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M2.6 Flashcards

1
Q
  • a MOVEMENT disorder
  • unknown cause
  • a degenerative disease of the brain that often impairs MOTOR SKILLS, speech, and other functions
A

PARKINSON’S DISEASE

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2
Q

Parkinson’s disease is also known as

A

Primary Parkinsonism
Idiopathic PD

idopathic - unknown

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3
Q

PATHOPHYSIOLOGY OF PARKINSONISM

occurs because of a LOSS of ____ in the nigrostriatal pahtway

A

DOPAMINE

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4
Q

PATHOPHYSIOLOGY OF PARKINSONISM

disrupts the balance between ____ and ____ systems within the striatum and basal ganglia

low DA, high Ach

A

dopaminergic and cholinergic systems

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5
Q

DRUG-INDUCED PARKINSONISM

deplete BIOGENIC MONOAMINES from their storage vesicles

inhibit DA storage

A

Reserpine and Tetrabenazine

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6
Q

DRUG-INDUCED PARKINSONISM

block DOPAMINE receptor

A

Haloperidol
Metoclopramide
Phenothiazines

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7
Q

DRUG-INDUCED PARKINSONISM

for TOURETTE’S

A

HALOPERIDOL

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8
Q

DRUG-INDUCED PARKINSONISM

a PROKINETIC agent

A

Metoclopramide

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9
Q

DRUG-INDUCED PARKINSONISM

inhibit storage of DA in vesicles

A

Reserpine

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10
Q

ANTIPARKINSON’S AGENTS

drugs that directly INCREASE dopamine levels

A

Levodopa
Selegiline
Amantadine

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11
Q

ANTIPARKINSON’S AGENTS

antiviral - for influenza

A

Amantadine

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12
Q

ANTIPARKINSON’S AGENTS

Dopamine receptor antagonist

A

Bromocriptine
Pergolide
Pramipexole
Ropinirole

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13
Q

ANTIPARKINSON’S AGENTS

ergot derivatives

from fungi

A

Bromocriptine
Pergolide

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14
Q

ANTIPARKINSON’S AGENTS

Acetylcholine receptor antagonist

A

Benztropine
Trihexyphenidyl
Biperiden

also used for EPS

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15
Q

ANTIPARKINSON’S AGENTS

Dopa decarboxylase inhibitor

A

Carbidopa

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16
Q

ANTIPARKINSON’S AGENTS

COMT ihibitor

A

Tolcapone
Entacapone

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17
Q

ANTIPARKINSON’S AGENTS

____ cannot pass through the Blood Brain Barrier

A

DOPAMINE

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18
Q

ANTIPARKINSON’S AGENTS

  • Pramipexole
  • Ropinirole
  • Bromocriptine
  • Pergolide
    are agonist of ____
A

Parkinsonism / Dopamine

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19
Q

ANTIPARKINSON’S AGENTS

____ can enter the Blood Brain Barrier

A

L-DOPA

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20
Q

ANTIPARKINSON’S AGENTS

L-DOPA when metabolized will turn into

A

DOPAMINE

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21
Q

ANTIPARKINSON’S AGENTS

the enzyme that metabolizes L-DOPA before it enters the BBB

A

DOPA decarboxylase
COMT

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22
Q

ANTIPARKINSON’S AGENTS

inhibit DOPA decarboxylase

A

Carbidopa

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23
Q

ANTIPARKINSON’S AGENTS

converts L-DOPA to dopamine

A

DOPA decarboxylase

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24
Q

ANTIPARKINSON’S AGENTS

MAO B inhibitors

A

Selegiline
Rasagiline

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25
Q

ANTIPARKINSON’S AGENTS

inhibits COMT – converts dopamine to 3-OMD

A

Tolcapone

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26
Q

MANAGEMENT OF PARKINSON’S DISEASE

FIRST line

A

Amantadine
Benztropine
Selegiline

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27
Q

ANTIPARKINSON’S AGENTS

SECOND line

A

L-dopa
Carbidopa
Entacapone
Tolcapone

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28
Q

ANTIPARKINSON’S AGENTS

THIRD line

A

Bromocriptine
Pergolide
Pramipexole
Roopinorole

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29
Q

AGENTS THAT INCREASE DOPAMINE LEVELS

  • is the metabolic precursor of DOPAMINE
  • transported into the brain and subsequently converted to dopamine in the basal ganglia
  • can pass through BBB
  • it restores the dopamine levels in the extrapyramidal centers
  • it is decarboxylated in the periphery
  • given in combination with carbidopa
  • decreases the rigidity, tremors and other symptoms
A

LEVODOPA

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30
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

transported into the brain and subsequently converted to dopamine in the ____

A

basal ganglia

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31
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

it restores the dopamine levels in the ____

A

extrapyramidal centers

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32
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

it is decarboxylated in the ____

A

periphery

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33
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

given in combination with

A

carbidopa

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34
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

L-dopa + Carbidopa

A

Sinemet 125

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35
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

L-dopa + Carbidopa + ENTACAPONE

36
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

how many % goes to the BRAIN

37
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

how many % gets metabolized in the GI TRACT

38
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

how many % gets metabolized in the PERIPHERAL TISSUES (toxicity)

39
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

Levodopa + Carbidopa:
what type of action

A

potentiation

carbidopa - does not have an effect itself; 1 + 0 = 1

40
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

PERIPHERAL EFFECTS:
involving eyes; DILATION

41
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

PERIPHERAL EFFECTS:
LOW WBC

A

blood dyscracias

42
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA

PERIPHERAL EFFECTS:
test for hemolytic anemia

A

+ COOMBS TEST

43
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA | AE/SE

off-periods of marked akinesia alternate over the course of a few hours with on-periods of imporved mobility but often marked dyskensia

A

ON-OFF PHENOMENON

OFF - less akinesia - no mobility
ON - dyskenisia - more movemen

44
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA | CONTRAINDICATIONS

HYPERTENSIVE crisis due to excess dopamine in the periphery

A

NONSELECTIVE MAOIs

45
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA | CONTRAINDICATIONS

diminishes the effectivness of levodopa because it increases PERIPHERAL BREAKDOWN of the drug

A

PYRIDOXINE

46
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA | CONTRAINDICATIONS

Pyridoxine is also known as

47
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | LEVODOPA | CONTRAINDICATIONS

oppose levadopa’s effect
(antagonist)

A

antipsychotics

48
Q

AGENTS THAT INCREASE DOPAMINE LEVELS

  • selectively inhibits MAO B
  • decrease the metabolism of dopamine by preventing inter-neuronal degradation
  • inhibition of MAO-B slows the breakdown of dopamine in the striatum
A

SELEGILINE
(Deprenyl)

49
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | SELEGILINE

decrease the metabolism of dopamine by preventing ____

A

inter-neuronal degradation

50
Q

AGENTS THAT INCREASE DOPAMINE LEVELS | SELEGILINE

inhibition of MAO B SLOWS the breakdown of dopamine in the ____

51
Q

AGENTS THAT INCREASE DOPAMINE LEVELS

  • an ANTIVIRAL agent (forinfluenza) that enhances the release of dopamine from surviving nigral neurons
  • inhibits the reuptake of dopamine at synapses
A

AMANTADINE

52
Q

DOPAMINE RECEPTOR AGONIST

  • an ergot derivatice that predominantly stimulates the STRIATAL D2 NON-ADENYL CYCLASE-linked dopamine receptors
  • ADVERSE EFFECTS:
    * hallucination and delirium
    * nausea and vomiting
    * cardiac arrythmia
    * postural hypotension
    * erythromelalgia
    * worsen ulcer
A

BROMOCRIPTINE
(Parlodel)

53
Q

DOPAMINE RECEPTOR AGONIST

  • stimulates POSTSYNAPTIC DOPAMINE receptors at both D1 and D2 receptor site in the nigrostriatum
  • ADVERSE EFFECTS:
    * anxiety
    * confusion
    * hallucinations
    * dyskenisia
54
Q

DOPAMINE RECEPTOR AGONIST

  • a NON-ergot D2-receptor SELECTIVE agonist
  • ADVERSE EFFECTS:
    • drowsiness
    • hallucination
    • insomnia
    • nausea
    • orthostatic hypotension
A

Pramipexole

55
Q

these are used to:
* help reduce cholinergic output of the striatum
* restore a normal balance between dopamine and acetylcholine within nigrostriatal system
ADVERSE EFFECTS:
* mydriasis (blurred vision; dilation)
* constipation
* dry mouth and skin
* urinary retention
* tachycardia

A

anticholinergics

56
Q

ACETYLCHOLINE RECEPTOR AGONIST

A

Benztropine
Biperiden
Trihexyphenidyl

BBT

57
Q

ACETYLCHOLINE RECEPTOR AGONIST

  • blocks MUSCARINIC CHOLINERGIC receptor in the CNS
  • reduces the EXCESSIVE cholinergic activity present in parkinsonism
  • ADVERSE EFFECTS:
    * agitation, nervousness, and confusion
    * blurred vision
    * memory loss
    * hallucination
    * difficulty breathing
A

BENZTROPINE

58
Q

ACETYLCHOLINE RECEPTOR AGONIST

  • partially block CENTRAL CHOLINERGIC receptors
  • helps in restoring the BALANCE of cholinergic and dopaminergic activity in the basal ganglia
A

TRIHEXYPHENIDYL

59
Q

ACETYLCHOLINE RECEPTOR AGONIST

are anticholinergics EQUALLY EFFECTIVE as levodopa?

A

NO, it is much LESS efficacious than levodopa

Levodopa > anticholinergics
they are only used to reduce symptoms

60
Q

ACETYLCHOLINE RECEPTOR AGONIST

clinical effects

A

reduce tremor, rigidity, akinesia, and drooling

61
Q

DOPA DECARBOZYLASE INHIBITOR

  • it does NOT cross blood brain barrier; cannot inhibit L-dopa conversion in the brain
  • reduces the metabolism of levadopa in the periphery
  • increases the availability of dopamine to the CNS
  • decrese the severity of the side effects of peripherally formed dopamine
62
Q

COMT INHIBITORS

  • a SELECTIVE and REVERSIBLE inhibitor of COMT
A

ENTACAPONE

63
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

  • CHRONIC MULTIPLE TICS
  • pathophysiologic basis is unknown
A

TOURETTE’S SYNDROME

64
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

most effective pharmacologic approach for TOURETTE’S syndrome

A

HALOPERIDOL

65
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

Tourette’s syndrome is also known as

A

Gilles de la Tourette’s Syndrome

66
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

  • characterized by PROGRESSIVE CHOREA and dementia

involuntary movement of HANDS & FEET

A

HUNTINGTON’S DISEASE

67
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

  • seems to be related to imnbalance of dopamine, Ach, and Dopa
  • results from functional overactivity in dopaminergic nigrostriatal pathways
68
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

drugs that alleviate CHOREA
(Huntington’s Disease):
* deplete CENTRAL MONOAMINES

A

Reserpine
Tetrabenazine

69
Q

DRUGS FOR OTHER MOVEMENT ABNORMALITIES

drugs that alleviate CHOREA
(Huntington’s Disease):
* block DOPAMINE receptors

A

Phenothiazine
Butyrophenone

70
Q

TIC CLASSIFICATIONS

  • SUDDEN
  • BRIEF
  • random
  • MEANINGLESS
  • isolated to muscle group: facial and neck, abdomen, extrimities, others
A

SIMPLE | MOTOR

71
Q

TIC CLASSIFICATIONS

  • SUDDEN
  • MEANINGLESS
  • random
  • often “allergy”-like (grunting, sniffing, throat clearing, coughing)
  • sometimes nonvocal (tounge clicking, sucking, hissing)
  • animal noises (barking, chirping, whistling)
A

SIMPLE | PHONIC

72
Q

TIC CLASSIFICATIONS

  • SLOWER and LONGER
  • PURPOSEFUL
  • dystonic, imitative, self-abusive
A

COMPLEX | MOTOR

73
Q

TIC CLASSIFICATIONS

  • often SUDDEN
  • MEANINGFUL linguistic elements
  • may be IMITATIVE (echoic)
  • speech atypicalities: palilalia
A

COMPLEX | PHONIC

74
Q

TIC CLASSIFICATIONS

repeating own spech
OWN SPEECH?!

75
Q

DRUG-INDUCED DYSKENISIAS

  • a disorder characterized by a variety of ABNORMAL MOVEMENTS
  • a common complication of LONG-TERM neuroleptic or metoclopramide drug treatement
A

TARDIVE DYSKINESIA

76
Q

DRUG-INDUCED DYSKENISIAS

  • INVOLUNATRY UNCONTROLLABLE movement in LOWER part of the body
A

Tardive Dystonia / Akathisia

77
Q

DRUG-INDUCED DYSKENISIAS

  • manifested by rhytmic VERTICAL movementsabout the MOUTH
A

RABBIT SYNDROME

78
Q
  • characterized by an unpleasant CREEPING DISCOMFORT that seem to arise deep within the LEGS and occasionally in the arms
A

RESTLESS LEG SYNDROME

79
Q

preferred treatment for RESTLESS LEG SYNDROME

A

DOPAMINE therapy

80
Q
  • inherited disorder of COPPER METABOLISM (copper deficiency)
  • biochemically, by reduced serum copper and ceruplasmin concentrations
  • pathologically, by marked increase copper in the brain and viscera
  • clinically, by signs of hepatic and neurologic dysfunction
A

WILSON’S DISEASE

81
Q

DRUGS FOR ALZHEIMER’S DISEASE AND OTHER DEGENERATIVE DISORDERS

a combination drug in extended release capsule that was approved in 2014 for moderate to severe disease

A

Donepizil + Memantine

82
Q

DRUGS FOR ALZHEIMER’S DISEASE AND OTHER DEGENERATIVE DISORDERS

  • cholinesterase inhibitor for MODERATE to SEVERE AD
  • prevents the breakdown of acetylcholine in the brain
  • AE: N&V, diarrhea
83
Q

DRUGS FOR ALZHEIMER’S DISEASE AND OTHER DEGENERATIVE DISORDERS

  • cholinesterae inhibitor for MILD to MODERATE AD
  • prevents the breakdown of acetylcholine and stimulates nictonic receptors
  • AE: N&V, diarrhea, loss of appetite, weight loss
A

GALANTAMINE

84
Q

DRUGS FOR ALZHEIMER’S DISEASE AND OTHER DEGENERATIVE DISORDERS

  • cholinesterase inhibitor for MILD to MODERATE AD
  • prevents the breakdown of acetylcholine and butyrylcholine in the brain
  • AE: N&V, diarrhea, loss of appetie, weight loss, muscle weakness
A

RIVASTIGMINE

85
Q

DRUGS FOR ALZHEIMER’S DISEASE AND OTHER DEGENERATIVE DISORDERS

  • N-methyl-D-aspartate agonist for MODERATE to SEVERE AD
  • blocks the toxic effects associated with excess glutamate and regulates glutamate activation
  • AE: dizziness, headache, constipation, confusion
86
Q

DRUGS FOR ALZHEIMER’S DISEASE

A

Tacrine
Donezipil
Galantamine
Rivastigmine
Memantine

MEMANTINE - NOT a cholinesterase inhibitor

PCOL (9 decks)

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