Neurodegenerative Diseases

Question 1

Parkinsonism results from

Answer 1

breakdown of dopamineergic neurons

Question 2

Cardinal Signs of Parkinsonism

Answer 2

Rigidity, Bradykinesia, tremor, postural.gate

Question 3

What are three groups of drugs used in Parkinsonism?

Answer 3

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

Question 4

Rx list that increases dopamine levels

Answer 4

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

Question 5

Rx list the are dopamine receptor agonists

Answer 5

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

Question 6

Cholinergic Receptor Antagonist

Answer 6

Benztropine (Cogentin)

Trihyexylphenidyl (Artane)

Question 7

MOA Levodopa

Answer 7

precursor of dopamine and enters the brain then converts.

Question 8

Levodopa pharmokinetics

Answer 8

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

Question 9

Carbidopa

Answer 9

• dopa decarboxylase inhibitor

- inhibits levodopa breakdown

Question 10

Sinemet

Answer 10

carbidopa + levodopa

Question 11

MAOIs + Levodopa

Answer 11

cause hyper tension

Question 12

Drugs that increase gastric emptying

Answer 12

contraindicated with levodopa

Question 13

Psychosis + levodopa

Answer 13

increased psychosis

Question 14

Angle closure glaucoma + levodopa

Answer 14

made more severe

Question 15

Adverse effects of levodopa

Answer 15

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

Question 16

When is the best time to use levodopa?

Answer 16

• works best in first few years of treatment

- effects wear off in 4 years

Question 17

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

Answer 17

• dopamine agonist

- catechol-O-methyl transferase inhibitor

Question 18

Amantadine MOA

Answer 18

• antiviral

- Increases release of dopamin from neurons and inhibits dopamine reuptake

Question 19

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

Answer 19

-rigidity, tremors, bradykinesia

Question 20

What ADR is associated with Amantadine?

Answer 20

hallucinations

Question 21

MAO A enzyme

Answer 21

breaks down norepinephrine and serotonin

Question 22

MAO B enzyme

Answer 22

breaks down dopamine

Question 23

MAO B inhibitors

Answer 23

used in parkinsons

Question 24

MAO B inhibirors 2 Rxs

Answer 24

Rasagiline

Selegiline

Question 25

Interactions of MAO B inhibitors

Answer 25

- with SSRI, TCA= serotonin syndrome - contraindicated with Demerol don't give with tramadol, methadone, dextromethorphan, fluoxetine or fluvoxamine

Question 26

Catechol-O-Methyltransferase COMT inhibitors

Answer 26

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

Question 27

COMTIs Rx

Answer 27

Tolcapone - hepatotoxicity | Entacapone

Question 28

Dopamine Receptor Agonist Rxs

Answer 28

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

Question 29

Dopamine Receptor Agonist MOA

Answer 29

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

Question 30

Contraindications of Dopamine Receptor Agonist

Answer 30

- hx of psychotic ilness - Recent Mi - peptic ulcer

Question 31

Apomorphine

Answer 31

- injectable, works fast 10 minutes | - Use with 5HT3 antagonists is contraindicated = hypotension

Question 32

Acetylcholine Receptor Antagonist MOA

Answer 32

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

Question 33

Acetylcholine Receptor Antagonist use:

Answer 33

tremor, rigidity

Question 34

Acetylcholine Receptor RXs

Answer 34

benztropine | Trihexyphenidyl

Question 35

Parkinson treatment strategies

Answer 35

- 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

Question 36

Drugs that induce Parinson syndrome

Answer 36

haloperidol | metoclopramide phenothiazines

Question 37

Why do drugs cause parkinson syndrome

Answer 37

because they antagonize dopamine receptors

Question 38

Treatment forpostural tremore

Answer 38

propranolol primidone topiramate

Question 39

Rx of tics

Answer 39

haloperidol

Question 40

Receptor agonists used in restless leg

Answer 40

Ropinirole levodopa benzos opiates

Question 41

What results in Alzheimer's?

Answer 41

damage of cholinergic and other neurons

Question 42

what is goal in alzheimers treatment?

Answer 42

we want flood of acetylcholine

Question 43

Cholinesterase inhibitors used in alzheimers

Answer 43

Donepezil | Tacrine

Question 44

Reversible cholinesterase inhibitors

Answer 44

Rivastigmine Galantamine Memantine

Question 45

MS treamtment

Answer 45

coticosteroid

Question 46

Disease modifying agnets for MS MOA and RX list

Answer 46

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)

Question 47

Huntington's Disease

Answer 47

hereditary | degeneration of GABA neurons

Question 48

Treatment for Huntington's

Answer 48

-Haloperidol | Diazepam

Question 49

Amyotrophic Lateral Sclerosis

Answer 49

- progressive motor diz | - death in 5 years

Question 50

Baclofen - ALS

Answer 50

for spasticity

Question 51

Gabapentin- ALS

Answer 51

slow decline in muscle strength

Question 52

Riluzole- ALS

Answer 52

protect neurons from toxic amino acids | prolongs life by 3 months