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Neurology Pharmacology Flashcards

1
Q

What classes of medication are used for Parkinson’s disease?

A 
Dopamine precursor 
Dopamine receptor antagonists 
Monoamine oxidase B inhibitors
COMT inhibitors 
Anticholinergics
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2
Q

Why is dopamine not used in treatment for Parkinson’s?

A

Unable to cross BBB

L-DOPA is moved across by active transport

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3
Q

What are some examples of dopamine precursors?

A

Levodopa

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4
Q

What does levodopa need in order to be able to act?

A

Sufficient dopaminergic cells in the substantia nigra to convert L-DOPA to dopamine

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5
Q

What is the route of administration for levodopa?

A

Oral

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6
Q

What is the mechanism of levodopa?

A

Crosses blood brain barrier

Converted to dopamine

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7
Q

What are the side effects of levodopa?

A

Nausea
Hypotension
Psychosis
Tachycardia

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8
Q

What other drugs contain levodopa?

A

Co-careldopa

Co-beneldopa

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9
Q

What is combined with levodopa?

A

Peripheral DOPA decarboxylase inhibitor

- prevent breakdown on DOPA

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10
Q

What is the drug name of co-careldopa?

A

Sinemet

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11
Q

What is the route of administration for co-careldopa?

A

Oral

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12
Q

What are the side effects of co-careldopa?

A

Nausea

Drowsiness

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13
Q

What is the name of the DOPA deycarboxylase inhibitor in co-careldopa?

A

Carbidopa

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14
Q

What is the name of the DOPA decarboxylase inhibitor in co-beneldopa?

A

Benserazide

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15
Q

What is the drug name of co-beneldopa?

A

Madopar

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16
Q

What is the route of administration for co-beneldopa?

A

Oral

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17
Q

What are the side effects of co-beneldopa?

A

Nausea
Anxiety
Postural hypotension

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18
Q

What are the advantages of levodopa?

A

Highly efficient

Low side effects

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19
Q

What are the disadvantages of levodopa?

A

Precursor - needs enzyme conversion

Long term effects

  • loses efficiency
  • involuntary movements
  • motor complications
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20
Q

What are examples of dopamine receptor agonists?

A

Ropinirole
Rotigotine
Apomorphine

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21
Q

What is the indication for apomorphine?

A

Parkinson’s patients with severe motor fluctuation

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22
Q

What is the route of administration for apomorphine?

A

Subcutaneous

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23
Q

What is the mechanism of apomorphine?

A

Activates dopamine receptor

Compensates for depleted supply of endogenous dopamine

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24
Q

What are the side effects of apomorphine?

A 
Confusion 
Dizziness
Drowsiness
Nausea
Psychiatric disorders
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25
What is the route of administration for ropinirole?
Oral
26
What is the mechanism of ropinirole?
Activates dopamine receptor Compensates for depleted supply of endogenous dopamine
27
What are the side effects of ropinirole?
``` Confusion Dizziness Drowsiness Sleep disorders N+V ```
28
What is the route of administration for Rotigotine?
Transdermal patch
29
What is the mechanism of Rotigotine?
Activates dopamine receptor Compensates for depleted supply of endogenous dopamine
30
What are side effects of Rotigotine?
``` Abnormal behaviour Dizziness Drowsiness N+V Psychiatric disorders ```
31
What are the advantages of dopamine receptor agonists?
Direct acting Less motor complications Possible neuroprotection
32
What are the disadvantages of dopamine receptor agonists?
Less efficient that L-DOPA Impulse control disrders More psychiatric side effects Expensive
33
What are examples of monoamine oxidase B inhibitors?
Selegiline | Rasagaline
34
What is monoamine oxidase B?
Enzyme that metabolises dopamine Predominantly in the dopamine containing regions of the brain
35
What is the mechanism of MAO B inhibitors?
Inhibits monoamine oxidase type B Prevents metabolism of dopamine More dopamine present
36
What is the route of administration of Selegiline?
Oral
37
What are the side effects of selegilline?
``` Arrhthymias Back pain Confsion Nausea Headache Hallucination ```
38
What is the route of administration for Rasagiline?
Oral
39
What are the side effects of Rasagiline?
``` Abdo pain Depression Postural hypotension Depression Sleep disorders ```
40
What is an example of a COMT inhibitor?
Entacapone
41
What is COMT?
Catechol-O-methyl transferase Breaksdown dopamine peripherally
42
What is the route of administration of Entacapone?
Oral
43
What is the mechanism of Entacapone?
Inhibits COMT Reduces peripheral L-DOPA breakdown
44
What are the side effects of Entacapone?
``` Abdo pain Confusion Dizziness Hallucination Movement disorders N+V ```
45
Which anticholinergics are used in the treatment of Parkinsons?
Trihexyphenidyl Orphenadrine Procyclidine
46
What is the mechanism of anticholinergics used in Parksinsons?
Inhibit ACh - treat tremor Antispasmodic effect on smooth muscle Balances cholinergic and dopaminergic activity in basal ganglia
47
What is the route of administration of Trihexyphenidyl?
Oral
48
What are the side effects of trihexyphenidyl?
``` Anxiery Confusion Flushing Dry mouth Vomiting ```
49
What is the route of administration of orphenadrine?
Oral
50
What are the side effects of orphenadrine?
Anxiety Dizziness Dry mouth Nausea
51
What is the route of administration of procyclidine?
Oral
52
What are the side effects of procyclidine?
Constipation Dry mouth Urinary retention Blurry vision
53
What are the advantages of anticholinergics?
Treat tremor | Do not act via dopamine systems
54
What are the disadvantages of anticholinergics?
No effect on bradykinesia Side effects
55
What other drug is used to treat Parkinsons?
Amantadine
56
What is the mechanism of amantadine?
Unknown Possibly - enhance dopamine release - anticholinergic NMDA inhibition
57
What is the route of administration of amantadine?
Oral
58
What are the side effects of amantadine?
``` Anxiety Confusion Constipation Depression Movement disorders ```
59
What drugs is used to manage myasthenia gravis?
Pyridostigmine | Neostigmine
60
What class are pyridostigmine/neostigmine?
Anticholinesterase inhibitors
61
What is the indication for neostigmine?
Use in ITU Quicker action IV + oral preparations
62
What is the mechanism of anticholinesterase inhibitors in myasthenia gravis?
Inhibit cholinesterase More circulating ACh Enhances neuromuscular transmission
63
What is the route of administration of pyridostigmine?
Oral
64
What is the pneumonic for antimuscarinic side effects?
SSLUDGE
65
What are the side effects of pyridostigmine?
``` Salivation Sweating Lacrimation Urinary incontinence Diarrhoea GI upset Emesis ``` Miosis

Pharmacology (27 decks)

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