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Pharm exam 3 > Gout and Parkinson Drugs > Flashcards

Gout and Parkinson Drugs Flashcards

1
Q

NSAIDs

A 
indomethacin, ibuprofen, ketorolac
antiinflammatory
inhibit prostaglandin synthesis
GI side effects
usually requires max recommended dosage
no aspirin since it inhibits uric acid excretions too
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2
Q

indomethacin

A

NSAID used for gout

CNS SE - confusion, HA, dizziness

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3
Q

Ketorolac

A

NSAID used for gout
injuectable IM
severe, acute attacks
also an analgesic

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4
Q

Colchicine

A

autumn crocus
unique antiinflammatory activity specific for gout
binds tubulin to prevent it’s polymerization to microtubules
reduces leukocytes, phagocytes at gout attack
inhibits neutrophils for producing or releasing glycoproteins
SE - diarrhea, GI upset, decrease in WBC, myopathy, aplastic anemia, alopecia, agranulocytosis
overdose - severe burning, throat pain, cNS depression, bloddy diarrhea
oral or IV for acute attacks
lower, less frequent doese for prevention

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5
Q

allupurinol

A

reduces formation of uric acid by inhibiting xanthine oxidase
preventative
SE -initial increase in gout attacks
-elevation of liver enzymes, dermatologic allergic reaction

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6
Q

febuxostat

A

newer xanthine oxidase inhibitor
less skin problems
elevation of liver enzymes
costly but useful when refractory w/ allupurinol

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7
Q

probenecid

A

uricosuric agent
inhibits secretion and reabsorption of organic acids - net effect, increased uric acid excretion
SE - increased risk of stone formation in kidney
contraindicated in pts with kidney stones
must maintain fluid consumption
preventative
may initialy increase gouty attacks

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8
Q

Rasburicase

A

recombinant urate-oxidase/uricase enzyme
converts uric acid to allantoin
manage uric acid in pediatric cancer patients where tumor lysis is part of therpy
slow IV infusion
SE - allergies, fever, HA, skin rash, N&V, bowel problems, GI pain

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9
Q

Pegloticase

A 
recombinant urate-oxidase/uricase enzyme
converts uric acid to allantoin
slow IV infusion
SE - allergies, fever, HA, skin rash, N&V, bowel problems, GI pain
severe, refractory gout
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10
Q

I-DOPA

A

amino acid - dopamine precursor transported to brain
enters brain by amino acid pump
metabolized by DOP carboxylase in brain and periphery
marked variation with patients so titrate dose
3-2 weeks before full effects
reduces symptoms but effects decrease as disease worsens
SE - N&V- stimulation of CRTZ
- cardiovascular: postural hypotension, incr. HR, arrhythmias
- behavior: large range - depression, psychotic, hallucinations, psychoses, increased libido and release of inhibitions, compulsive behavior- clozapine use to manage
- choreiform movements
-end of does and on -off phenomenon
-decreased levels of prolactin
-makes glaucoma, malignant melanoma and gout worse
-hot flashes, elevation of liver enzymes, blood dyscrasias,
contraindications - arrhythmias, psychosis, melanoma, glaucoma, active peptic ulcer disease
interacts with MAO inhibitors & tricyclic antidepressents - can cause severe hypertension

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11
Q

Carbidopa

A

given with I-DOPA
inhibits DOPA carboxylase in periphery, doesn’t pass BBB
lowers necessary dose of I-DOPA - lowering SE
esp, N+V (CRTZ outside of BBB), cardiovascular effects, worsen behavioral effects

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12
Q

bromocryptine

A

ergot derivate that is a non-specific DA receptor agonist
used in pts that cannot tolerate or respond to I-DOPA
with I-DOPA to decrease “on-off phenomenon”
SE - N&V, postural hypotension, mental disturbance, choreiform movements, inhibits prolactin secretion
mental toxicity of I-DOPA and bromocryptine are additive

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13
Q

carbergoline

A

newer dopamine agonist
approved for tx of hyperprolactinemia
bromocryptine is not used for this anymore

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14
Q

ropinirole

A

non-ergot dopaminergic agonists that target D2 & D3
increasingly used as 1st line drugs
SE - less severe - choreiform, dyskinetic movements, N&V, mental - dizziness, confusion, sedation, behavioral changes, etc.
also used to treat restless leg syndrome

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15
Q

pramipexole

A

non-ergot dopaminergic agonists that target D2 & D3
increasingly used as 1st line drugs
SE - less severe - choreiform, dyskinetic movements, N&V, mental - dizziness, confusion, sedation, behavioral changes, etc.
also used to treat restless leg syndrome
some evidence for antioxidant and neuroprotective effects to slow parkinson’s

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16
Q

amantadine

A

stimulates dopamine release from nerve endings, less effective than I-DOPA, better than anticholinergics
can potentiate I-DOPA
SE - mental disturbances, hyperexcitability, ataxia, confusion, convulsions, choreiform movements, excreted by kidney

17
Q

Selegiline/Deprenyl

A

MAO-B inhibitor in braine, prevents DA breakdown
high doses - interacts with tyramine (cheese toxicity)
supplement to I-DOPA especially in latter stages & on-off
SE - similar but less to I-DOPA - tremor, dyskinesias, choreiform, hallucinations, agitation, behavior and mood changes, nausea, wt loss
controversial studies of slowing disease progression (MPTP metabolism)

18
Q

Rasalagine

A

MAO-B inhibitor in the brain, prevents DA breakdown
high doses- interacts w/ tyramine
newer, more powerful - early and late stages tx
SE - similar but less to I-DOPA - - tremor, dyskinesias, choreiform, hallucinations, agitation, behavior and mood changes, nausea, wt loss

19
Q

entacapone

A

newer drugs inhibit metabolism of DA and I-DOPA by COMT, helps sustain I-DOPA blood levels
use w/ I-DOPA and I-DOPA + carbidopa
adverse effects - increased dopamine and catecholines - hallucinations, N&V, hypertension

20
Q

benztropine

A

mild parkinsons - tremor only
drug of choice from iatrogenic parkinsonism from DA antagonists
SE - automatic - dry mouth, skin, hyperthermia, constipation and urine retention, loss of visual accomodation, incr. HR
- behavior - sedation, confusion, memory impairment
drug interactions with CNS depressants- alcohol, opiods, etc
inhibits some synaptic repuptake of dopamine

21
Q

trihexyphenidyl

A

mild parkinsons - tremor only
drug of choice from iatrogenic parkinsonism from DA antagonists
SE - automatic - dry mouth, skin, hyperthermia, constipation and urine retention, loss of visual accomodation, incr. HR
- behavior - sedation, confusion, memory impairment
drug interactions with CNS depressants- alcohol, opiods, etc

22
Q

diphenhydramine

A

anticholinergic activity

antihistamine

23
Q

Huntington’s Disease

A

extrapyramidal motor symptoms
tx - dopaminergic antagonists - antipsychotics, benzodiazepines, acetylcholine - enhance GABA
cholinesterase inhibitors

24
Q

essential tremor

A

propranolol, primidone, clonidine, gabapentin

25
Q

ballismus

A

dopamine antagonists

26
Q

dystonia

A

anticholinergics, benzodiazepines, botox

27
Q

tic disorders

A

dopamine antagonists

Pharm exam 3 (4 decks)

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