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!!!!! Pharm Spring 16 Exam 2 !!!!! > Neurodegenerative diseases > Flashcards

Neurodegenerative diseases Flashcards

1
Q

Drug classes in treatment for Alzheimees

A
  1. Cholinesterase Inhibitors
  2. NMDA receptor Antagonist
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2
Q

Cholinesterase inhibitors

A
  1. Donepezil (Aricept)
  2. Rivastigmine (Exelon)
  3. Galantamine (Razadylne)
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3
Q

NMDA receptor antagonist

A

Memantine (Namenda)

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4
Q

Mechanism of action for cholinesterase inhibitors

A
  1. Prevents action of acetylcholinesterase
  2. this increases acetlycholine in the synapse
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5
Q

Nausea

Bronchospasm

A

Cholinesterase inhibitors

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6
Q

Headache, Dizziness, Diarrhea

A

Cholineaterase inhibitors

and

NMDA receptor antagonists

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7
Q
  1. sedation
  2. fatigue
  3. hypertension
  4. rash
  5. weight gain
  6. urinary frequency
  7. anemia
A

NMDA receptor antagonists- Memantine

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8
Q

Memantine (Namenda) mechanism of action

A
  1. Block leaky channels to reduce calcium induced excitotoxicity
  2. Block leaky channels to reduce background noise and make signals relatively stronger
  3. Blocks the pathalogical activation of NMDA receptors
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9
Q

What is drug therapy for parkinsons aimed at

A

increasing dopamine or decreasing Acetylcholine to balance the two

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10
Q

Three mechanisms of action of dopiminergic agents

A
  1. increase amounts of dopamine in th Striatum
  2. incresed delivery or decreased degredation of dopamine
  3. Mimic the effects of dopamine - dopamine agonists
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11
Q

what is the mechanism of action of anticholonergic agents

A

Prevent cholonergic inhibition of dopamine release

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12
Q

First line of therapy for Parkinsons

A

Levadopa

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13
Q

80% of paitines show improvement, and 20% Regain normal function with levadopa therapy, but what else is very improtant about this therapy

A

Its effects wer off over time (2-3 years) likely due to advanced neuro degeneration

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14
Q

Levadopa mechanism of action

A

levadopa is converted to dopamine increasing dopamine in the striatum

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15
Q

Levadopa is converted to ____________providing dopamine in the striatum, this happens in the _________________. Levadopa is only needed in the _________ and large amounts of levadopa in the __________ causes problems. This is why Levadopa is dosed with ___________ a ________________ and ___________a ___________ which causes sthe same amount of Levadopa to reach the brain with a ____________ dose. ___________ is added when ________________ wanes.

A
  1. dopamine
  2. periphery and the brain.
  3. brain
  4. periphery
  5. Carbadopa a peripheral decarboxylase inhibitor
  6. Entacopne a COMT inhibitor
  7. smaller
  8. Entacapone
  9. Levadopa/Carbadopa
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16
Q

Acute side effects of Levadopa

A

Disappear after a few week s and include nausea, anorexia and hypotension

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17
Q

Sede effects of Levadopa

A
  1. involutary movements
  2. on-off effects (hypokinesia and improvements)
  3. Psychosis - schizophrinia like symptoms with excess domamine
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18
Q

Adverse drug interaction with Levadopa

A

MAO Inhibitors- will cause an overload of dopamine and NE

19
Q

Levadopa when given alone is degraded by

A

Mosty decarboxylases and a little by COMT causing ittle to get to the brain

20
Q

When levadopa is given with a DDC inhipibitor (Decarboylase inhibitor) ____________.

A

Dopamine is still broken down by COMT and not as much gets to the brain

21
Q

Optimization of levadopa happens when

A

Levadopa is given with a DDC inhibitor and a COMT inhibitor - this allows for the most amount of the drug to get to the brain

22
Q

Dopamine agonists

A

Pramipexole and Ropinirole

23
Q

Highly selective for D2/D3 receptors

A

Pramipexole and Ropinirole

24
Q

may cuase halucinations and compulsive behaviors

A

Pramipexole and Ropinirole

25
Q

Increases dopamine in the synapes

A

Selegiline

26
Q

MAO-B inhibitor

A

Selegiline

27
Q

Because _________ is an MAO-B inhibitor it is not involed in _______________. It specifically decreases ____________. and does not have the _____________________

A
  1. Selegiline
  2. NE metabolism
  3. Dopamine degredation
  4. unwanted effects of non-selctive MAOIs
28
Q

Enhances dopamine release into the synapse

A

Amantadine

29
Q

Anticholinergic drug used for parkinsons

A

Benzotropine

30
Q

MOA for anticholinergic drug for parkinsons

A

Benzotropine - causes a blockade of muscarinic receptors relieving the inhabition of dopaminergic neurons causing more dopamine release

31
Q

Muscarinic receptors

A

in striatum where they inhibit dopamine release from dopamine neurons

32
Q

Benzotropine side effects

A

Anticholinergic - Anti SLUDG

  1. dry mouth
  2. dry eyes
  3. urinary retention
  4. constipation
33
Q

Clearance can be reduced by increasing urinary pH - ie giving bicarbonate

34
Q

Prolongtion of Succinylcholine

A

Cholinesterase inhibitors - Donepexil, Rivastigmine, Galamtamine

35
Q

Assess for anticholinergic siede effects especially HR

A

Anticholinergic drugs like Benztropine - Decreased HR

36
Q

avaoid drugs that impact cholinergic tone like TCA’s

A

Anticholinergic drugs - Benztropine

37
Q

Evaluate for anticholinergic-like side effects

A

Amantadine

38
Q

Rule out congestive heart failure side effect

A

Amantadine

39
Q
  1. MUST receive q6-12 hours
  2. Administer 20 minutes pre-op and intraop to avoid SUDDEN sloss of effect and neuromuscular/respiratory failure
A

Levadopa decarboxylase inhibitors

40
Q

effects include

  1. cardiac dysrhythmias
  2. adrenergic stimulation
  3. orthostatic hypotension
  4. GI
A

Levadopa decarboxylase inhibitors

41
Q

Side effects include

  1. CV
  2. hypotension
  3. pleuropulmonary fibrosis
A

Synthetic dopamine agonists -Pramipexole and ropinirole

42
Q

AVOID Ephedrine and Mepreidine

A

Selegiline (MAO-B inhibitor)

43
Q

Use extreme caution with vasoactive medications

A

Selegiline (MAO-B inhibitor)

44
Q

Pronounced effect with neuromuscular blockers, sedative agent, diuretics

A

Selegiline (MAO-B inhibitor)

!!!!! Pharm Spring 16 Exam 2 !!!!! (11 decks)

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