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Pharmacology > Neurodegnerative Diseases > Flashcards

Neurodegnerative Diseases Flashcards

1
Q

Which drugs cause Parkinson like symptoms

A

Haloperidol
Metoclopramide
Valproate
Chlorpromazine

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2
Q

What is the first line drug for Parkinson’s disease

A

L-DOPA

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3
Q

What converts L DOPA to dopamine in the substantia nigra

A

It gets decarboxylated by DOPA decarboxylase

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4
Q

L DOPA side effects

A

Nausea, vomiting, cardiac arrhythmias, hypotension

CNS: anxiety confusion and hallucinations

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5
Q

What is wearing off syndrome

A

Happens in chronic use of LDOPA and can cause dyskaniesia and akaniesia

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6
Q

What happens over time with L DOPA use

A

The therapeutic window narrows leading to on and off phenomenon

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7
Q

Who is L DOPA contraindicated in

A

Psychotic patients

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8
Q

How to improve bioavailability of L DOPA

A

we administer it with Carbidopa -> drops peripheral side effects

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9
Q

What’s the % of L dopa reaching the brain with and without Carbidopa

A

Without 1-3%

With 5-10%

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10
Q

What’s the major peripheral pathway of L DOPA breakdown after

A

COMT

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11
Q

What are the COMT inhibitors

A

Tolcapone and entacapone

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12
Q

Which COMT inhibitor enters the CNS

A

tolcapone

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13
Q

Which COMT INHIBITR has long half life

A

Tolcapone

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14
Q

What are the adverse effects of tolcapone

A

Hepatotoxic

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15
Q

What are the MAO B inhibitors

A

selegiline and rasagiline

Extra safinamide

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16
Q

Which MAO B inhibitor is more potent

A

Rasagiline

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17
Q

What happens when selegiline is metabolised

A

It is converted to amphetamines

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18
Q

What is the initiation therapy for Parkinson’s disease

A

Dopamine receptor agonist

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19
Q

What’s the drug combination in advanced Parkinson’s

A

Carbidopa/LDOPA + D2 agonist

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20
Q

Which D2 agonist isn’t used any more

A

Bromocriptine as it has a lot of side effects

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21
Q

Which D2 agonist is used for restless leg syndrome

A

Ropinirole

22
Q

Long term use of bromocriptine side effects

A

Vasospasm in patients with peripheral vascular disease

Pulmonary and retroperitoneal fibrosis

23
Q

Which anti muscarinic agents are used in the treatment of Parkinson’s

A

Benztropine and trihexphnidyl

24
Q

What are Benztropine and trihexphnidyl contraindications

A

BPH and GLUCOMA

25
Q

What’s the mechanism of action of amantadine

A

Enhances effects of endogenous dopamine and inhibits cholinergic receptors

26
Q

When is LDOPA TAKEN

A

30 mins before food to avoid food competing with L DOPA. Absorption

27
Q

L DOPA drug interactions

A

With Vitamin B6 it increases peripheral breakdown

28
Q

What happens in Alzheimer’s disease

A

Neuronal loss in the temporal lobe including entraorhinal cortex and hippocampus

29
Q

What ACHE inhibitors are used in Alzheimer’s

A

Donepezil
Galantamine
Rivastigmine

30
Q

Which ACHE inhibitor is given oral and indicated for Parkinson’s dementia

A

Rivastigmine (only one not metabolised by CYP 450)

31
Q

Which ACHE inhibitor is given as a transdermal patch for people who can’t with the side effects

A

Rivastigmine

32
Q

ACHE inhibitors side effects

A

Bradycardia and bronchoconstriction

Nause, vomiting and diarrhoea

33
Q

Mechanism of action of NMDA antagonist

A

Prevent NMDA receptors excite toxicity

34
Q

Which NMDA inhibitor is used for Alzheimer’s

A

MEMANTINE

35
Q

MEMANTINE mechanism of action

A

Non competitive NMDA type glutamate receptor antagonist blocking Ca2+ influx into neurons

36
Q

NMDA antagonist can it be used as monotherapy

A

Yes or with ACHE Inhibitors

37
Q

What is Huntington’s disease

A

It’s an inherited neurological disorder

-Movement disorder due to defect in basal ganglia

38
Q

What happens in Huntington’s disease

A

Over activity of dopamine due to imbalance decrease of ACH and GABA which antagonise DOPAMINE

39
Q

Drugs that deplete the central dopamine store by blocking entry to neurone storage vesicles

A

Roseripine and tetrabanzine

40
Q

Drugs that block dopaminergic receptors

A

Phenothiazines and butyrophenones and haloperidol

AE : Parkinsonism and restlessness

41
Q

What is bipolar disorder

A

Mood shift between two extremes depression and mania (euphoria)

42
Q

What’s used in the treatment of bipolar disorder

A

Mood stabilisers mainly LITHIUM

43
Q

What anticonvulsants are used to treat bipolar disorder

A

Carbamazepine
Valproate
Gabapentin
Lamotrigine

44
Q

When are anticonvulsants used instead of lithium

A

When lithium does not work or is not sutiable

45
Q

Lithium onset of action

A

7-10 days

46
Q

Is lithium eliminated by the liver

A

No it’s not

47
Q

What is mediated lithium effect

A

IP3 and DAG

48
Q

Lithium indications

A

Acute mania
Prophylaxis of BPD
mania/hypo mania- depression

49
Q

Lithium therapeutic index

A

Narrow

Can cause goiter (hypothyroidism) edema, teratogenic

50
Q

What’s an alternative to lithium

A

Carbamazepine-P450 inducer

51
Q

Carbamazepine side effects

A

Can cause agranulocytosis leukopenia

52
Q

What’s the most sedating antidepressant

A

Doxepin

Pharmacology (33 decks)

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