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neurology FA > Parkinson disease, Huntigton disease drugs, headaches - drugs > Flashcards

Parkinson disease, Huntigton disease drugs, headaches - drugs Flashcards

1
Q

Huntington disease - mode of inferitence / chromosome and trinucleotide repeat / age

A

AD trinucleotide repeat disorder (anticipation)
ch 4
CAG
20-50

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2
Q

Huntington disease - symptoms / and movment disorders

A
  1. choreiform movements
  2. aggression –> athetosis, chorea
  3. depression
  4. dementia
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3
Q

Huntington disease - neurotransmitter alternations

A
  1. increased dopamine
  2. decreased GABA
  3. decreased Ach
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4
Q

Huntington disease - MRI

A

Atrophy of caudate and putamen with hydrocephalus ex vacuo

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5
Q

Huntington disease - Drugs

A
  1. Haloperidol
  2. Tetrabenazine
  3. reserpine
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6
Q

Huntington Drugs - Haloperidol - mechanism of action

A

D2 receptor antagonist

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7
Q

Huntington Drugs - Tetrabenazine - mechanism of action

A

inhibits vesicular monoamine transporter (VMAT) –> limits dopamine vesicle packagings and release

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8
Q

VMAT

A

vesicular monoamine transporter

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9
Q

Huntington Drugs and mechanims of action

A
  1. Haloperidol –> D2 receptor antagonist
  2. Tetrabenazine –> VMAT inhibitor
  3. reserpine –> VMAT inhibitor
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10
Q

Huntington Drugs - vesicular monoamine transporter (VMAT) inhibition —>

A

limits dopamine vesicle packagings and release

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11
Q

Alzheimer disease - histology exp

A
  1. loss of ach neurons
  2. senile plaques in gray matter
  3. Neurofibrillary tangles
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12
Q

Alzheimer disease - drugs and mechanism of action

A
  1. Memantine –> NMDA receptor antagonists
  2. Donepezil –> Ache inhibitors
  3. galantamine –> Ache inhibitors
  4. rivastigmine –> Ache inhibitors
  5. tacrine –> Ache inhibitors
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13
Q

Alzheimer disease - groups of drugs (no the drugs)

A
  1. NMDA receptor antagonists

2. Ache inhbitors

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14
Q

Alzheimer disease - NMDA receptor antagonist - drug

A

Memantine

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15
Q

Memantine - side effects

A
  1. Dizziness
  2. confusion
  3. hallucinations
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16
Q

Memantine - mechanims of action

A

NMDA receptor antagonists –>HELPS PREVENT EXCITOXICITY (mediated by Ca2+)

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17
Q

Alzheimer disease - Ache inhibitors - drugs

A
  1. Donepezil
  2. galantamine
  3. rivastigmine
  4. tacrine
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18
Q

Alzheimer disease - Ache inhibitors - side effects

A
  1. nausea
  2. dizziness
  3. insomnia
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19
Q

Parkinson disease - histology

A
  1. Lewy bodies

2. loss of dopaminergic neurons of substantia nigra pars compacta (de-pigmentation)

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20
Q

Parkinson disease - symproms

A

MNEMONIC: TRAP

  1. Tremor (pill-rolling tremor at rest)
  2. Rigidity (cogwheel)
  3. Akinesia (or bradykinesia)
  4. Postural instability
  5. Shuffling gait
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21
Q

Parkinsonism mechanism

A

loss of dopaminergic neurons and excess cholinergic activity

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22
Q

Parkinson disease drug - strategy

A
  1. dopamine agonists
  2. increase dopamine availability
  3. increase L-DOPA availability
  4. prevent dopamine breakdown
  5. curb excess cholinergic activity
23
Q

Parkinson disease drug - dopamine agonists (drugs)

A
  1. bromocriptine (ergot)
  2. pramipexole (non-ergot)
  3. ropinirole (non-ergot)
24
Q

Parkinson disease drug - dopamine agonists - preferred drugs

A

non ergot:

  1. pramipexole
  2. ropinirole
25
Q

Parkinson disease drug - increase dopamine availability - drugs and mechanism?

A

amantadine –> increases dopamine release and decreases dopamine reuptake

26
Q

amantadine - clinical use

A
  1. Parkinson disease

2. antiviral against influenza A and rubella

27
Q

amantadine is also used as an antiviral against

A
  1. influenza A

2. rubella

28
Q

amantadine - toxicity

A
  1. ataxia

2. livedo reticularis

29
Q

Parkinson desease drugs - increase L-DOPA availability - mechanism

A

agents prevent peripheral (pre-BBB) L-DOPA degradation –> increase L-DOPA entering CNS –> increase central L-DOPA available for conversion to dopamine

30
Q

agents that prevent peripheral (pre-BBB) L-DOPA degradation

A
  1. carbidopa
  2. entacapone
  3. tolcapone
31
Q

entacapone - mechanism of action

A

prevent peripheral L-DOPA degradation to 3-0-methyldopa (3-OMD) by inhibiting COMT

32
Q

tolcapone - mechanism of action

A
  1. prevent peripheral L-DOPA degradation to 3-0-methyldopa (3-OMD) by inhibiting peripheral COMT
  2. blocks conversion of dopamine to DOPAC by inhibiting central COMT
33
Q

carbidopa - mechanism of action

A

block peripheral conversion of L-DOPA to dopamine by inhibiting peripheral DOPA decarboxylase –> reduse side effects of peipheral L-DOPA conversion into dopamine (eg. nausea, vomiting)

34
Q

Parkinson disease drug - COMT inhibitors

A
  1. tolcapone (central and peripheral COMT)

2. entacapone (peripheral COMT)

35
Q

Parkinson disease drug - prevenet dopamine breakdown - mechanism

A

agents act centrally (post-BBB) to block breakdown of dopamine –> increase available dopamine

36
Q

Parkinson disease drug - prevenet dopamine breakdowν drugs

A
  1. selegiline (and rasagilini)

2. Tocpapne

37
Q

tolcapone - mechanism of action

A
  1. prevent peripheral L-DOPA degradation to 3-0-methyldopa (3-OMD) by inhibiting peripheral COMT
  2. blocks conversion of dopamine to DOPAC by inhibiting central COMT
38
Q

selegiline - mechanism of action

A

blocks conversion of dopamine into DOPAC by selectively inhibiting MAO-B

39
Q

MAO-B preferentially metabolizes …. over …

A

dopamine
over
norepinephrine and seretonin

40
Q

selegiline - clinical use

A

adjunctive agen to L-dopa in treatment of Parkinson

41
Q

selegiline - toxicity

A

May enhance adverse effects of L-DOPA

42
Q

L-dopa to dopamine - enzyme?

A

DOPA decarboxylase

43
Q

L-dopa to 3-0-methyldopa

A

COMT

44
Q

L-dopa - clinical use

A

Parkinson disease

45
Q

L-dopa - toxicity

A
  1. arrhythmias from increased peripheral formation of catecholamines
  2. Long term use can lead to dyskenesia following administration (on-off phenomeno), akinesia between doses
46
Q

L-dopa - mechanism of action

A

unlike dopamine, L-dopa can cross BBB and is converted by dopa decarboxylase in the CNS to dopamine

47
Q

L-dopa to dopamine in the CNS- enzyme?

A

CNS dopa decarboxylase

48
Q

Parkinson disease drug - curb excess cholinergic activity - drugs and action

A

Benzotropine (antimuscarinic) –> improves tremor and rigidity but has little effect on bradykinesia

49
Q

memantine - side effects

A
  1. Dizziness
  2. confusion
  3. hallucinations
50
Q

Parkinson disease - drug that causes livedo reticularis

A

amantadine

51
Q

Parkinson disease - benzotropine - mechasism of action and uses

A

antimuscarinic –> improves tremor and rigidity but has little effect on bradykinesia

52
Q

Parkinson disease - peripheral COMT inhibitors

A
  1. entacapone

2. tolcapone

53
Q

Parkinson disease - central COMT inhibitors

A

tolcapone

54
Q

all Parkinson drugs and mechanism of action (shortly)

A
  1. Bromocriptine (dopamine agonist)
  2. Pramipexole (dopamine agonist)
  3. ropinirole (dopamine agonist)
  4. amantadine (incr dopamine release and inh reuptake)
  5. Levodopa (increases dopamine levels in CNS)
  6. carbidopa (DOPA decarboxylase inhibitor)
  7. entacapone(peripheral COMT inhibitor)
  8. tolcapone (central and peripheral COMT inhibitor)
  9. selegiline (MAO-B inhibitor) (and rasagilini)
  10. benzotropine (antimuscarinic)

neurology FA (31 decks)

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