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Pharm 3 Shea > Movement Disorder 3- MJ > Flashcards

Movement Disorder 3- MJ Flashcards

1
Q

Which disease?

•Impaired biliary copper excretion leads to accumulation of copper in several organs (liver, brain, cornea)

A

Wilson disease

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2
Q

The following are sxs of Wilson Disease?

•Symptoms include liver and CNS

  • Liver – N/V/fatigue/jaundice/muscle cramps
  • CNS - tremors or uncontrolled movements, muscle stiffness, problems with speech, swallowing, or physical coordination
A

Wilson Disease

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3
Q

What are the 2 treatment options for Wilson Disease?

A
  1. Chelating agents (D-penicillamine, Trientine)
  2. Oral zinc
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4
Q

The following describes which tx option for Wilson Disease?

•remove extra copper from the body by releasing it from organs into the bloodstream

A

Chelating agents (D-penicillamine, Trientine)

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5
Q

MOA of which med used to tx Wilson Disease?

•Contains a free sulfhydryl group that functions as a copper chelating moiety**

A

D-penicillamine

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6
Q

ADEs of which med used to tx Wilson Disease?

•Early onset:

  • fever
  • cutaneous eruptions
  • lymphadenopathy
  • neutropenia
  • thrombocytopenia,
  • proteinuria

•Late onset-months to years: proteinuria

A

D-penicillamine

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7
Q

Txs for Wilson Disease:

What should you give patients who are taking D-penicillamine in order to prevent pyridoxal phosphate deficiency**

A

Pyridoxine

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8
Q

How does trientine (a copper chelator) differ from D-penicillamine?

A
  • by a lack of sulfhydryl group
  • Chelates copper by forming a stable complex with its four constituent nitrogens
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9
Q

The following describes which drug used to treat Wilson Disease?

  • Chelates copper by forming a stable complex with its four constituent nitrogens and is as effective as D-penicillamine
  • MOA: Functions principally by removing copper from less strongly bound sites on proteins and membranes, and it increases renal copper excretion
A

Trientine

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10
Q

What is the pharmacokinetics of Trientine, a med used to tx Wilson Disease?

A

Poorly absorbed; only 1 percent of the ingested amount is excreted in the urine.

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11
Q

Treatments for Wilson Disease

T/F: Trientene has more adverse effects than D-penicillamine

A

FALSE

Trientine has fewer ADEs than D-penicillamine

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12
Q

Wilson Disease treatments: Trientine

  • Hypersensitivity reactions and pancytopenia are _____
  • Neurologic worsening is seen but appears to be ______ common than with D-penicillamine
A
  • rare
  • less
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13
Q

Treatments of Wilson disease:

Trientine is not specific to copper, it also chelates _____. Because of this, what should you not coadminister with this medication?

A

Iron

So don’t give iron! The trientine iron complex is nephrotoxic

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14
Q

Wilson Disease Treatment: Trientine

  • Copper deficiency induced by trientine can lead to _____ overload in the liver.
  • This excess______ may potentiate liver injury
A

iron

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15
Q

Monitoring:

Adequacy of trientine treatment (for Wilsons Disease) should be determined by measuring _____ _____ ______, which should be in the range of 200 to 500 mcg (3 to 8 micromoles) daily

A

24-hour copper excretion

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16
Q

MOA of which med used to tx Wilson Disease?

  • interferes with the absorption of copper
  • Induces metallothionein (an endogenous chelator of metals) in enterocytes which has a greater affinity for copper than for zinc, causing it to bind luminal copper and thereby preventing its entry into the circulation
  • Excreted in stool
A

Oral Zinc

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17
Q

Treatments for Wilson Disease:

  • The 2 forms of oral zinc salts are zinc acetate, zinc sulfate and zinc gluconate.
  • Which one has better absorption? Which one is more tolerable?
A
  • Best absorption= zinc acetate
  • More tolerable (than zinc sulfate) w/ respect to GI side effects= Zinc gluconate
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18
Q

What are the 2 adverse effects of oral zinc?

A
  1. GI upset

2. Elevation in serum amylase (also seen in saliva) and lipase w/o clinical evidence of pancreatitis

19
Q
A
20
Q

What disease?

  • disorder of the motor neurons of the ventral horn of the spinal cord (lower motor neurons) and the cortical neurons that provide their afferent input (upper motor neurons)
  • gradual deterioration and death of motor neurons
  • rapidly progressive weakness, muscle atrophy, fassciculations, spasticity, dysarthria, dysphagia, resp. compromize
  • Sensory, autonomic and oculomotor function generally spared
A

ALS

21
Q

Suspected etiology of which disease?

•Evidence that glutamate reuptake may be abnormal in the disease, leading to accumulation of glutamate and excitotoxic injury

A

ALS

22
Q

Which med used to treat ALS?

  • Presynaptic and postsynaptic effects
  • Inhibits glutamate release**

•Inactivation of voltage-dependent Na+ channels**

•Ability to interfere with intracellular events that follow transmitter binding at excitatory amino acid receptors**

A

Riluzole

23
Q

Which ALS med’s in vitro action is blocked by pertussis toxin?

A

Riluzole

24
Q

Which med? (used to tx ALS)

  • absorbed orally and is highly protein bound
  • High fat meals decrease absorption
  • extensive metabolism in the liver by both CYP–mediated hydroxylation and glucuronidation
A

Riluzole

25
Q

What are the 5 ADEs of riluzole? (drug used to tx ALS)

“HANDE”

A
  1. _HTN*_
  2. _Abd pain*_
  3. _Neuromuscular and arthralgia, tremor*_
  4. _Decreased lung function*_
  5. _Elevations of serum transaminases (periodic monitoring recommended)*_

“HANDE”

26
Q

Which ALS drug has the following:

  • Slows decline of physical function- MOA unknown
  • Free radical scavenger
  • Prevents oxidative damage to cell membranes
A

Edaravone

27
Q

Which drug (Riluzole or Edaravone) is indicated for patients with ALS who:

  • Have a disease duration of <2yrs
  • Living independently
  • Have an FVC ≥80 percent
A

Edaravone

28
Q

What are the 4 ADEs of Edaravone (used to tx ALS) and why should you be cautious of giving this to a pt w/ asthma?

A
  1. Injection site contusion
  2. Gait disturbance
  3. HA
  4. Allergic rxns (b/c of sodium bisulfite)

sulfites can cause serious asthmatic reactions in as <5% of asthmatic pts

29
Q

What are the 3 meds you can give for symptomatic therapy of ALS, specifically spasticity?

A
  1. _Baclofen *_
  2. _Tizanidine *_
  3. _Clonazepam *_
30
Q

What does Baclofen do to tx ALS?

A

•Baclofen acts to restore the lost inhibition by stimulating postsynaptic GABA receptors

(note- Baclofen works postsynaptically and TIzanidine acts presynaptically)

31
Q

How does Tizanidine help tx ALS?

A

•Tizanidine acts presynaptically to stimulate GABA release from spinal cord inhibitory interneuron.

(note- Baclofen works postsynaptically and TIzanidine acts presynaptically)

32
Q

MOA of TIzanidine or Baclofen? (used to tx ALS)

  • GABAB receptor agonist= ______
  • agonist of α2 adrenergic receptors in the CNS=_______
A

•GABAB receptor agonist= Baclofen (B for Baclofen)

•Agonist of α2 adrenergic receptors in the CNS= Tizanidine

  • Increases presynaptic inhibition of motor neurons
33
Q

What is the 1 ADE of Baclofen? (used to tx ALS)

A

Sedation

34
Q

T/F: an Alternative for delivery of Baclofen for tx of ALS is:

directly into the space around the spinal cord using a surgically implanted pump and an intrathecal catheter

A

True

35
Q

What are the 3 ADEs of Tizanidine? (used to tx ALS)

“DAD”

A

•Drowsiness

•Asthenia (abnormal physical weakness or lack of energy)

•Dizziness

36
Q

Which drug class can be used to tx ALS and are effective antispasticity agents but can contribute to respiratory depression in pts w/ advanced ALS?

A

Benzodiazepines (Diazepam or Clonazepam)

37
Q

What is the MOA of Benzodiazepines (Diazepam/clonazepam) in the tx of ALS

A

•Enhances the inhibitory effect of GABAA receptors

38
Q

What are the 4 ADEs (“CADS”) of Benzodiazepines in the tx of ALS?

What other condition exhibits these effects?

A
  1. Amnesia
  2. Confusion
  3. Drowsiness
  4. Slurred speech

Other condition: Being Drunk

39
Q

Which disease?

  • Neuromuscular disease characterized by weakness and marked fatigability of skeletal muscle
  • Exacerbations and partial remissions occur frequently
  • Defect in the synaptic transmission- autoimmune response primarily to the ACh receptor at the post-junctional end plate.
A

Myasthenia Gravis

40
Q

What are the 2 drugs used to tx Myasthenia Gravis and what is their mechanism?

A

Anticholinesterase drugs: (“NPs treat Myasthenia Gravis”)

  • Pyridostigmine
  • Neostigmine
41
Q

What is the mechanism of Neostigmine and Pyridostigmine, anticholinesterase drugs used to tx myasthenia Gravis

A

Inhibit the action of the metabolizing enzyme acetylcholinesterase

42
Q

Tx of Myasthenia Gravis:

What is the drug of choice to reverse too much acetylcholine?

A

Atropine (anticholinergic)

43
Q

What are the 6 ADEs of anticholinesterase medications? What 2 are most important because they could be life threatening?

A

ADEs: “SLUDGE”

  1. Salivation
  2. Lacrimation
  3. Urination
  4. Diarrhea
  5. GI upset
  6. Emesis

Most important:

  1. Cardio
  2. Respiratory
  3. Pupils will be constricted–> how to judge it

Pharm 3 Shea (17 decks)

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