Neurodegenerative Disorders Flashcards
Mention members of ChEI
Donepezil (long acting)
Rivastigment (short acting, available in transdermal patch)
Mechanism of action of ChEI
- Inc cholinergic transmission by inhibiting AChE
- Orally active, cross BBB, more selective to central AchE
- Improve cognitive function but do not delay disease progress
Mention uses of ChEI
Mild, moderate, severe AD, parkisnonism dementia (rivastigmine only)
Mention side effects of ChEI
Cholinomimetic effect
Drug interactions involving CYP450 ex rivastigmine
Mention mechanism of action & uses of NMDA receptor blockers
Non-competitive antagonist of NMDA receptors, limiting influx of Cavinto neurons thus protect from excitotoxicity
U, moderate to severe AD
Mention side effects of memantine
Confusion, dizziness, headache, agitation, hallucination
Constipation
Mention agents used in treatment of depression & psychosis in AD
Aripiprazole, olanzipine, respiridone
Mention components of Namzaric
Memantine + donepezil
……imroves walking in MS patients
Fampridine
Mention management of acute exacerbations of MS
Methylpredinsolone 0.5-1 g/d IV for 5 days followed by tapered oral prednisolone
Enumerate adverse effects of corticosteroids
- Catabolic:
A. Carbs: hyoerglycemia (DM)
B. Fat: lipolysis redistribution to face, abdomen & shoulders
C. On protein: muscle wasting, thinning of skin, growth retardation, osteoporosis - Salt & water reten.:edema, inc weight, HTN
- Behavioural changes: psychosis & depression
- Peptic ulcer, infection, poor wounding healing, hirshutism
…..is 1st line therapy as DMD in MS
describe its mechanism of action
Interferon-B
Immunomodulatory effects help to diminish inflammatory responses that lead to demyelination of axon sheaths.
Adverse effects of inetrferon-B
Flu-like symptoms
Depression
Local reaction at inject.site
Inc hepatic enzymes (AST&ALT)
……is first oral DMD approved
Describe its mechanism of action
Finglomod
Binds & block S1P1 receptor & alters lymphocyte migration, resulting in fewer lymphocytes in CNS, T-cell sequestration in LN
Mention adverse effects of finglomod
- 1st dose bradycardia
- Inc risk of infection
- Macular edema (cautious in DM)
Describe mechanism & indication of action of Natalizumab
Monoclonal Ab against a4B1, dec BBB invasion by T-cells
Indicated for pateints with progressive MS, with failed 1st line treatment
Mention adverse effects of Natalizumab
- Allergic reaction
- Anti-natalizuman Abs
- Progessive multifocal leucoencephalopathy
Specific recommendations: - Test for JC
- Avoid in immunocompromised
- Do not give for more than 24 mon
- Monitor pt
…….is first FDA approved drug for ALS
Describe its mechanism of action
Riluzole
Inhibits gluatamate release inhibiting Na channels
NMDA receptor antagonist
Improve survival time & delay need for ventilation
Define diffuse axonal injury & its locations
Injury of white matter with axonal swelling due to acceleration & deceleration
Corpus callosum, periventricular white matter, hippocampus, cerebral & cerebellar peduncles
Compare epidural & subdural hematoma with respect location & involved vessels
Epi: between dura & skull, most commonly ruprute of middle meningeal artery often 2ry to temporoparietal fracture.
Sub: between dura & arachnoid, due to rupture of bridging vein, (r.f.:brain atrophy, anticoagulanttherapy, shaking, whiplash)
Compare epi & subdural hemorrhage with respect symptoms & CT
Epi: luicid episode before loss of consciousness (talk & die syndrome), trans-tentorial herniation, biconvex hemorrhage that doesn’t cross suture lines
Sub: slow venous bleeding with delayed onset of gradually inc headache & confusion, cresent-shaped hemorrhage that crosses suture lines, gyri are preseved since pressure is distributed equally, cannot cross tentorium.
