Neuro Drugs

Question 1

Medications for Cognitive Impairment

Answer 1

Cholinesterase inhibitors

NMDA receptor antagonist

Question 2

Donepezil (Aricept)

Answer 2

Cholinesterase inhibitors

Question 3

Rivastigmine (Exelon)

Answer 3

Cholinesterase inhibitors

Question 4

Galantamine (Razadyne)

Answer 4

Cholinesterase inhibitors

Question 5

Cholinesterase inhibitors mechanism of action

Answer 5

Block the breakdown of acetylcholine (Ach) in the synaptic cleft
Increase availability of acetylcholine to postsynaptic Ach receptors

Question 6

Cholinesterase inhibitors

indications

Answer 6

Alzheimer’s disease
Parkinson’s disease dementia
Lewy body dementia (off label)

Question 7

Cholinesterase inhibitors side effects

Answer 7

Gastrointestinal: N/V, diarrhea, cramps
Anorexia, weight loss 
Urinary incontinence
Salivation, lacrimation 
Bradycardia / syncope

Question 8

Memantine (Namenda)

Answer 8

NMDA Receptor Antagonist

Question 9

Memantine Mechanism of action

Answer 9

Noncompetitive NMDA receptor antagonist

May reduce abnormal glutamatergic activity

Question 10

Memantine indication

Answer 10

Alzheimer’s disease – moderate to severe

Question 11

Memantine side effects

Answer 11

Dizziness
Headache
Confusion
Constipation

Question 12

motor symptoms of PD due to

Answer 12

dopamine deficiency

loss of nigrostriatal dopaminergic neurons in substantial nigra

Question 13

dopamine deficiency causes

Answer 13

less activation of direct pathway
less inhibition of indirect pathway
inhibits movements

Question 14

levodopa given concurrently with

Answer 14

carbidopa

causes nausea and vomiting due to peripheral metabolism in area postrema

Question 15

sinemet

Answer 15

25 mg carbidopa/100 mg levodopa

Question 16

levodopa side effects

Answer 16

Nausea / vomiting
Sleepiness
Hallucinations
Orthostatic hypotension

Question 17

levodopa unique side effects

Answer 17

wearing off

dyskinesias

Question 18

levodopa induced dyskinesias

Answer 18

Abnormal involuntary movements caused by levodopa

Often are choreiform (dance-like)

Question 19

Pramipexole (Mirapex)

Answer 19

Dopamine agonists

Question 20

Ropinirole (Requip)

Answer 20

Dopamine agonists

Question 21

Rotigotine (Neupro)

Answer 21

Dopamine agonists

Question 22

Dopamine agonists mechanism

Answer 22

Directly stimulate postsynaptic (and presynaptic) dopamine receptors

Question 23

advantages of dopamine agonists mechanism

Answer 23

less wearing off

less dyskinesias

Question 24

disadvantages of dopamine agonists mechanism

Answer 24

Less effective
More orthostatic hypotension, psychosis, and daytime sleepiness
“Sleep attacks” (falling asleep w/o warning)
Pedal edema
Impulse control disorders

Question 25

dopamine agonist withdrawal symptoms

Answer 25

mimics cocaine withdrawal ``` Fatigue/malaise Anxiety/panic Depression/dysphoria Irritability /agitation Sleep disturbance Suicidality Drug cravings Nausea / vomiting Orthostatic hypotension Diaphoresis Generalized pain Restlessness ```

Question 26

non-dopaminergic medications fo PD

Answer 26

Anticholinergics Amantadine Monoamine oxidase (MAO-B) inhibitors Catechol-O-methyltransferase inhibitors*

Question 27

anticholinergic side effects

Answer 27

``` Memory impairment Confusion / psychosis Constipation Urinary retention Dry mouth Dry eyes Blurry vision ```

Question 28

amantadine (symmetrel) side effects

Answer 28

Anticholinergic side-effects Edema Orthostatic hypotension Livedo reticularis (rash)

Question 29

MAO-B inhibitors side effects

Answer 29

Nausea Insomnia Hallucinations Orthostatic hypotension

Question 30

COMT inhibitors use

Answer 30

reduce wearing off. not effective as mono therapy work synergistically with carbidopa

Question 31

indications of DBS

Answer 31

parkinson's disease essential tremor dystonia

Question 32

huntington's disease pathology

Answer 32

Death of specific striatal medium spiny neurons in the indirect pathway Loss of striatal projections to the globus pallidus externa Disinhibition of the thalamus

Question 33

dopamine depleters and blockers

Answer 33

Reduce dopaminergic function in the basal ganglia, and tend to reduce movement Useful in the treatment of chorea and other hyperkinetic movement disorders

Question 34

side effects of haloperidol

Answer 34

``` Drug-induced parkinsonism Acute dystonic reactions Akathisia (restlessness) Cardiac arrhythmias (QT prolongation) Neuroleptic malignant syndrome ```

Question 35

treatment of chorea in HD

Answer 35

Tetrabenazine (Xenazine) Blocks the vesicular monoamine transporter-2 (VMAT2), which transports monoamines into synaptic vesicles Depletes monoamines, including dopamine, serotonin, and norepinephrine