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HLSC 222- midterm 1 > Alzheimers > Flashcards

Alzheimers Flashcards

1
Q

Alzheimer Disease

A

progressive memory loss, impaired thinking

neuropsychiatric symptoms (hallucinations, delusions)

Sixth leading cause of death

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2
Q

Pathologic findings in AD

A

cerebral atrophy

neuron degeneration

neuritic plagues

neurofibrillary tangles

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3
Q

what can drugs do for AD

A

little to relieve symptoms or prevent neuronal loss

no significant delay in AD progression

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4
Q

what causes AD

A

its idiopathic

neural degeneration
- starts in hippocampus (memory)
- later in cerebral cortex

reduced cholinergic transmission
- Advanced: ACH 90% below normal

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5
Q

Beta- Amyloid and Neuritic Plagues

A

Form outside neurons

  • hallmark of AD
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6
Q

Neurofibrillary tangles and Tau

A

tangles form INSIDE disrupted microtubules / Tau spreads

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7
Q

Drugs approved for AD

A

3 cholinesterase inhibitors

1) Donepezil

2) Galantamine

3) Rivastigmine

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8
Q

Cholinesterase Inhibitors mechanism

A

prevent breakdown of ACh by Acheylcholinesterase (AChE)

Results in enhanced transmission by cholinergic neurons that have not yet been destroyed

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9
Q

Therapeutic Use for Cholinesterase Inhibitors

A
  • mild to moderate symptoms
  • only benefits 1/12 patients
    -benefits short lived
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10
Q

what Cholinesterase Inhibitor is approved for severe symptoms

A

Donepezil (doon-epa-zill)

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11
Q

Adverse Effects of Cholinesterase Inhibitors
Gi
CNS
Lungs

A

Increased ACh in periphery
- GI effects
-CNS: dizziness, headache
-Lungs: bronchoconstriction

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12
Q

Drug interactions with Cholinesterase Inhibitors

A

drugs that block cholinergic receptors should be avoided

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12
Q

Dosing Cholinesterase Inhibitors

A

highest doses= greatest benefits but most intense adverse effects

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13
Q

Individual Cholinesterase Inhibitors

A

Rivastigmine (ri-vuh-stig-meen)

Galantamine (gull-ant-a-meen)

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14
Q

Rivastigmine )ri-vuh-stig-meen) properties

A

Approved for AD and Parkinsons, demential

IRREVERSIBLE inhibition of AChE

PO dosing

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15
Q

Rivastigmine Adverse Effects

A

Anorexia, bradycardia, fall-related fractures

Symptoms of increased ACh in patients with peptic ulcer disease, urinary obstruction and lung disease

16
Q

Rivastigmine Drug Interactions

A

NO significant drug interactions
- does not interact with liver metabolizing enzymes

17
Q

Galantamine (gull-at-a-meen) Properties

A

REVERSIBLE inhibitor for mild to moderate AD

Prepared by extract of daffodil bulbs

Benefits short lived :(

18
Q

Galantamine adverse effects

A

GI tract

Anorexia

Weight loss

Bradycardia–> from too much ACH in periphery

Bronchoconstriction

19
Q

N-Methyl-D-Asparate Receptor Antagonist (NMDA) drug

A

Memantine (prototype)

20
Q

normal physiology NMDA receptor

A

Resting state
- Mg occupies NDMA receptor = blocks calcium uptake

Activated State
- Glutatmate bind to NMDA = Mg displaced
- Calcium enters

Returns to Resting

= a “signal” in learning and memory process

21
Q

Pathophysiology NMDA receptor

A

Improper glutamate binding
- PERSISTENT activated state

  • slow excessive influx Ca2+

= impaired learning, memory and eventually neuronal death

22
Q

Memantine mechanism of action

A

Binds to NMDA receptor
- block Ca2+ entry when extracellular glutamate is low
= STOPS CA2+ INFLUX
= ALLOWS post synaptic Ca2+ levels to normalize

  • once appropriate glutamate released, memantine is displace
  • glutamate diffuses away
    –> MEMANTINE AGAIN BLOCKS CHANNEL
23
Q

Therapeutic Use Memantine

A

Modest benefits for moderate to severe AD

  • sometimes symptoms improve
24
Q

Adverse Effects memantine

A

Common: dizziness, headache, confusion

Less Common: GI tract

25
Q

memantine drug interaction

A

Sodium bicarbonate decreases renal excreation of NMDA
- toxic levels of memantine may accumulate

HLSC 222- midterm 1 (10 decks)

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