Neurodegenerative Disorders

Question 1

Mention members of ChEI

Answer 1

Donepezil (long acting)
Rivastigment (short acting, available in transdermal patch)

Question 2

Mechanism of action of ChEI

Answer 2

1. Inc cholinergic transmission by inhibiting AChE
2. Orally active, cross BBB, more selective to central AchE
3. Improve cognitive function but do not delay disease progress

Question 3

Mention uses of ChEI

Answer 3

Mild, moderate, severe AD, parkisnonism dementia (rivastigmine only)

Question 4

Mention side effects of ChEI

Answer 4

Cholinomimetic effect
Drug interactions involving CYP450 ex rivastigmine

Question 5

Mention mechanism of action & uses of NMDA receptor blockers

Answer 5

Non-competitive antagonist of NMDA receptors, limiting influx of Cavinto neurons thus protect from excitotoxicity
U, moderate to severe AD

Question 6

Mention side effects of memantine

Answer 6

Confusion, dizziness, headache, agitation, hallucination
Constipation

Question 7

Mention agents used in treatment of depression & psychosis in AD

Answer 7

Aripiprazole, olanzipine, respiridone

Question 8

Mention components of Namzaric

Answer 8

Memantine + donepezil

Question 9

……imroves walking in MS patients

Answer 9

Fampridine

Question 10

Mention management of acute exacerbations of MS

Answer 10

Methylpredinsolone 0.5-1 g/d IV for 5 days followed by tapered oral prednisolone

Question 11

Enumerate adverse effects of corticosteroids

Answer 11

1. Catabolic:
   A. Carbs: hyoerglycemia (DM)
   B. Fat: lipolysis redistribution to face, abdomen & shoulders
   C. On protein: muscle wasting, thinning of skin, growth retardation, osteoporosis
2. Salt & water reten.:edema, inc weight, HTN
3. Behavioural changes: psychosis & depression
4. Peptic ulcer, infection, poor wounding healing, hirshutism

Question 12

…..is 1st line therapy as DMD in MS
describe its mechanism of action

Answer 12

Interferon-B
Immunomodulatory effects help to diminish inflammatory responses that lead to demyelination of axon sheaths.

Question 13

Adverse effects of inetrferon-B

Answer 13

Flu-like symptoms
Depression
Local reaction at inject.site
Inc hepatic enzymes (AST&ALT)

Question 14

……is first oral DMD approved
Describe its mechanism of action

Answer 14

Finglomod
Binds & block S1P1 receptor & alters lymphocyte migration, resulting in fewer lymphocytes in CNS, T-cell sequestration in LN

Question 15

Mention adverse effects of finglomod

Answer 15

1. 1st dose bradycardia
2. Inc risk of infection
3. Macular edema (cautious in DM)

Question 16

Describe mechanism & indication of action of Natalizumab

Answer 16

Monoclonal Ab against a4B1, dec BBB invasion by T-cells
Indicated for pateints with progressive MS, with failed 1st line treatment

Question 17

Mention adverse effects of Natalizumab

Answer 17

1. Allergic reaction
2. Anti-natalizuman Abs
3. Progessive multifocal leucoencephalopathy
   Specific recommendations:
4. Test for JC
5. Avoid in immunocompromised
6. Do not give for more than 24 mon
7. Monitor pt

Question 18

…….is first FDA approved drug for ALS
Describe its mechanism of action

Answer 18

Riluzole
Inhibits gluatamate release inhibiting Na channels
NMDA receptor antagonist
Improve survival time & delay need for ventilation

Question 19

Define diffuse axonal injury & its locations

Answer 19

Injury of white matter with axonal swelling due to acceleration & deceleration
Corpus callosum, periventricular white matter, hippocampus, cerebral & cerebellar peduncles

Question 20

Compare epidural & subdural hematoma with respect location & involved vessels

Answer 20

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)

Question 21

Compare epi & subdural hemorrhage with respect symptoms & CT

Answer 21

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.