Chapter 13: Chronic Neurologic Disorders

Question 1

what is the only clinical indication of irreversible cholinesterase inhibitors?

Answer 1

treat glaucoma

Question 2

what are reversible cholinesterase inhibitors used to treat?

Answer 2

Alzheimer’s disease and Parkinson’s disease

reverse the effects of nondepolarizing neuromuscular blocking agents following surgery

Question 3

expected pharmacological action of cholinesterase inhibitors

Answer 3

prevent the enzyme cholinesterase from inactivating acetylcholine

increases the amount of ACh available at receptor sites, therefore increases transmission of nerve impulses at sites that respond to ACh

Question 4

complications of cholinesterase inhibitors

Answer 4

excessive muscarinic stimulation causes increases GI motility, GI secretions, salivation, diaphoresis, bradycardia, urinary urgency

Question 5

diaphoresis

Answer 5

sweating

Question 6

how are severe adverse effects of cholinesterase inhibitors treated?

Answer 6

atropine

Question 7

cholinergic crisis

Answer 7

neuromuscular blockade causes excessive muscarinic stimulation (cramping, sweating, salivation, paralysis, weakness) and respiratory depression

paralysis of respiratory muscles is possible and can be fatal

Question 8

contraindications and precautions for cholinesterase inhibitors

Answer 8

patient receiving succinylcholine
pregnancy
GI or renal obstruction

use caution for patients with seizure disorders,
hyperthyroidism, peptic ulcer disease, asthma, bradycardia, and hypotension

Question 9

what are neostigmine and edrophonium used for?

Answer 9

they reverse neuromuscular blockade caused by NONDEPOLARIZING neuromuscular blocking agents

Question 10

why should cholinesterase inhibitors not be given with succinylcholine?

Answer 10

Succinylcholine is a DEPOLARIZING neuromuscular blocker, so cholinesterase inhibitors increase the neuromuscular blockage

Question 11

how is effectiveness of cholinesterase inhibitors evaluated?

Answer 11

recovery of muscle strength
improved cognition
slowed progression of disease onset

Question 12

functions of dopaminergic medications

Answer 12

promote dopamine synthesis
activate dopamine receptors
prevent dopamine breakdown
promote dopamine release
block the degradation of levodopa.

Question 13

levodopa

Answer 13

dopamine synthesis medication

Question 14

carbidopa

Answer 14

dopamine agonist

Question 15

function of levodopa/carbidopa

Answer 15

levodopa crosses blood-brain barrier and is converted to dopamine to restore balance of dopamine and acetylcholine

carbidopa decreases amount of levodopa that is converted to dopamine before it crosses the blood-brain barrier so that more levodopa reaches the CNS

Question 16

dopamine agonists

Answer 16

activate dopamine receptors

Question 17

examples of dopamine agonists

Answer 17

pramipexole
bromocriptine
ropinirole

Question 18

dopamine releaser

Answer 18

prevents dopamine reuptake

amantadine

Question 19

COMT inhibitors

Answer 19

block breakdown of levodopa

entacapone
tolcapone

Question 20

MAO-B inhibitors

Answer 20

prevent dopamine breakdown

selegiline
rasagiline

Question 21

therapeutic uses of levodopa/carbidopa

Answer 21

Parkinson’s Disease

Question 22

when do the beneficial effects of levodopa/carbidopa diminish?

Answer 22

after 5 years of use

Question 23

expected pharmacological action of levodopa/carbidopa

Answer 23

do not halt progression

offer relief from dyskinesias and increase ability to perform ADLs