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Pharm-Neuro > Neurodegenerative Diseases > Flashcards

Neurodegenerative Diseases Flashcards

1
Q

Parkinsonism results from

A

breakdown of dopamineergic neurons

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2
Q

Cardinal Signs of Parkinsonism

A

Rigidity, Bradykinesia, tremor, postural.gate

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3
Q

What are three groups of drugs used in Parkinsonism?

A

1) Drugs that increase dopamine levels
2) Dopamine Receptor Agonists
3) Cholinergic Receptor Antagonists

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4
Q

Rx list that increases dopamine levels

A 
Levodopa 
Carbidopa
Amantadine
Selegeline (Eldepryl)
Rasagliline (Azilect)
Tolcapone (Tasmar)
Entacapone (Comtan)
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5
Q

Rx list the are dopamine receptor agonists

A 
Bromocriptine (Parlodel)
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
Apomorphine (Apokyn)
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6
Q

Cholinergic Receptor Antagonist

A

Benztropine (Cogentin)

Trihyexylphenidyl (Artane)

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7
Q

MOA Levodopa

A

precursor of dopamine and enters the brain then converts.

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8
Q

Levodopa pharmokinetics

A
  • metabolized quickly
  • only 3% reaches brain if given oraly, need large doses
  • conversion of levodopa declines as parkinson progresses
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9
Q

Carbidopa

A
  • dopa decarboxylase inhibitor

- inhibits levodopa breakdown

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10
Q

Sinemet

A

carbidopa + levodopa

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11
Q

MAOIs + Levodopa

A

cause hyper tension

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12
Q

Drugs that increase gastric emptying

A

contraindicated with levodopa

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13
Q

Psychosis + levodopa

A

increased psychosis

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14
Q

Angle closure glaucoma + levodopa

A

made more severe

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15
Q

Adverse effects of levodopa

A

tachycardia, arrhythmias, orthostatic hypotension, hypertension
Dyskinesia- involuntary movements

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16
Q

When is the best time to use levodopa?

A
  • works best in first few years of treatment

- effects wear off in 4 years

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17
Q

What do you add when the effectiveness of levodopa wears off?

A
  • dopamine agonist

- catechol-O-methyl transferase inhibitor

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18
Q

Amantadine MOA

A
  • antiviral

- Increases release of dopamin from neurons and inhibits dopamine reuptake

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19
Q

What three things does Amantadine work well on in parkinson pts?

A

-rigidity, tremors, bradykinesia

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20
Q

What ADR is associated with Amantadine?

A

hallucinations

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21
Q

MAO A enzyme

A

breaks down norepinephrine and serotonin

22
Q

MAO B enzyme

A

breaks down dopamine

23
Q

MAO B inhibitors

A

used in parkinsons

24
Q

MAO B inhibirors 2 Rxs

A

Rasagiline

Selegiline

25
Q

Interactions of MAO B inhibitors

A
  • with SSRI, TCA= serotonin syndrome
  • contraindicated with Demerol

don’t give with tramadol, methadone, dextromethorphan, fluoxetine or fluvoxamine

26
Q

Catechol-O-Methyltransferase COMT inhibitors

A

inhibiting dopa decarboxylase (with carbidopa), another system is activated to metabolize dopamine, COMT

27
Q

COMTIs Rx

A

Tolcapone - hepatotoxicity

Entacapone

28
Q

Dopamine Receptor Agonist Rxs

A

Bromocriptine (Parlodel)-
Pramipexole (Mirapex)-
Ropinirole (Requip)-
Apomorphine

29
Q

Dopamine Receptor Agonist MOA

A

Act directly on dopamine receptors (as opposed to levodopa that makes dopamine to act on dopamine receptors)

30
Q

Contraindications of Dopamine Receptor Agonist

A
  • hx of psychotic ilness
  • Recent Mi
  • peptic ulcer
31
Q

Apomorphine

A
  • injectable, works fast 10 minutes

- Use with 5HT3 antagonists is contraindicated = hypotension

32
Q

Acetylcholine Receptor Antagonist MOA

A

Decrease effect of acetylcholine in basal ganglia, shifts balance towards dopamine side

33
Q

Acetylcholine Receptor Antagonist use:

A

tremor, rigidity

34
Q

Acetylcholine Receptor RXs

A

benztropine

Trihexyphenidyl

35
Q

Parkinson treatment strategies

A
  • Start with amantadine or antimuscarinic (or both) and then progress to dopaminergic therapy (Dopamine agonist +/- levodopa)
  • severe Parkinson’s symptoms on long term levodopa and progressing may add COMTI or MAO B inhibitor
  • young patients or mild disease consider MAO B inhibitors earlier as it may delay disease progression
36
Q

Drugs that induce Parinson syndrome

A

haloperidol

metoclopramide phenothiazines

37
Q

Why do drugs cause parkinson syndrome

A

because they antagonize dopamine receptors

38
Q

Treatment forpostural tremore

A

propranolol
primidone
topiramate

39
Q

Rx of tics

A

haloperidol

40
Q

Receptor agonists used in restless leg

A

Ropinirole
levodopa
benzos
opiates

41
Q

What results in Alzheimer’s?

A

damage of cholinergic and other neurons

42
Q

what is goal in alzheimers treatment?

A

we want flood of acetylcholine

43
Q

Cholinesterase inhibitors used in alzheimers

A

Donepezil

Tacrine

44
Q

Reversible cholinesterase inhibitors

A

Rivastigmine
Galantamine
Memantine

45
Q

MS treamtment

A

coticosteroid

46
Q

Disease modifying agnets for MS MOA and RX list

A

these agents modify the cellular functions modifying their DNA to induce cell apoptosis

Beta interferons (Avonex, Rebif, Betaseron)
Glatiramer acetate (Copaxone)
Mitoxantrone (Novantrone)
Natalizumab (Tysabri)

47
Q

Huntington’s Disease

A

hereditary

degeneration of GABA neurons

48
Q

Treatment for Huntington’s

A

-Haloperidol

Diazepam

49
Q

Amyotrophic Lateral Sclerosis

A
  • progressive motor diz

- death in 5 years

50
Q

Baclofen - ALS

A

for spasticity

51
Q

Gabapentin- ALS

A

slow decline in muscle strength

52
Q

Riluzole- ALS

A

protect neurons from toxic amino acids

prolongs life by 3 months

Pharm-Neuro (6 decks)

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