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Pharm 8 > neuro drugs > Flashcards

neuro drugs Flashcards

1
Q

sx of PD

A

primary motor: resting tremor, rigidity, bradykinesia, gait/posture disturbances
other motor: micrographia, masked facies, dec blinking, soft voice, dysphagia, freezing
nonmotor: anosmia, sensory disturbances, mood d/o, sleep d/o, cognitive impairment, autonomic d/o (orthostasis, GI/GU/GYN disturbances)

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2
Q

cause of PD

A

destruction of DA-producing cells in substantia nigra pars compacta

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3
Q

levodopa

A

prodrug converted to DA by AAAD/LAAD/dopa decarboxylase

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4
Q

levodopa ADR

A

arrhythmia (B-receptor activity), hypotension, vomiting, dyskinesia, on-off effects, psychosis

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5
Q

levodopa drug interactions

A

B6 (increases levodopa peripheral conversion to DA)

high protein meals - dec absorption and peak plasma concentration

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6
Q

carbidopa MOA and use

A

given with levodopa

inhibits peripheral AAAD to maximize levodopa reaching CNS

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7
Q

tolcapone MOA

A

COMT inhibitor, preventing DA metabolism in CNS and L-dopa metabolism in periphery

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8
Q

entacapone MOA

A

COMT inhibitor, preventing L-dopa metabolism in periphery

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9
Q

tolcapone and entacapone ADR

A

tolcapone: hepatotoxic
entacapone: not as toxic so preferred

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10
Q

selegiline and rasagiline MOA and use

A

MAO-B inhibitors (CNS)
early tx for PD or adjunct with levodopa
also used in MPTP-induced PD

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11
Q

MAO-B inhibitor ADR

A

increases ADRs of L-dopa, dyskinesia, psychosis, insomnia

*no interaction with tyramine like MAO-A inhibitors

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12
Q

bromocriptine and pergolide MOA, use, ADR

A

ergot alkaloid D2 agonists
use: PD, hyperprolactinemia, acromegaly
ADR: alpha-R activity causes HTN, vasoconstriction, gangrene

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13
Q

pramipexole and ropinirole

A

non-ergot D2 agonists for PD

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14
Q

amantadine MOA and ADR

A

causes increased DA release

ADR: livedo reticularis (small clots occlude capillaries)

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15
Q

benztropine

A

muscarinic blocker to decrease tremor and rigidity in PD

ADR: atropine-like sx (dry mouth, urinary retention, constipation)

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16
Q

trihexyphenidyl

A

muscarinic blocker to decrease tremor and rigidity in PD

ADR: atropine-like sx (dry mouth, urinary retention, constipation)

17
Q

diphenhydramine

A

muscarinic blocker to decrease tremor and rigidity in PD

ADR: atropine-like sx (dry mouth, urinary retention, constipation)

18
Q

drugs useful in drug-induced PD

A

MPTP-induced: selegiline, rasagiline

med-induced: benztropine, trihexyphenidyl, diphenhydramine

19
Q

cause and sx of Alzheimer’s

A
  • neuronal dysfunction and loss in medial and temporal lobe, nucleus basalis of Meynert (ACh) and cortical and hippocampal cells; some effect on 5HT, glutamate, and neuropeptide
  • sx: early- anterograde episodic memory loss; late- increased dependence progressing to akinetic mute state
  • COD: immobility -> pneumonia, PE
20
Q

donepezil

A

non-competitive inhibition of AChE

metabolism by CYP2D6, 3A4

21
Q

rivastigmine

A

non-competitive inhibition of AChE and BuChE

metabolism by esterases (not CYP!)

22
Q

galantamine

A

competitive* inhibition of AChE

metabolism by CYP2D6, 3A4

23
Q

tacrine

A

non-competitive inhibition of AChE and BuChE

metabolism by CYP1A2

24
Q

memantine

A

adjunct or alternative tx with AChE inhibitors, decreases clinical deterioration of AD patients
non-competitive antagonist of NMDA-R

25
Q

ADRs of AChE inhibitors

A

GI distress, muscle cramping, abnormal dreams

*caution with bradycardia and syncope

26
Q

Huntington’s disease

A

autosomal dominantly inherited motor incoordination and cognitive decline/personality changes
early sx: fine motor incoordination, impaired rapid eye movements

27
Q

tx for HD with depression or irritability

A

fluoxetine

28
Q

tx for HD with paranoia, delusions, or psychosis

A

low dose haloperidol

29
Q

tx for HD with rigidity +/- paranoia

A

clozapine, quetiapine, carbamazepine

30
Q

tx for HD with large amplitude chorea

A

tetrabenazine (VMAT2 inhibitor)

ADR: hypotension, suicidality

31
Q

tx for HD with seizures

A

clonazepam or valproic acid

32
Q

cause and sx of ALS

A

loss of ventral horn motor neurons (LMN) and afferent cortical neurons (UMN)

sx: rapidly progressive weakness, muscle atrophy, fasciculations, spasticity, dysarthria, dysphagia, respiratory compromise
* spares sensory, autonomic, and oculomotor function

33
Q

riluzole MOA

A

prolongs survival of ALS by months

inhibits glutamate release, blocks NMDA and Kainate glutamate-R, and blocks v-g Na channels

34
Q

riluzole ADR

A

hepatic injury

35
Q

tx of clasped-knife spasticity in ALS

A

baclofen (GABA-B agonist), tizanidine (a2 agonist), clonazepam

Pharm 8 (2 decks)

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