Drugs for Parkinsonism and Alzheimer Disease

Question 1

a chronic, progressive, neuro disorder that affects the extrapyramidal motor tract, which controls posture, balance, and locomotion (low dopamine)

Answer 1

parkinson disease (PD)

Question 2

major features of PD

Answer 2

rigidity, bradykinesia, gait disturbances, and tremors

chest and head thrust forward with knees and hips flexed, shuffling gait, and absence of arm swing, and masked facial expressions

pill rolling tremors

1mill americans, 2% chance, men/women equal

Question 3

frequently occurs as an adverse reaction to certain drugs

Answer 3

pseudoparkinsonism

Question 4

parkinsonism symptoms can also result from what

Answer 4

poisons (carbon monoxide and manganese) or from disorders (encephalitis, infections, stroke, trauma)

Question 5

inhibitory neurotransmitter

Answer 5

dopamine (DA)

Question 6

excitatory neurotransmitter

Answer 6

acetylcholine (ACh)

Question 7

what are the 5 categories of drugs to treat PD

Answer 7

1) anticholinergics
2) dopaminergic replacement
3) dopamine agonists
4) MAO-B inhibitors
5) COMT inhibitors

Question 8

increase the effects of DA in the brain by reducing the effects of ACh. This reduces the rigidity and some of the tremors characteristic of PD but has minimal effect on bradykinesia.

parasympatholytics that inhibit the release of ACh

Answer 8

anticholinergics

e.g. trihexyphenidyl and benztropine

Question 9

anticholinergics are contraindicated in ___

Answer 9

glaucoma

Question 10

what can be given for mild PD symptoms

Answer 10

diphenhydramine

Question 11

effective in diminishing symptoms of PD and increasing mobility; short half-life

large doses are needed to achieve a response

Answer 11

levodopa

enzyme dopa decarboxylase converts levodopa to DA in the brain, but also converts 99% of levodopa to be converted to DA before it reaches the brain.

Question 12

an alternative drug used in combo because so much levodopa is metabolized before it reaches the brain

inhibits the enzyme dopa decarboxylase (more levodopa reaches the brain)

Answer 12

carbidopa

Question 13

by combining levodopa with carbidopa, more DA reaches the basal ganglia and ___ doses of levodopa are required to achieve the desired effect.

Answer 13

smaller

**advantage

Question 14

disadvantage of combining carbidopa/levodopa

Answer 14

more side effects (N/V, dystonic movement, and psychotic behavior)

angioedema, palpitations, and orthostatic hypotension may occur

Question 15

stimulate DA receptor activation and provide relief from PD symptoms such as tremor and rigidity

dopaminergics

Answer 15

DA agonists

e.g. bromocriptine and apomorphine hydrochloride

Question 16

how to relieve dry mouth from anticholinergic agents

Answer 16

hard candy, ice chips, or sugarless chewing gum

Question 17

the enzyme MAO-B causes catabolism (breakdown) of DA.

inhibit MAO-B and thus prolongs the action of levodopa

Answer 17

Monoamine Oxidase B Inhibitors (MAO-B inhibitors)

**selegiline hydrochloride

Question 18

large doses of selegiline may also inhibit MAO-A, an enzyme that promotes metabolism of tyramine.

What foods contain tyramine?

what can ingestion of these foods cause, if not metabolized by MAO-A?

Answer 18

aged cheese, red wine, and bananas

hypertensive crisis

Question 19

the enzyme Catechol-O-Methyltransferase (COMT) inactivates DA.

When taken with levodopa they increase the amount of levodopa concentration in the brain

Answer 19

COMT Inhibitors
**tolcapone

Check LFTs

Question 20

an incurable dementia illness characterized by chronic, progressive neurodegenerative conditions with marked cognitive dysfunction

Answer 20

Alzheimer Disease

Question 21

patho of alzheimer disease

Answer 21

degeneration of cholinergic neuron and deficiency in ACh

neuritic plaques that form mainly outside of the neurons and in the cerebral cortex

protein accumulation in high levels that may contribute to neuronal injury

Question 22

the etiology of alzheimer disease is ____

Answer 22

unknown

Question 23

how long from diagnosis of alzheimer disease does death usually occur?

Answer 23

4-8 years

Question 24

symptoms of alzheimer disease

Answer 24

memory lapses, irritable, moody, personality and behavioral changes

Question 25

what age does alzheimer disease usually get diagnosed

Answer 25

45-65

Question 26

how many americans have alzheimers

Answer 26

5.4mill

Question 27

alzheimers is the ___ leading cause of death

Answer 27

6th

Question 28

this drug class treats alzheimers by allowing for more ACh and inhibits an enzyme that breaks down ACh

Answer 28

AChE inhibitors

** donepezil, memantine, galantamine, rivastigmine (LFTs)