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Neuro Pharm Quiz > Dementia Drugs > Flashcards

Dementia Drugs Flashcards

1
Q

what condition is responsible for the largest fraction of dementia cases

A
  • Alzheimer’s disease
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2
Q

the movement symptoms of Huntington’s disease result largely from aberrations in the _____ pathway

what happens in this pathway

A
  • nigrostriatal dopaminergic
  • releases dopamine into the striatum
  • modulates signaling through the direct and indirect movement pathways of the basal ganglia
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3
Q

early stage Huntington disease is characterized by ______ in dopamine levels

A
  • increase
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4
Q

drugs used to treat Huntington Disease

A
  • Tetrabenazine

- Aripiprazole

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5
Q

MOA of Tetrabenazine

A
  • inhibit VMAT transporter which transports dopamine into presynaptic vesicles
  • reduces amount of dopamine released
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6
Q

MOA of Aripiprazole

may also treat

A
  • dopamine antagonist
  • directly compete with dopamine for binding to dopamine receptors on the postsynaptic cell
  • agitation and psychotic symptoms
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7
Q

toxicities of Aripiprazole

A
  • extrapyramidal symptoms
  • neuroleptic malignant syndrome
  • gynecomastia
  • amorrhea
  • sexual disfunction
  • metabolic syndrome
  • anti-cholinergic toxicities
  • orthostatic hypotension
  • sedation
  • prolonged QT
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8
Q

Parkinson’s disease is characterized by

A
  • loss of dopaminergic neurons in nigrostriatal pathway
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9
Q

the pharmacotherapy goal of Parkinson’s disease is _____ that for Huntington disease

A
  • opposite
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10
Q

MOA of L-DOPA (Levodopa)

what do we give it with

A
  • can cross the BBB where it is then converted into dopamine
  • Carbidopa
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11
Q

MOA of Carbidopa

can it cross the BBB

A
  • inhibitor of DDC which converts levodopa into dopamine in peripheral tissues
  • increases amount of drug that reaches the brain
  • cannot cross the BB so so doesn’t not interfere with conversion of levodopa to dopamine in the brain
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12
Q

MOA of Entacapone

when do we add this to the treatment regimen

A
  • inhibits COMT which breaks down levodopa

- after therapeutic effects of levodopa and carbidopa begin to fluctuate or wear off

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13
Q

what is the wearing off phenomenon with levodopa

A
  • fewer neurons available in later stages of disease to convert levodopa to dopamine
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14
Q

toxicities of levodopa

A
  • nausea/vomiting (chemoreceptor trigger zone)
  • orthostatic hypotension (medulla)
  • psychosis (mesocortical pathway)
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15
Q

MOA of Tolcapone

A
  • COMT inhibitor
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16
Q

toxicities of Entacapone

A
  • diarrhea
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17
Q

toxicities of Tolcapone

A
  • diarrhea

- hepatotoxicity

18
Q

levodopa interacts with which drugs

why?

A
  • nonselective MAOIs
  • isocarboxazid
  • phenelzine
  • trianylcipromine
  • increase dopamine levels to a dangerous point
19
Q

MOA of bromocriptine

A
  • dopamine agonist in striatum
20
Q

MOA of pramipexole

A
  • dopamine agonist in striatum
21
Q

MOA of Ropinirole

A
  • dopamine agonist in striatum
22
Q

toxicities of Bromocriptine

useful in treating

A
  • prolactin suppression from pituitary gland
  • cardiac valve fibrosis
  • prolactinomas and other endocrine disorders
23
Q

toxicities of pramipexole and ropinirole

A
  • sedation
  • somnolence
  • sleep attacks
24
Q

MOA of selegiline

A
  • monoamine oxidase B inhibitor

- blocks breakdown of dopamine in neurons

25
Q

MOA of rasagiline

A
  • monoamine oxidase B inhibitor

- blocks breakdown of dopamine in neurons

26
Q

MOA of amantadine

A
  • helpful for treating influenza

- stimulates release of dopamine from nigrostriatal neurons

27
Q

toxicities of amantadine

A
  • dizziness
  • insomnia
  • somnolence
  • hallucinations
28
Q

MOA of benztropine

- trihexiphenidyl

A
  • direct antagonist of acetylcholine
  • reduces contribution from cholinergic stratal neurons
  • re-establish balance between acetylcholine and dopamine signaling in the striatum
29
Q

toxicities of anti-cholinergics

A
  • dry mouth
  • tachycardia
  • constipation
  • urinary retention
30
Q

what drugs are good for treating mild PD symptoms in young patients

A
  • MAOi OR
  • amantadine OR
  • anti-cholinergic (avoid in older patients)
31
Q

what drugs are good for treating moderate PD symptoms in younger patients

A
  • levodopa/carbidopa OR

- DA agonist (avoid in older patient)

32
Q

what drugs are good for treating severe PD symptoms

A
  • levodopa/carbidopa PLUS
  • DA agonist
    OR MAOI
33
Q

what do you use to treat dementia with lewy bodies

A
  • cholinesterase inhibitors
34
Q

late in Lewy body dementia, what may occurs

how do you treat

A
  • parkinsonian features

- same drugs as Parkinson’s

35
Q

MOA of Donepezil

A
  • cholinesterase inhibitor
  • block normal degradation of acetylcholine at the synapse
  • all stages of Alzheimer’s treatment
36
Q

MOA of Galantamine

A
  • cholinesterase inhibitor
  • block normal degradation of acetylcholine at the synapse
  • mild-moderate symptoms of Alzheimer’s
37
Q

MOA of Rivastigmine

A
  • cholinesterase inhibitor
  • block normal degradation of acetylcholine at the synapse
  • mild-moderate symptoms of Alzheimer’s
38
Q

toxicities of cholinesterase inhibitors

A
  • pro-cholinergic - arrhythmias
  • insomnia
  • vivid dreams
  • bradycardia
  • syncope
39
Q

avoid cholinesterase inhibitors with

A
  • beta blockers/Ca2+ channel blockers
40
Q

treatment of Alzheimer’s disease

A
  • cholinesterase inhibitors

- glutamate receptor antagonist

41
Q

MOA of memantine

how does this impact AD

A
  • glutamate receptor competitive antagonist
  • glutamate cannot reuptake due to AB plaques
  • excess glutamate leads to excitotoxicity and cell death

Neuro Pharm Quiz (5 decks)

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