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Pharm 2 > Alzheimers, PD > Flashcards

Alzheimers, PD Flashcards

1
Q

class: Levodopa (Dopar®)
Levodopa/carbidopa (Sinemet®)
Levodopa/carbidopa intestinal gel (Duodopa®)

A

Dopamine precursors

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2
Q

class: Apomorphine (Apokyn®)
Bromocriptine (Parlodel®)
Pramipexole (Mirapex®)
Ropinirole (Requip®)
Rotigotine (Neupro®)

A

dopamine agonists

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3
Q

class: Benztropine (Cogentin®)
Trihexyphenidyl (Artane®)

A

Anticholinergic agents (muscarinic receptor antagonists)

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4
Q

class: Selegiline (Eldepryl®)
Rasagiline (Azilect®)
Safinamide (Xadago®)

A

Monoamine oxidase B inhibitor

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5
Q

class: Tolcapone (Tasmar®)
Entacapone (Comtan®)

A

Catechol O-methyl transferase (COMT) inhibitor

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6
Q

levodopa response diminished in ___ years

A

3-5

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7
Q

pt counseling for levodopa

A

take on empty stomach

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8
Q

carbidopa function

A

Carbidopa inhibits peripheral dopa decarboxylase
§ Allows more levodopa to enter CNS
§ Carbidopa does not cross BBB, blocks dopa decarboxylase from converting levodopa to
dopamine in the plasma, allowing more levodopa to cross BBB

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9
Q

AEs:
GI: n/v, anorexia, acid production
Cardiovascular – orthostatic hypotension, tachycardia, arrhythmias à increased peripheral
catecholamines
§ Behavioral – agitation, confusion, depression, anxiety, delusion, hallucinations, compulsive
behavior
§ Dyskinesia – choreoathetosis (superimposed on normal involuntary movements of PD)
§ Response fluctuations – “on vs off” phenomenon, end of dose akinesia

A

Levodopa/carbidopa

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10
Q

Levodopa/carbidopa interactions

A

MAO-A inhibitors w/in 2 wks, vitamin B6

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11
Q

Levodopa/carbidopa cautions

A

Psychotic pts
§ CVD/arrhythmia hx
§ Glaucoma
§ Melanoma
§ PUD

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12
Q

Ergot derivative Dopamine Receptor Agonist

A

Bromocriptine

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13
Q

MOA: D2 receptor agonists

A

opamine Receptor Agonists

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14
Q

AEs: hypotension, nausea (pre-treat w/ anti-emetic), dyskinesia, somnolence

A

Apomorphine (Apokyn)

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15
Q

anti emetic for use w/ apomorphine

A

Trimethobenzamide 300mg PO/IM TID
o Start 3 days before initiating apomorphine, continue 2 months then reassess need

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16
Q

med interactions: apomorphine

A

AVOID ondansetron à hypotension and LOC
• AVOID dopamine antagonists (promethazine and metoclopramide) à dec effectiveness

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17
Q

AEs:
o GI: N/V, loss of appetite, anorexia
o CV: orthostatic hypotension
o Dyskinesia – similar to levodopa, reduce total dose of dopaminergic drugs
o Behavioral – confusion, hallucinations, somnolence, impulse control disorders
§ Previous tendency or new phenomena
§ Gambling, shopping, etc

A

dopamine Receptor Agonists

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18
Q

dopamine Receptor Agonists cautions

A

Cardiac dz, psychosis hx, CNS depressant use

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19
Q

Monoamine Oxidase B Inhibitors for PD: low or high dose?

A

low

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20
Q

AEs:
o Insomnia à administer early in the day, less likely w/ rasagiline
o Dizziness, orthostatic hypotension
o GI distress
o Dyskinesia
o At therapeutic doses, less likely to cause HTN crisis or serotonin syndrome

A

Monoamine Oxidase B Inhibitors

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21
Q

MOA: lowers peripheral metabolism of dopamine/levodopa
o Preserves levodopa à decreases clearance, more enters CNS à prolonged effect, less dosage used
o Reduces response fluctuations à increase “on” time, decrease “off” time

A

Catechol-O-Methyl Transferase Inhibitor

22
Q

AEs: typically attributed to increase in levodopa exposure
o GI – N/V/D
o CV – orthostatic hypotension
o Compulsive behaviors possible

A

Catechol-O-Methyl Transferase Inhibitor

23
Q

Catechol-O-Methyl Transferase Inhibitor cautions

A

Psychosis, hx of melanoma, CNS depressant use

24
Q

main effect of anticholinergic agents

A

improves resting tremor

25
Q

AEs: constipation, xerostomia, urinary retention, confusion, blurred vision, tachycardia

A

Anticholinergic Agents

26
Q

Anticholinergic Agents cautions

A

Elderly
o CV dz
o Prostatic dz
o Glaucoma

27
Q

Amantadine (Symmetrel) as monotherapy for PD?

A

no

28
Q

MOA: NMDA receptor antagonist
o Blocks glutamate transmission, enhances dopamine release, blocks acetylcholine
o Weak anti-Parkinson’s’ action (bradykinesia, rigidity, tremor) that typically lasts a few weeks

A

Amantadine (Symmetrel)

29
Q

pharm targets for alzheimers

A

Improving cholinergic neurotransmission
o Inhibiting acetylcholinesterase
Inhibition of NMDA receptor-mediated excitotoxicity; limits glutamate

30
Q

class: Donepezil (Aricept®)
Rivastigmine (Exelon®)
Galantamine (Razadyne®)

A

Cholinesterase Inhibitors

31
Q

class: Memantine (Namenda®)

A

NMDA antagonist

32
Q

AEs:
o N/V/D à do not give anticholinergic medications for management of symptoms
o SLUDGE = salivation, lacrimation, urination, diarrhea, GI upset, emesis

A

Cholinesterase Inhibitors

33
Q

AEs:
§ N/V/D, SLUDGE
§ HA, insomnia, muscle cramps
§ Bradycardia, syncope, dizziness

A

Donepezil (Aricept)

34
Q

Donepezil (Aricept) interactions

A

CYP3A4 substrate metabolism

35
Q

wait ___ before switching to different cholinesterase inhibitor

A

3-6 months

36
Q

Donepezil (Aricept) dose increases

A

4-6 weeks between 5 and 10mg increment
o 3 months between 10-23mg increment

37
Q

which cholinesterase inhibitor comes in transdermal patch

A

Rivastigmine

38
Q

Rivastigmine dosing

A

2 weeks for oral dose adjustment, 4 weeks for patch dose adjustment

39
Q

AEs:
§ n/v/d, SLUDGE (less w/ transdermal patch)
§ Anorexia, dizziness, fatigue
§ Parkinson’s Exacerbation
• b/c if dopamine neurons are lost ACh is imbalanced and we are adding more ACh
o Too much ACh

A

Rivastigmine

40
Q

MOA: Nicotinic receptor modulator à releases additional ACh
§ Increases glutamate and serotonin

A

Galantamine

41
Q

Galantamine dosing

A

4 weeks between dose adjustments

42
Q

indications: Memantine

A

mod-severe AD

43
Q

Memantine dose adjustments

A

1 week between dose adjustments

44
Q

AEs:
o Dizziness, HA, confusion
o Somnolence
o Weight gain
o Hallucinations
o Aggression

A

Memantine

45
Q

tell pt to take MAO-B inhibitors when?

A

am bc of insomnia

46
Q

MAO-B inhibitor causing the least insomnia

A

rasagiline

47
Q

classes to treat AZ

A

Cholinesterase Inhibitors
NMDA Antagonist

48
Q

classes to treat PD and suffixes

A

Dopamine Precursors (-dopa)
Dopamine Receptor Agonists (ole, tine)
Monoamine Oxidase B Inhibitors (line, amide)
Catechol-O-Methyl Transferase Inhibitor (pone)
Anticholinergic Agents (pine, dyl)

49
Q

main levodopa SEs

A

nausea, agitation, confusion, dyskinesia

50
Q

main dopamine receptor agonist SEs

A

Behavioral à confusion, hallucinations, somnolence, impulse control disorders
§ Previous tendency or new phenomena
§ Gambling, shopping, etc

Pharm 2 (29 decks)

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