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Parkinson's Flashcards

1
Q

How do the Inhibitor Neurotransmitters work?

A

Hyperpolarization

IPSPs

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2
Q

What are the 2 inhibitory neurotransmitters?

A

GABA

Glycine

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3
Q

Where does GABA work?

A

CNS

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4
Q

Where does Glycine work?

A

Spinal cord

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5
Q

During inhibition, what two cations are responsible? What do each do?

A 
K+ = Efflux 
Cl- = Influx
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6
Q

How do the Excitatory Neurotransmitters work?

A

Depolarization

EPSPs

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7
Q

What are the 2 excitatory neurotransmitters?

A

Glutamate

AcH

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8
Q

What is the most abundant NT in the brain?

A

Glutamate

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9
Q

With Ach-which cation is there an influx of?

A

Sodium (Na+)

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10
Q

What is Serotonin?

A

NT that can be excitatory OR inhibitory depending on the receptor stimulated

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11
Q

What percent of Parkinson’s patients have hallucinations?

What is the treatment for these patients?

A

-20%
-Stop meds that give psychosis
AND
Start Atypical Antipsychotics or Neuroleptics (quietiapine > Haloperidol)

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12
Q

What is Parkinson’s disease?

A

progressive neurological disorder of muscle movement characterized by:

  1. Tremor: Pill rolling
  2. Muscle rigidity: Cogwheel or ratchet movements
  3. Bradykinesia
  4. Postural and gait abnormalities–stooped posture
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13
Q

What are Benzodiazepines at low doses?

A

Anoxiolytic (Anti-anxiety)

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14
Q

What are Benzodiazepines at high doses?

A

Sedative/Hypnotic

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15
Q

T or F: Benzodiazepines have great analgesic action?.

A

False: Benzos have NO ANALGESIC action

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16
Q

Which drugs are used for Parkinson’s?

A
  1. Dopa mimetics
  2. MAO-B inhibitors
  3. COMT inhibitors
  4. Dopa agonists
  5. Anti-viral
  6. Anti-muscarinics
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17
Q

Which drugs are used for Alzheimers’?

A
  1. ACE inhibitors

2. NMDA receptor antagonists

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18
Q

What are the 2 Dopa mimetics?

A
  1. Levodopa

2. Carbidopa

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19
Q

What are the 2 MAO-B inhibitors used in Parkinsons? ?

A
  1. Selegiline

2. Rasagiline

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20
Q

What are the 2 COMT inhibitors used in Parkinsons? ?

A
  1. Entacapone

2. Tolcapone

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21
Q

What are the 5 Dopa agonists used in Parkinsons? ?

A
  1. Bromocriptine
  2. Pramipexole
  3. Ropinerole
  4. Rotingotine
  5. Amporphine
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22
Q

Which anti-viral is used in Parkinsons’?

A

Amantadine

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23
Q

Which antimuscarinics are used in Parkinsons?

A
  1. Benztropine
  2. Trihexyphenidyl
  3. Biperiden
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24
Q

Which AchE inhibitors are used in Alzheimers’?

A
  1. Donepezil
  2. Galantamine
  3. Rivastigmine
  4. Tacrine
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25
What is the NMDA inhibitor used in Alzheimer's?
Memantadine
26
What is the DOC for Parkinson's?
Dopa Mimetics | Levodopa-Carbidopa
27
Which drug can cross the BBB and has a "honeymoon period" where its respond to Tx and for 3-5 years?
Levodopa/Carbidopa
28
What are the adverse effects of Levodopa/Carbidopa?
1. Hypotension 2. Arrhythmias 3. N/V (treat with Zofran) 4. Dyskinesias 5. Psychosis 6. On/Off periods 7. *HTN crisis when taken with MAOI-A's
29
Would a NA glaucoma patient with a Pyridoxine (B6) deficiency be safe taking Levodopa/Carbidopa?
NO; both are contraindicated
30
Which drugs are NON-selective D1 and D2 receptor agonists?
Bromocriptine
31
What are the contraindications of Bromocriptine?
1. CVD 2. Prevoius MI 3. Uncontrolled HTN 4. Pregnancy 5. Ulcers
32
What is the overall goal of drugs that treat Parkinsons'?
Try to increase the amount of Dopamine
33
Which drug is a MAOB inhibitor but binds IRREVERSIBLY?
Rasagiline
34
What is the MOA of Levodopa?
Dopamine substrate to replace lost Dopa
35
What is the MOA of Carbidopa?
Blocks DDC to allow more L-Dopa into the brain
36
Which Parkinson's drug (MAOB inhibit.) has metabolites that are possible neurotoxic?
Rasagiline (also 2x expensive)
37
Which Parkinson's (MAOB inhibit.) drug gives you HTN with high doses along with what other adv effect?
1. Selegiline | 2. Insomnia
38
Which Parkinson's drug is worthless if given without LDopa?
Entacapone (COMT inhib.)
39
Which COMT inhib. has hepatoxicity and thus not used anymore?
Tolcapone
40
What are the adverse effects of Entacapone?
1. Orthostatic Hypotension 2. Dyskinesia 3. Hallucinations 4. N/V
41
What is the MOA of the COMT inhibitors?
Prevents metabolism of Dopa in to 3-0 methyldopa by inhibiting COMT
42
Which Anti-Parkinsons drug is an Ergot alkaloid?
Bromocriptine
43
What are the adverse effects of Bromocriptine?
1. Hallucinations/Delusions 2. Delirium/confusion 3. GERD 4. Orthostatic Hypotension 5. Arrhythmias 6. MI 7. Dyskinesias (rare) 8. RETROPERITONEAL FIBROSIS
44
Which drugs are the SELECTIVE D2 agonists for Parkinsons?
1. Pramipexole 2. Ropinerole 3. Rotigotine 4. Apomorphine
45
Which group of drugs can be used as a monotherapy for Parkinsons to delay TX with L dopa?
Dopa agonists--D2 selective group these can also be used to treat Restless leg syndrome
46
What are the containdications of the D2 selective group for Parkinsons?
1. Dementia and elderly (increases death) | 2. Cimetidine (decreases metabolism)
47
What is the contraindication of Apomorphine?
1. Odansetron (Zofran)
48
What is the indication for the IV only Apomorphine?
Reserved for off periods with LDopa treatment
49
What are the adv effects of the IV only Apomorphine?
Severe N/V (Tx: trimethobenzamide)
50
Which SELECTIVE D2 agonist is topical?
Rotigotine
51
Which SELECTIVE D2 agonist is PO?
Ropinerol
52
A patient is experiencing these symptoms: 1. Orthostatic Hypotension 2. N 3. Vertigo 4. Insomnia 5. Somnolence What is the causative agent? And what can be taken for the Somnolence?
Pramipexol, Ropinerol, Rotigotine TX: Modafinil
53
What is the MOA of Amantidine?
NMDA Glutamate receptor antagonist increases the synthesis and release of Dopa from surviving neurons
54
What is the Indication of Amantadine?
Parkinsons Brady and Rigidity > Tremors
55
What are the adverse affects of Amantadine?
``` Restelessness Insomnia Agitation Confusion Hallucinations Orthostatic Hypotension URINARY RETENTION DRY MOUTH ```
56
Which anti-parkinson drug needs surviving neurons to have a positive effect?
Amantadine--the anti-viral
57
What is the MOA of the anti-muscarinics used for Parkinson's?
Block the excitatory muscarinic receptors to restore Dopa balance
58
Which drugs can be used as LDopa add ons?
1. COMT inhibitors 2. Bromocriptine 3. Antimuscarinics
59
Would a NA glaucoma patient with BPH and pyloric stenosis be safe in taking an anti-muscarinic?
NO; all 3 conditions are contraindicated
60
What are the indications for the antimuscarinics used for Parkinsons'?
1. Parkinsons 2. LDopa add on 3. Tremor, Drooling > Bradykinesia
61
If the Parkinsons' patient is suffering from Brady and Rigidity what would you prescribe?
Amantadine
62
If the Parkinsons' patient is suffering from tremors and drooling, what would you prescribe?
Antimuscarinics
63
What are the adverse effects of Antimuscarinics?
SLUDWARM + HALLUCINATIONS + CONFUSION
64
What is the MOA of the AchE inhibitors used to treat Alzheimes?
Inhibit AchE
65
What is the DOC for Alzheimers?
AchE inhibitors
66
What are the adverse effects of the AchE inhibitors?
1. All (EXCEPT Rivastigmine) inhibit CYP450 2. Bradykinesia 3. NVD 4. Anorexia 5. Tremors 6. Muscle Cramps
67
Which AchE inhibitor has a hepatoxicity effect?
Tacrine
68
Which drug is an NMDA glutamate inhibitor with adverse effects of confusion, agitation, and restlessness?
Memantine
69
Which drug is used to decrease the progression of Alzheimers short term memory loss?
Memantine
70
Which drug with adverse effects of confusion, agitation, and restlessness is also similar to PCP?
Memantine
71
Which anti-parkinson's drug works in the periphery?
Entacapone

Pharm Exam 1 (8 decks)

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