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Pharm Exam 1 > Parkinson's > Flashcards

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
Q

What is the NMDA inhibitor used in Alzheimer’s?

A

Memantadine

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26
Q

What is the DOC for Parkinson’s?

A

Dopa Mimetics

Levodopa-Carbidopa

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27
Q

Which drug can cross the BBB and has a “honeymoon period” where its respond to Tx and for 3-5 years?

A

Levodopa/Carbidopa

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28
Q

What are the adverse effects of Levodopa/Carbidopa?

A
  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
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29
Q

Would a NA glaucoma patient with a Pyridoxine (B6) deficiency be safe taking Levodopa/Carbidopa?

A

NO; both are contraindicated

30
Q

Which drugs are NON-selective D1 and D2 receptor agonists?

A

Bromocriptine

31
Q

What are the contraindications of Bromocriptine?

A
  1. CVD
  2. Prevoius MI
  3. Uncontrolled HTN
  4. Pregnancy
  5. Ulcers
32
Q

What is the overall goal of drugs that treat Parkinsons’?

A

Try to increase the amount of Dopamine

33
Q

Which drug is a MAOB inhibitor but binds IRREVERSIBLY?

A

Rasagiline

34
Q

What is the MOA of Levodopa?

A

Dopamine substrate to replace lost Dopa

35
Q

What is the MOA of Carbidopa?

A

Blocks DDC to allow more L-Dopa into the brain

36
Q

Which Parkinson’s drug (MAOB inhibit.) has metabolites that are possible neurotoxic?

A

Rasagiline (also 2x expensive)

37
Q

Which Parkinson’s (MAOB inhibit.) drug gives you HTN with high doses along with what other adv effect?

A
  1. Selegiline

2. Insomnia

38
Q

Which Parkinson’s drug is worthless if given without LDopa?

A

Entacapone (COMT inhib.)

39
Q

Which COMT inhib. has hepatoxicity and thus not used anymore?

A

Tolcapone

40
Q

What are the adverse effects of Entacapone?

A
  1. Orthostatic Hypotension
  2. Dyskinesia
  3. Hallucinations
  4. N/V
41
Q

What is the MOA of the COMT inhibitors?

A

Prevents metabolism of Dopa in to 3-0 methyldopa by inhibiting COMT

42
Q

Which Anti-Parkinsons drug is an Ergot alkaloid?

A

Bromocriptine

43
Q

What are the adverse effects of Bromocriptine?

A
  1. Hallucinations/Delusions
  2. Delirium/confusion
  3. GERD
  4. Orthostatic Hypotension
  5. Arrhythmias
  6. MI
  7. Dyskinesias (rare)
  8. RETROPERITONEAL FIBROSIS
44
Q

Which drugs are the SELECTIVE D2 agonists for Parkinsons?

A
  1. Pramipexole
  2. Ropinerole
  3. Rotigotine
  4. Apomorphine
45
Q

Which group of drugs can be used as a monotherapy for Parkinsons to delay TX with L dopa?

A

Dopa agonists–D2 selective group

these can also be used to treat Restless leg syndrome

46
Q

What are the containdications of the D2 selective group for Parkinsons?

A
  1. Dementia and elderly (increases death)

2. Cimetidine (decreases metabolism)

47
Q

What is the contraindication of Apomorphine?

A
  1. Odansetron (Zofran)
48
Q

What is the indication for the IV only Apomorphine?

A

Reserved for off periods with LDopa treatment

49
Q

What are the adv effects of the IV only Apomorphine?

A

Severe N/V (Tx: trimethobenzamide)

50
Q

Which SELECTIVE D2 agonist is topical?

A

Rotigotine

51
Q

Which SELECTIVE D2 agonist is PO?

A

Ropinerol

52
Q

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?

A

Pramipexol, Ropinerol, Rotigotine

TX: Modafinil

53
Q

What is the MOA of Amantidine?

A

NMDA Glutamate receptor antagonist

increases the synthesis and release of Dopa from surviving neurons

54
Q

What is the Indication of Amantadine?

A

Parkinsons

Brady and Rigidity > Tremors

55
Q

What are the adverse affects of Amantadine?

A 
Restelessness 
Insomnia
Agitation
Confusion 
Hallucinations 
Orthostatic Hypotension
URINARY RETENTION
DRY MOUTH
56
Q

Which anti-parkinson drug needs surviving neurons to have a positive effect?

A

Amantadine–the anti-viral

57
Q

What is the MOA of the anti-muscarinics used for Parkinson’s?

A

Block the excitatory muscarinic receptors to restore Dopa balance

58
Q

Which drugs can be used as LDopa add ons?

A
  1. COMT inhibitors
  2. Bromocriptine
  3. Antimuscarinics
59
Q

Would a NA glaucoma patient with BPH and pyloric stenosis be safe in taking an anti-muscarinic?

A

NO; all 3 conditions are contraindicated

60
Q

What are the indications for the antimuscarinics used for Parkinsons’?

A
  1. Parkinsons
  2. LDopa add on
  3. Tremor, Drooling > Bradykinesia
61
Q

If the Parkinsons’ patient is suffering from Brady and Rigidity what would you prescribe?

A

Amantadine

62
Q

If the Parkinsons’ patient is suffering from tremors and drooling, what would you prescribe?

A

Antimuscarinics

63
Q

What are the adverse effects of Antimuscarinics?

A

SLUDWARM + HALLUCINATIONS + CONFUSION

64
Q

What is the MOA of the AchE inhibitors used to treat Alzheimes?

A

Inhibit AchE

65
Q

What is the DOC for Alzheimers?

A

AchE inhibitors

66
Q

What are the adverse effects of the AchE inhibitors?

A
  1. All (EXCEPT Rivastigmine) inhibit CYP450
  2. Bradykinesia
  3. NVD
  4. Anorexia
  5. Tremors
  6. Muscle Cramps
67
Q

Which AchE inhibitor has a hepatoxicity effect?

A

Tacrine

68
Q

Which drug is an NMDA glutamate inhibitor with adverse effects of confusion, agitation, and restlessness?

A

Memantine

69
Q

Which drug is used to decrease the progression of Alzheimers short term memory loss?

A

Memantine

70
Q

Which drug with adverse effects of confusion, agitation, and restlessness is also similar to PCP?

A

Memantine

71
Q

Which anti-parkinson’s drug works in the periphery?

A

Entacapone

Pharm Exam 1 (8 decks)

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