Neuro 8

Question 1

peripheral metabolism of levodopa is decreased when administered with ________________, thus increasing plasma levels, increasing half-life, thus allowing more to reach the brain

Answer 1

dopa-decarboxylase inhibitors (Carbidopa)

Question 2

levodopa + Carbidopa decreases daily dose of levodopa by _________%

Answer 2

75

Question 3

benefits of levodopa often diminish after __________________

Answer 3

3-4 years

Question 4

adverse effects of levodopa

Answer 4

1. anorexia, N/V 2. cardiac arrhythmias (tachycardia, afib) 3. postural hotn 4. behavioral effects (more common with combo therapy) 5. tardive dyskinesia

Question 5

what are tardive dyskinesia sx

Answer 5

1. grimacing 2. lip smacking 3. lip puckeringn 4. pursing of lips 5. excessive eye blinking 6. tongue smacking

Question 6

80% of patients on levodopa for > 10 years will have what sx ?

Answer 6

tardive dyskinesia

Question 7

do not give levodopa with ___________________ meds, for they reduce the effectiveness of it

Answer 7

phenothiazines (esp compazine)

Question 8

what are your dopamine agonist drugs used in the tx of parkinsons

Answer 8

1. pramipexole 2. ropinirole 3. rotigotine

Question 9

pramipexole is a drug used with parkinsons, that has a high affinity for the __________ receptor

Answer 9

D3

Question 10

which dopamine agonists can be used as monotherapy for parkinsons

Answer 10

1. pramipexole 2. ropinirole

Question 11

ropinirole is used in tx of parkinsons, that has a high affinity for what receptor

Answer 11

D2

Question 12

which dopamine agonists can be used to allow the dose of levodopa to be reduced

Answer 12

pramipexole and ropinirole

Question 13

which dopamine receptor agonists can be used in patients with advanced parkinsons dz

Answer 13

pramipexole and ropinirole

Question 14

which dopamine agonist (in parkinsons tx) is rapidly absorbed and excreted mostly unchanged in the urine

Answer 14

pramipexole

Question 15

which dopamine agonist for parkinsons tx is metabolized by the CYP450 system

Answer 15

ropinirole

Question 16

what dopamine agonist in parkinsons tx is a skin patch that provides more continuous dopaminergic stimulation than oral meds in early dz

Answer 16

rotigotine

Question 17

what is the con with rotigotine in tx of parkinsons

Answer 17

since it is a patch, has localized reactions at application site

Question 18

adverse effects of dopamine agonists

Answer 18

1. anorexia 2. N/V 3. constipation, dyspepsia, reflux, peptic ulcer bleeding 4. postural hotn 5. cardiac arrhythmias 6. periperhal edema 7. tardive dyskinesia 8. confusion, hallucination, and delusions

Question 19

what s/e with dopamine agonists would you d/c the tx

Answer 19

cardiac arrhythmias

Question 20

what meds other than dopamine agonists, levodopa, and carbidopa can be used in parkinsons (sx) tx?

Answer 20

1. MAOI (selegiline & rasagiline [more potent]) 2. catechol-o-methytransferase inhibitors (tolcapone & entacapone) 3. apomorphine hydrochloride 4. acetycholine blockers

Question 21

toxicity of chlorpromazine (Thorazine)

Answer 21

1. extension of effects of alpha and muscarinic blockade 2. block of dopa R –> akathisia, dystonia, parkinsonian sx, TD, and hyperprolactinemia

Question 22

effects of chlorpromazine

Answer 22

1. alpha blocker 2. muscarinic blocker 3. H1 blocker 4. CNS depression 5. decreases seizure threshold

Question 23

MOA of haloperidol

Answer 23

blockage of D2&raquo_space; 5HT2a

Question 24

effects of haloperidol

Answer 24

1. some alpha blockade 2. minimimal M blockade 3. much less sedation than phenothiazines (chlorpromazine)

Question 25

clinical applications of haloperidol

Answer 25

1. schizophrenia (alleviates positive sx) 2. bipolar (manic phase) 3. huntingtons dz 4. tourrettes

Question 26

s/e of haloperidol

Answer 26

1. extrapyramidal dysfunction

Question 27

Clozapine MOA

Answer 27

blockade of 5-HT2a receptors > D2 block

Question 28

effects of Clozapine

Answer 28

1. some alpha blockade 2. some M blockade 3. variable H1 block

Question 29

clinical applications of clozapine

Answer 29

1. schizophrenia (+ and - sx) 2. agitation in alzheimers & parkinsons

Question 30

s/e with clozapine

Answer 30

1. agranulocytosis 2. DM 3. hypercholesterolemia 4. weight gain

Question 31

effects of lithium (as antipsychotic)

Answer 31

1. no significant antagonistic actions on ANS R or specific CNS receptors 2. no sedation

Question 32

clinical application of lithium

Answer 32

1. bipolar affective d/o 2. prophylactic use can prevent mood swings btwn mania and depression 3. depression

Question 33

s/e (toxicity) of lithium

Answer 33

1. tremor 2. edema 3. hypothyroidism 4. renal dysfx 5. dysrhythmias 6. pregnancy category D

Question 34

clearance of lithium is decreased by _______________ and some __________

Answer 34

thiazides; NSAIDs

Question 35

MOA of carbamazepine as an antipsychotic

Answer 35

MOA unclear for bipolar

Question 36

effects of carbamazepine

Answer 36

dose-related diplopia and ataxia

Question 37

clinical application of carbamazepine

Answer 37

1. acute mania 3. prophylaxis of mania in depressive stage of bipolar

Question 38

s/e of carbamazepine

Answer 38

1. hematotoxicity 2. induction of CYP450 metabolism