Chp 13 Chronic Neurologic Disorders

Question 1

Anticholinesterase agents are used to treat what? (4)

Answer 1

Reversible inhibitors: myasthenia gravis, Alzheimer’s disease, parkinson’s disease
Irreversible inhibitors: tx glaucoma

Question 2

Action of anticholinesterase agent?

Answer 2

Prevents inactivation of ACh, thus increasing the amount of Ach available at receptor sites.

Question 3

What meds is used to treat myasthenia gravis? (3)

Answer 3

Neostigmine, Ambenonium, Pyridostigmine

Question 4

What medication is used to diagnose myasthenia gravis?

Answer 4

Edrophonium

Question 5

What meds reverses nondepolarizing neuromuscular blocking agents? (3)

Answer 5

neostigmine, Pyridostigmine, Edrophonium

Question 6

Anticholinesterase adverse effects? (2)

Answer 6

1. Excessive muscarine stimulation r/t increased GI motility, gi secretions, bradycardia. treatable by atropine
2. Cholinergic crisis: excessive muscarinic stimulation and respiratory depression from neuromuscular blockade.

Question 7

Therapeutic intent of meds for myasthenia gravis? (2)

Answer 7

1. Fewer episodes of fatigue

2. Improvements in strength when performing ADLs.

Question 8

What do anti-parkinson’s medications do?

Answer 8

Dopaminergic medications promote dopamine synthesis, activates dopamine receptors, prevent dopamine breakdown, and promote dopamine release.

Question 9

Dopamine synthesis medication is prepared in combo with dopamine agonist. What are 2 dopamine agonist?

Answer 9

1. carbidopa
2. levodopa/carbidopa.

Carbidopa prevents levodopa from converting to DA in the GI. More levodopa reaches CNS.
Levodopa can cross the blood-brain barrier (Dopamine can’t) and then is converted to dopamine.

Question 10

What’s the expected actions of dopaminergic medications?

Answer 10

Does not halt Parkinson’s disease, but does offer symptomatic relief.

Question 11

What are some Levodopa/Carbidopa side effects? (7)

Answer 11

1. N/V, drowsiness
2. Dyskinesias (Head bobbing, tics, grimacing, tremors)
3. Hypotension
4. CV effets from beta 1 stim (Tachycardia, palp, irreg HR)
5. Psychosis (hallucinations, nightmares)
6. Discoloration of sweat and urine
7. Activation of malignant melanoma

Question 12

What are 3 Doapmine agonist?

Answer 12

Pramipexole, Ropinirole, Apomorphine (Bromocriptin)

Used as monotherpay in early stage PD.
Bromocriptin is used too but poorly tolerated.

Question 13

What are side effects of dopamine agonists? (6)

Answer 13

-ole, -ine

1. Day time sleepiness
2. Hypotension
3. Psychosis
4. Impulse control disorder
5. Dyskinesias
6. Nausea

Question 14

What is a dopamine releaser?

Answer 14

Amantadine

Question 15

What are side effects of a dopamine releaser? (3)

Answer 15

1. CNS efects (Confusion, dizziness, restlessness)
2. Atropine like effecs (Dry mouth, blurred vision etc)
3. Discoloration of skin, i.e livedo reticularis

Question 16

What are meds for COMT inhibitors? (2)And what do they do?

Answer 16

Entacapone, tolcapone -one

used in combo with levodopa/carbidopa to inhibit levodopa metabolism in intestine

Question 17

Side effects of COMT inhibitors? (Same as agonists) (7)

Answer 17

1. Day time sleepiness
2. Hypotension
3. Psychosis
4. Impulse control disorder
5. Dyskinesias
6. Nausea
7. Discoloration of urine to a yellow orange

Question 18

Therapeutic uses of MAO-B Inhibitors?

Answer 18

Used in combo of levodopa/carbidopa to decrease the wear-off effect.

Question 19

What are MAO-B inhibitor meds (2)?

Answer 19

1. Selegiline, Rasagiline, -giline

Question 20

What are adverse effects of MAO-B inhibitor? (2/3)

Answer 20

1. Insomnia (for selegiline)
2. HTN crisis triggered by foods with tyramine in it
3. HTN crisis and even death from certain meds. i.e antidepressant, MAO inhibitors etc

Question 21

What foods contain tyramine? (List 5)

Answer 21

avocados, soybeans, figs, smoked meats, dried or cured fish, cheese, yeast products, beer, chianti wine, chocolate, caffeinated beverages