Drugs For Neurodegenerative Diseases

Question 1

Parkinsons

Answer 1

Death of dopaminergic (DA) neurons in substantia nigra

If DA is absent Ach has more dramatic stimulatory effect on striatum

90% of Da-ergic neurons in the striatum need to die before symptoms begin

Question 2

Parkinsons Symptoms

Answer 2

Bradykinesia- shuffling gait
Tremors
Muslce rigidity
Affective flattening

Question 3

Secondary Parkinsonism

Answer 3

Not PD but similar symptoms

Anti-psychotic medication can lead to extra pyramidal symptoms

Question 4

Drugs for PD moa / strategies

Answer 4

Dopamine system agonists

• give levodopa (precursor to DA)
• inhibit breakdowm of levodopa
• agonize DA receptors

Question 5

Why not give DA for PD?

Answer 5

BBB endothelial cells metabolize DA via MAOs

Question 6

Actual Drugs for PD

Answer 6

Levodopa-carbidopa (parcopa)
Entacapone (comtan)
Levodopa-carbidopa-entacapome (stalevo)

Question 7

Levodopa-carbidopa (parcopa) moa

Answer 7

Provide DA precursor and (-) DOPA decarboxylase in perphery

Question 8

Entacapone (comtan) moa

Answer 8

Inhibits COMT in periphery

Which limits levodopa metabolism

Question 9

Levodopa-carbidopa-entacapome (stalevo) moa

Answer 9

Provide DA precursor and limit levadopa metabolism in periphery so more enters the brain

Question 10

Actual Drugs for PD pt 2

Answer 10

Apomorphine (apokyn)
Bromocriptine (parlodel)
Rotigotine (neupro)

Question 11

Apomorphine (apokyn) moa

Answer 11

DA receptor agonist

Question 12

Bromocriptine (parlodel) moa

Answer 12

DA receptor agonist

Used in adj with pt 1 drugs

Question 13

Rotigotine (neupro) moa

Answer 13

DA receptor agonist

Transdermal patch

Question 14

Alzheimer’s (AD) / tx strategies

Answer 14

Cholinergic dysfunction in memory centers of the brain

Inhibit AchE

Question 15

AD symptoms

Answer 15

Impaired memory
Confusion 
Inability to recognize family and friends
Aggression/depression
Psychoses

Question 16

Drugs for AD

Answer 16

Donepezil(Aricept)

Memantine (namenda)

Question 17

Donepezil(Aricept) moa

Answer 17

AchE inhibitor

1 tx strategy for AD/ modest at best

Question 18

Memantine (namenda) moa

Answer 18

NDMA (glutamte) receptor antagonist

Question 19

Multiple Sclerosis (MS)

Answer 19

Antibodies target and destroy myelin in brain and spinal cord (CNS)

Question 20

MS symptoms

Answer 20

Fatigue
Neuropathic pain
Heat sensitivity,spasticity
Dec balance
Visual impairment

Question 21

Drugs for MS tx

Answer 21

Reduce circulating immune cells- reduce attack on myelin

Question 22

Actual drugs for MS (relapsing-remitting amd Secondary-Progressive)

Answer 22

Interferon beta 1a (avonex)
Fingolimod (gilenya)
Glatiramer (copaxone)

Question 23

Interferon beta 1a (avonex) moa

Answer 23

Cytokine drug- reduce pro inflammatory cytokines

Question 24

Fingolimod (gilenya) moa

Answer 24

Small molecule that reduces number of circulating lymphocytes

Question 25

Glatiramer (copaxone) moa

Answer 25

Mimics myelin basic protein (MBP)

Decoy!

Question 26

Actual drugs for MS (progressive-relapsing amd primary progressive)

Answer 26

Mitoxantrone (novantrone)

Alemtuzumab (lemtrada)

Question 27

Mitoxantrone (novantrone) moa

Answer 27

Chemo agent, suppresses cell division

Question 28

Alemtuzumab (lemtrada) moa

Answer 28

IgG monoclonal antibody- binds B and T cells which removes them from circulation