel rigidity
difficulty maintaining balance (postural instability)

28
Q

mild-potency drugs for PD

A

anticholinergics
amantadine
MAO-B inhibitors

29
Q

anticholinergic drugs used to tx PD

A

trihexyphenidyl
benztropine
specifically useful for symptom of drooling

30
Q

discontinuation of anticholinergic drugs in PD

A

must be tapered as abrupt dc can exacerbate adverse effects

31
Q

contraindications to anticholinergics for PD

A

narrow-angle glaucoma

benztropine is contraindicated in patients <3

32
Q

anticholinergics and KCL

A

should be avoided d/t increased risk of ulcers

33
Q

amantadine dosage in renal dysfunction

A

needs adjusted

34
Q

amantadine and memantine

A

concomitant use has increased risk of QT prolongation and psychosis

35
Q

indication for MAO-B inhibitors in PD

A

may delay need for levodopa by a few months but do not delay clinical progression of PD

36
Q

MAO-B inhibitor drugs for tx of PD

A

selegiline

rasagiline

37
Q

contraindications to MAO-B inhibitors

A

meperidine, methadone, propoxyphene, tramadol, St. John’s wort, cyclobenzaprine, dextromethorphan, other MAOBIs

38
Q

additional contrindications with MAOBI selegiline

A

concurrent therapy with carbamazepine, SSRIs, SNRIs, clomipramine, imipramine

39
Q

major adverse effect when MAOBIs are used with serotonergic drugs or tyramine-containing foods

A

serotonin syndrome

40
Q

moderate potency drugs to tx PD

A

dopamine agonists

41
Q

dopamine agonist drugs for tx of PD

A

pramipexole, ropinirole, rotigotine

42
Q

contraindications for dopamine agonists in PD

A

elderly

43
Q

high potency drugs for tx of PD

A

levodopa

catechol-O-methyltransferase inhibitors

44
Q

what happens after several years of tx with levodopa

A

“wearing-off” syndrome where symptoms return prior to next dose

45
Q

why is dopamine itself not used to tx PD

A

cannot cross blood-brain barrier

46
Q

why is levodopa administered with carbidopa

A

carbidopa limits peripheral breakdown of levodopa allowing fourfold increase in circulating levodopa to cross blood-brain barrier and reduces N/V side effects

47
Q

contraindications to levodopa/carbidopa

A

Narrow-angle glaucoma

48
Q

carbidopa-levodopa interactions

A

avoid meals high in protein as it can reduce absorption

increase fluid/fiber intake as constipation reduces absorption as well

49
Q

why are catechol-O-methyltransferase inhibitors (COMTIs) used in conjunction with levodopa

A

decrease “wearing-off” syndrome

50
Q

COMTIs available drugs

A

entacapone

tolcapone

51
Q

lab monitoring with COMT drugs (entacapone, tolcapone)

A

LFT q2-4wks for first 6mo and periodically thereafter

52
Q

starting therapy for patients with mild motor symptoms in PD

A

MAOBI before trying a dopamine agonist or levodopa

53
Q

starting drug therapy with moderate-severe impairment in PD

A

dopamine agonist or levodopa (DA is chosen over levodopa in the younger population)

54
Q

considerations with mild-mod potency drugs for PD

A

anticholinergics are generally avoided
amantadine should be chosen over MAOBI in younger patients
MAOBI are favored over amantadine in the elderly and those with renal impairment

55
Q

tx of depression in PD

A

typically pramipexole or venlafaxine

TCAs and DAs have been labeled as “likely efficacious”

56
Q

tx psychosis in PD

A

clozapine and quetiapine have the most evidence for use

57
Q

what other agents have been shown to reduce hallucinations in PD

A 
donepezil
rivastigmine (Exelon)
ziprasidone

Pharmacology (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions