Neurodegenerative

Question 1

Parkinson’s Disease is a neurodegenerative disorder of the extrapyramidal system associated with neurotransmission of the balance of ____ and ____ in the striatum

Answer 1

dopamine and acetylcholine (ACh)

Question 2

Pramipexole (Mirapex)

Mechanism of action

Answer 2

Dopamine agonist

Question 3

Levodopa/carbidopa (Dopar) (Sinemet)

Mechanism of action

Answer 3

Dopamine precursor

Question 4

Entacapone (Comtan)

Mechanism of action

Answer 4

Blocks COMT (enzyme that breaks down L-Dopa)

Question 5

What is the most effective drug for Parkinson’s and what is the biggest downside of it?

Answer 5

Levodopa is most effective, but long-term use carries a higher risk for disabling dyskinesias

Question 6

What is levodopa given in combination with?

Answer 6

Carbidopa

Question 7

What is an important food-drug interaction for Levodopa?

Answer 7

Neutral amino acids compete with levodopa for intestinal absorption and for transport across the blood-brain barrier. High protein foods will reduce therapeutic effects

Question 8

What does carbidopa reduce the incidence of?

Answer 8

-Adverse cardiac effects
-Nausea/vomiting

Question 9

Levodopa

Adverse effects

Answer 9

-Orthostatic hypotension
-Dyskinesias
-Psychosis
-Nausea/vomiting
-Sudden “off phenomenon”

Question 10

What helps with the “off phenomenon” in with Levodopa?

Answer 10

Can be reduced with dopamine agonists, COMT inhibitors

Question 11

Levodopa/carbidopa drug interactions

Answer 11

First generation antipsychotics

Question 12

What does carbidopa do?

Answer 12

Increases available levodopa in the CNS and allows for 75% decrease in levodopa dosage, therefore it reduces cardiovascular and GI adverse effects

Question 13

How long does it take for Parkinson’s drugs to take effect?

Answer 13

Up to a month

Question 14

Pramipexole (Mirapex)

Adverse effects

Answer 14

-Nausea
-Dizziness
-Daytime somnolence
-Rare instances of “sleep attacks”

Question 15

What is the pathophysiology of Alzheimer’s?

Answer 15

Degeneration of neurons
-Early in the hippocampus
-Later in the cerebral cortex

Reduced cholinergic transmission
-Levels of ACh 90% below normal

Question 16

What are risk factors for AD?

Answer 16

-Age
-Family history
-Female
-Head injury
-Low educational level
-Production of apoE4
-Estrogen/progestin therapy
-Tobacco use
-Sedentary lifestyle

Question 17

How is AD diagnosed?

Answer 17

-One episodic memory impairment
-One AD biomarker (MRI, PET scan)

Question 18

What is the goal of drug therapy in AD?

Answer 18

Drugs make the neurons that are still functional work a little better for a period of time

Question 19

How well do AD drugs work?

Answer 19

Drugs yield improvement that is statistically significant but clinically marginal

Question 20

______ inhibitors may delay or slow progression of the AD but will not stop it

Answer 20

Cholinesterase

Question 21

Cholinesterase inhibitors

Drug interactions

Answer 21

Drugs that block cholinergic receptors reduce the response to cholinesterase inhibitors - antihistamines, TCAs, conventional antipsychotics

Question 22

Cholinesterase inhibitors

Answer 22

Donepezil (Aricept) and Rivastigmine (Exelon)

Question 23

Patch prescribed for AD

Answer 23

Rivastigmine

Question 24

AD drugs - Cholinesterase inhibitors - Donepezil and Rivastigmine

Adverse effects

Answer 24

Bradycardia (uncommon)
Orthostatic hypotension (uncommon)
GI
Dizziness
Headaches

Question 25

Memantine (Namenda)

Mechanism of action

Answer 25

NMDA receptor antagonist

Question 26

Memantine (Namenda)

Indication

Answer 26

Moderate to severe AD

Question 27

Drugs for neuropsychiatric symptoms in AD

Answer 27

atypical antipsychotics - Risperidone (Risperdal) and olanzapine (Zyprexa)