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Pharm 225B > CNS 1 -PD, AD, Epilepsy > Flashcards

CNS 1 -PD, AD, Epilepsy Flashcards

1
Q

Dopamine replacement
Parkinson’s Disease

A

levodopa/carbidopa

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2
Q

Dopamine agonist (4)`
Parkinson’s Disease

A

pramipexole
ropinerole
bromocriptine- ergot alkaloid, rare use
rotigotine (patch)

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3
Q

COMT inhibitors (2)
Parkinson’s Disease

A

entacapone
tolcapone

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4
Q

Dopamine releaser
Parkinson’s DIsease

A

amantadine

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5
Q

MAO-B inhibitor (2)
Parkinson’s Disease

A

selegiline
rasagiline

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6
Q

Anticholinergics (3)
Parkinson’s Disease

A

trihexyphenidyl (artane)
benzotropine (cogentin)
biperadin (akineton)

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7
Q

Levodopa
PD

A

immediate precursor of dopamine
- transported across BBB via amino acid transporters and converted to dopamine in the brain

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8
Q

Levodopa MOA
PD

A

increase amount of dopamine in the brain
(giving dopamine back)

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9
Q

Carbidopa MOA
PD

A

inhibits peripheral decarboxylase
- maximizing L-dopa delivery to the brain

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10
Q

Entacapone MOA
PD

A

inhibits COMT (catechol- O- methyltransferase)
- maximizing L-dopa delivery to the brain
- increases plasma t1/2 of L-dopa -> increasing availability

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11
Q

L-dopa AE
PD

A

N/V
loss of effectiveness
dyskinesias
psychosis
postural hypotension

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12
Q

Dopamine agonists (D2) uses
PD

A
  • monotherapy in younger pts, also for RLS
  • adjunctive therapy w/ L-dopa (orthostatic HTN, dyskinesias)
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13
Q

Non-ergot derivatives (3)
PD

A

pramipexole (mirapex)
ropinirole (requip)
apomorphine (apokyn) - SQ

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14
Q

Non-ergot derivatives AE
PD

A

nausea
sleep attacks
insomnia
compulsive behaviors

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15
Q

Ergot derivatives (1)
PD

A

bromocriptine

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16
Q

MAO-B inhibitors MOA
PD

A

inhibit metabolism, prolong L-dopa effects
- may have neuroprotective effects

selegine (eldepryl), rasagiline (azilect)

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17
Q

Amantadine (symmetrel) antiviral PD

A

MOA: stimulates dopamine release
blocks dopamine reuptake
blocks cholinergic and glutaminergic receptors

uses: dyskinesias

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18
Q

Amantadine (symmetrel) antiviral AE
PD

A

insomnia
agitation
irritability
hallucinations
restlessness

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19
Q

Antimuscarinic (anticholinergic) MOA
PD

A

block relative excess cholinergic fxn in basal ganglia
uses: tremors, rigidity

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20
Q

Antihistamine (1)
PD

A

diphenhydramine (benadryl)

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21
Q

Acetylcholinetrerase inhibitors (AChE-Is)
AD

A

donepezil (aricept)

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22
Q

AChE-Is MOA
AD

A

increase cholinergic transmission by reducing ACh metabolism

uses: symptomatic therapy for mild to moderate AD

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23
Q

AChE-Is AE
AD

A

N/V
diarrhea
bradycardia
lightheadedness
insomnia
vivid dreams

24
Q

Memantine (namenda) MOA
AD

A

blocks CA+ influx into neurons caused by excessive glutamate signaling

uses: symptomatic therapy for moderate to severe AD

25
Q

Memantine (namenda) AE
AD

A

lightheadedness
confusion
headache

26
Q

Anti-epileptic drugs (AED) MOA

A
  1. ion channel blockade
    - blockade of voltage-gated Ca+ channels
    - prolonged inactivation of Na+ channels
  2. GABA potentiation
    - direct action on GABA receptor
    - indirect GABA effect -> decrease reuptake or metabolism, increase release
27
Q

Phenytoin (dilantin) MOA
AED

A

suppresses action potential through inactivation of Na+ channels

uses: partial or generalized tonic clonic seizures

28
Q

Phenytoin (dilantin) AE
AED

A

cerebellar-vestibular symptoms:
nystagmus
ataxia
diplopia
vertigo
arrhythmias
hypotension
gingival hyperplasia

BBW: Steven’s Johnson syndrome (SJS)

29
Q

Phenytoin (dilantin) drug interactions

A

phenytoin may decrease by diazepam, cimetidine, alcohol, valproic acid

30
Q

Carbamazepine (tegretol) MOA
AED

A

inactivates Na+ channels

uses: drug of choice for partial seizures and may be first for generalized tonic-clonic seizures

31
Q

Carbamazepine (tegretol) AE
AED

A

vertigo
ataxia
diplopia
blurred vision (cerebellar-vestibular)
small risk of small bone marrow suppression
water retention
induction of hepatic enzymes

BBW: Steven’s johnson syndrome (SJS)

32
Q

Valproic Acid (depakene, depakote) MOA
AED

A

blocks Na+ and Ca+ channels, also gaba effects

uses: first line for all seizure types, bipolar disorder, migraine prevention

33
Q

Valproic Acid (depakene, depakote) AE

A

N/V
anorexia
hepatotoxicity
pancreatitis
rash
wt gain
hair loss
tremor or bone marrow suppression
hepatic enzyme inhibitor

  • not recommended for pregnant women
34
Q

Ethosuximide (zarontin) MOA
AED

A

inhibits Ca+ channels in thalamic neurons

uses: drug of choice for absence seizures

35
Q

Ethosuximide (zarontin) AE

A

N/V
anorexia

36
Q

phenobarbitol MOA
AED

A

potentiates GABA signaling through direct receptor binding

uses: effective for generalized tonic-clonic and partial seizures, primarily used in children

37
Q

Aducanumab (aduhelm)

A

MOA: monoclonal antibody therapy that removes amyloid

uses: AD to lower amyloid levels in AD brain, does not slow the decline of cognitive fxn

AE: urticaria, angioedema

38
Q

phenobarbitol AE
AED

A

marked sedation but some tolerance develops
irritability
hyperactivity in children
agitation
confusion in elderly
respiratory depression
induces hepatic enzymes

39
Q

topiramate (topamax) MOA
AED

A

blocks Na+ and Ca+ channels
potentiates GABA and blocks glutamate receptors

uses: partial and generalized seizures, Lennox-Gastaut, monotherapy, migraine prophylaxis

40
Q

topiramate (topamax) AE
AED

A

cerebellar/vestibular: ataxia, diplopia, dizziness
CNS: somnolence, cognitive slowing, nervousness
GI: nausea, vomiting, anorexia
metabolic acidosis
kidney stones
hypohydrosis
glaucoma

41
Q

levetiracetam (keppra) MOA
AED

A

not fully understood that it involves a synaptic vesicle protein SV2A may modulate release of glutamate and GABA
- not metabolized by CYP

42
Q

levetiracetam (keppra) uses
AED

A

myoclonic seizures
primary gen tonic-clonic
partial- onset seizures
migraine
bipolar
new onset pediatric epilepsy

43
Q

Other anti-epileptic drugs (4)

A

oxycarbazepine (trileptal)
lamotrigine (lamictal)
gabapentin (neurotin)
pregabalin (lyrica)

44
Q

Treatment drugs for status epilepticus

A

Initial drug: benzodiazepine (IV lorazepam or diazepam)
2nd drug: IV fosphenytoin or phenytoin

45
Q

Sedative hypnotic drugs

A

barbiturates
benzodiazepines
BZ-like drugs

also used as:
anti-anxiety
anticonvulsants
sedation/anesthesia
hypnotic
muscle relaxation
alcohol withdrawal

46
Q

Benzodiazepines (BDZs) MOA

A

enhance inhibitory activity of GABA by binding to benzodiazepine site on receptor

47
Q

BDZ antagonist

A

flumanzenil (IV/IM)

48
Q

Benzodiazepines (BDZs) AE

A

excessive or additive sedation w/other CNS depressants
confusion
anterograde amnesia
abuse potential
tolerance and cross tolerance w/ETOH

49
Q

Zaleplon (sonata)

A

more selective because binds only to GABA receptors with alpha-1 subunits
- rapid absorption, short half life

50
Q

Zolpidem (ambien)

A

binds BZ site selectively with minimal muscle relaxing and effects
- rapid onset, oral spray and sublingual tablets

AE: drowsiness, complex sleep behaviors (driving, cooking, sex)

51
Q

Exzopiclone (lunesta)

A

not restricted to short term use 12 mo.

AE: unpleasant taste, HA, complex sleep behaviors, rebound insomnia

52
Q

Suvorexant (belsomra)

A

dual orexin receptor antagonist (DORA)

uses: helps for sleep, reduce insomnia

53
Q

Ramelteon (rozerem)

A

melatonin receptor agonist

uses: helps for sleep, reduce insomnia

AE: dizziness, fatigue

54
Q

Antidepressants (4)

A

venlafaxine
paroxetine
escitalopram
duloxetine

55
Q

Busprione (buspar)

A

MOA: partial agonist 5HT1a also D2 activity, selective anxiolytic, not a benxodiazepine

uses: anxiety

56
Q

Propofol

A

MOA: promotes GABA release
AE: hypotension, can be abused

57
Q

ketamine- esketamine (spravato)

A

MOA: S-Enantiomer of ketamine with analgesic anesthetic and antidepressant activities

uses: major depression disorders

Pharm 225B (9 decks)

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