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Adv Pharm I > Exam 2 Neuro > Flashcards

Exam 2 Neuro Flashcards

1
Q

Medications used to treat Alzheimer’s

A

Cholinesterase inhibitors
NMDA receptor antagonist
Combination

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2
Q

Cholinesterase inhibitors

A

Rivastigmine
Donepezil
Galantimine

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3
Q

NMDA receptor antagonist

A

Memantine

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4
Q

Combination Rx for alzheimers

A

Donepezil + memantine

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5
Q

MOA Cholinesterase inhibitors

A

Selectively inhibit cholinesterase (enzyme that hydrolyzes or inactivates Ach) in CNS.
Increase Ach concentrations in cerebral cortex

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6
Q

Benefit of cholinesterase inhibitors

A

May slow deterioration of cognitive function. Preserves memory, learning, attention

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7
Q

Route of administration for donepezil

A

PO, ODT

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8
Q

Route of administration for rivastigmine

A

PO, transdermal patch

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9
Q

Route of administration for galantamine

A

PO

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10
Q

Adverse effects for all cholinesterase inhibitors

A

Diarrhea, nausea/vomiting, bradycardia, dizziness, syncope, urinary incontinence, hypersalivation, sweating

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11
Q

Adverse effect of donepezil

A

Insomnia

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12
Q

Adverse effect of rivastigmine

A

Hepatotoxicity

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13
Q

Adverse effect of galantamine

A

Weight gain

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14
Q

Drug interactions of cholinesterase inhibitors

A

Anticholinergic drugs

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15
Q

Cholinesterase inhibitor adverse effects pneumonic

A

DUMBELS - diarrhea, urination, miosis, bronchospasm, Messi, lacrimation, salivation

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16
Q

Cholinergic crisis s/s - pneumonic

A

SLUDGE - salivation, lacrimation, urination, defecation, gastric upset, emesis

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17
Q

MOA of memantine

A

NMDA receptor antagonist. Attenuates excitotoxic effects of glutamate (neuroprotective)

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18
Q

Adverse effects for memantine

A

Constipation, headache, confusion, dizziness, hallucinations, hypertension

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19
Q

NMDA receptor antagonist characteristics

A

Indicated for moderate to severe disease, can be used in combination with cholinesterase inhibitors

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20
Q

Parkinson’s mortality is due to

A

Immobility - aspiration PNA, clotting disorder

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21
Q

Parkinson’s without treatment

A

Progress to akinetic state 5-10 years

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22
Q

S/s Parkinson’s

A

Severe loss of dopaminergic neurons in substantia negra

Presence of Lewy bodies - creates imbalance of acetylcholine and dopamine

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23
Q

Pharmacologic targets for Parkinson’s disease

A

See slide 2 on page 9; neuro ptt 1

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24
Q

Extrapyramidal symptoms in Parkinson’s

A

Bradykinesia, muscular rigidity, resting tremor, postural instability, tics

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25
Presentation of Parkinson’s disease
Extrapyramidal symptoms, speech disturbances, anxiety
26
Dopaminergic agents used for Parkinson’s disease
Levodopa, amantadine
27
Levodopa MOA
Biosynthetic precursor of dopamine. Increases concentration of dopamine in the brain
28
Metabolism of levodopa
Metabolized in peripheral tissue by decarboxylase and catechol-O-methyl transferase (COMT). Less than 1% of Rx reaches brain if given as monotherapy. Need decarboxylase inhibitor and COMT inhibitor
29
Characteristic of levodopa
ALWAYS given in combination with carbidopa
30
Adverse effects of levodopa
N/V (take antacid 30m prior), orthostatic hypotension, sedation, depression, delirium, paranoia, delusions, hallucinations, motor fluctuations
31
New formulation of levodopa (name)
Rytary
32
Characteristics of Rytary
Minimal reduction in motor fluctuations, less freq. dose, can be opened & sprinkled, not interchangeable with sinemet, EXPENSIVE
33
MOA carbidopa
Decarboxylase inhibitor. Inhibits conversion of levodopa to dopamine in peripheral tissues. Increases amount of levodopa that enters brain. Decreases CVS/GI adverse effects
34
Carbidopa negative aspects
Wearing off phenomenon. Loss of efficacy over time. Effective for 2-5 years or need higher dose.
35
Carbidopa administration
Always given in combination with levodopa (sinemet)
36
Titration of carbidopa
Titrate slowly to a minimum of 75 mg daily - reduce incidence of peripheral conversion // reduce AES
37
COMT inhibitors
Tolcapone and entacapone
38
COMT inhibitors MOA
Inhibits peripheral metabolism of levodopa through inhibition of COMT
39
COMT inhibition used in combo with?
Levodopa/carbidopa to enhance effectiveness and **manage wearing off ** Entacapone combined with levodopa/carbidopa
40
Adverse effects of COMT inhibitors
Hepatotoxicity (tolcapone) — monitor LFTs, orthostatic hypotension, diarrhea, hallucinations, brown-orange urine discoloration
41
MAO inhibitors
Selegiline, rasagiline, safinamide
42
MAO Inhibitors MOA
Irreversibly inhibits the MAO enzyme system. MAO-A: catabolize serotonin and norepinephrine MAO-B: catabolize dopamine
43
Selective MAO-B
At low doses | Selegiline, rasagiline
44
Characteristics of selegiline/rasagiline
Neuroprotective - blocks free radical formation with dopamine degradation that cause neuronal degeneration. ***Enhances and prolongs effects of dopamine.
45
Adverse effects of MAO inhibitors
Augments levodopa toxicities (dyskinesias, psychiatric symptoms), N/D, orthostatic hypotension, hallucinations, insomnia, serotonin syndrome (in combo w/ serotonergic agents)
46
MAO inhibitors interactions
At high doses (should be avoided) - MAO-A can be inhibited. AVOID foods/drinks high in tyramine (aged cheese, smoked meat, red wine) Reduction in tyramine catabolism —> hypertensive crisis
47
MAO Inhibitors typically used as?
Adjunctive therapy
48
Safinamide
MAO-B inhibitor, DA reuptake inhibitor
49
DA receptor agonists MOA
Directly activate the dopamine receptors in the brain. | Can also activate other dopamine receptors
50
Advantages of DA-receptor agonists over levodopa
Direct action on receptor —> less free radicals released. Less motor fluctuations, dyskinesias. Longer half life = longer action
51
Types of DA-receptor agonists
Pramipexole, ropinirole, apomorphine, rotigotine
52
Pramipexole characteristics
Requires renal adjustment
53
Ropinirole characteristics
Metabolized by CYP1A2, cigarette smoking INDUCES CYP1A2
54
Apomorphine characteristics
SubQ injection, requires close supervision, infusion related rxn - requires test dose. Profound nausea — requires pretreatment.
55
Rotigotine characteristics
Transdermal patch
56
Disadvantages of DA receptor agonists
Difficult to use in elderly d/t increased CNS effects. May cause/exacerbate dyskinesias
57
Adverse effects of DA-receptor agonists
N/V - reduced with food, anorexia, postural hypotension, sedation, hallucinations, confusion, vivid dreams, impaired impulse control, sleep attacks, behavior (impulse) side effects (gambling/shopping).
58
DA-Receptor agonists caution
Patients with hx of psychotic illness
59
Acetylcholine receptor antagonists
Benztropine, trihexyphenidyl
60
MOA acetylcholine receptor agonists
Competes with Ach at muscarinic receptors. Block dopamine reuptake —> prolongs dopamine effect
61
Which medication helps reduce tremor more than other manifestations?
Acetylcholine receptor antagonists (benztropine, trihexyphenidyl)
62
Adverse effects of acetylcholine receptor antagonists
Anticholinergic - sedation, depression, CONFUSION. Dry mouth, blurred vision, constipation, urinary retention
63
Which medications have a favorable effect on rigidity and bradykinesia?
Acetylcholine receptor antagonists
64
Patients often find which medications difficult to tolerate?
Acetylcholine receptor antagonists
65
Many Parkinson’s disease patients have this associated symptom
Psychosis
66
Pimavanserin MOA
Selectively blocks 5-HT2a and 2c receptors
67
Adverse effects of pimavanserin
Worsening hallucinations, QTc prolongation, death; BBW increased mortality in elderly patients with dementia related psychosis

Adv Pharm I (8 decks)

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