Drugs Affecting Neurologic Functioning: Part 2

Question 1

MAO-B inhibitors meds

Answer 1

Selegiline (Eldepryl)

Rasagiline (Azilect)

Question 2

What do MAO-B inhibitors do?

Answer 2

They inhibit the enzyme MAO-B from inactivating dopamine

Question 3

Adverse effects of MAO-B inhibitors

Answer 3

Insomnia
Orthostatic hypotension
Dizziness
Suicidal ideations

Question 4

MAO-B Inhibitors are primarily used as…

Answer 4

Anti-depressants

Question 5

Extremely high doses of MAO-B inhibitors can,,,

Answer 5

Inhibit Mao-A and increase the risk for hypertensive crisis when eaten with foods high in tyramine (aged cheese, red wine, bananas)

Question 6

MAO-B Inhibitors are very effective but not great drugs because…

Answer 6

They interact with anything and everything

Question 7

COMT Inhibitors meds

Answer 7

Tolcapone (Tasmar)

Entacapone (Comtan)

Question 8

COMT Inhibitors work by…

Answer 8

Inhibiting the COMT enzyme which inactivates dopamine

Question 9

COMT inhibitors are used in conjunction with…

Answer 9

Sinimet

Question 10

Sinemet + Comtan =

Answer 10

Stalevo

Question 11

Adverse effects of COMT Inhibitors

Answer 11

Affects liver function (Tasmar)
Dark yellow-orange urine
Can intensify effects of levodopa

Question 12

Anticholinergics meds

Answer 12

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

Question 13

Anticholinergics mechanism of action

Answer 13

Inhibit the release of acetylcholine

Question 14

Anticholinergics are used for…

Answer 14

Drug-induced parkinsonism

• pseudoparkinsonism
• Often caused by anti-psychotics

Question 15

Adverse effects of anticholinergics

Answer 15

Dry mouth, blurred vision, constipation, tachycardia, urinary retention

Question 16

Alzheimer’s disease is characterized by…

Answer 16

Progressive memory loss
Impaired thinking
Neuropsychiatric symptoms (Hallucinations, delusions)

Question 17

Pathophysiology of Alzheimer’s Disease

Answer 17

Neuronal degeneration
Reduced levels of acetylcholine
Neurofibrillary tangles

Question 18

We treat Alzheimer’s with drugs that…

Answer 18

Maximize acetylcholine

Question 19

Early symptoms of Alzheimer’s

Answer 19

Memory loss

Confusion

Question 20

Later symptoms of Alzheimer’s

Answer 20

Impaired judgement

Personality changes

Question 21

Is there any effective therapy for Alzheimer’s core symptoms?

Answer 21

No

Question 22

Cholinesterase inhibitors action

Answer 22

Block the breakdown of acetylcholine by acetylcholinesterase
-Increase availability of acetylcholine
NOT a cure - slows progression

Question 23

Cholinesterase inhibitors show improvement in _____ of patients

Answer 23

25-30%

Question 24

Cholinesterase inhibitors therapeutic effects

Answer 24

Cognition

Memory

Question 25

Adverse effects of acetylcholinesterase inhibitors

Answer 25

GI (NVD) | CNS (Dizziness, headache)

Question 26

Why is GI side effects harmful for Alzheimer's patients?

Answer 26

They may forget that they need to use the bathroom

Question 27

GI side effects of acetylcholinesterase inhibitors

Answer 27

First 3 months is worst

Question 28

Individual cholinesterase inhibitors

Answer 28

Rivastigmine (Exelon) Donepezil (Aricept) Tacrine (Cognex)

Question 29

Rivastigmine (Exelon)

Answer 29

- GI effects - Significant weight loss in some patients - Hepatotoxicity

Question 30

Donepezil (Aricept)

Answer 30

Most widely used | No hepatotoxicity

Question 31

Tacrine (Cognex)

Answer 31

``` Hepatotoxicity Frequent dosing (shorter half-life) ```

Question 32

Mementine (Namenda) uses

Answer 32

Moderate to severe dementia

Question 33

Mementine (Namenda) therapeutic effects

Answer 33

Slow decline in function | Symptom improvement

Question 34

Mementine (Namenda) is used in combination with...

Answer 34

Aricept | -Less decline in cognitive function

Question 35

Memantine (Namenda) mechanism of action

Answer 35

Modulates the effects of glutamate at the NMDA receptors - play a critical role in memory

Question 36

Adverse effects of Memantine (Namenda)

Answer 36

Well tolerated - Dizziness - Confusion - Headache