Parkinson's/Alzheimer's (Exam #1) Flashcards
What four major sxs are seen with Parkinson’s Disease (PD)?
- Bradykinesia
- Muscular rigidity
- Resting tremor
- Impaired balance/gait
Which DA pathway is affected with PD, and which sub-pathway is OVER vs. UNDER active? What does this ultimately result in?
Loss of DA neurons in Nigrostriatal pathway (SNPC)
- Indirect pathway = OVER active
- Direct pathway = UNDER active
Results in decreased glutamate into cortex
What is the MOA of L-Dopa (Levodopa), and how does this occur?
Increase DA levels
- L-Dopa crosses BBB and is converted into DA in neuron
What are the two major AEs associated with L-Dopa (Levodopa)?
What drug can be combined with L-Dopa to reduce these AEs? What does the addition of this drug also allow for?
AEs = peripheral effects
- N
- V
Ad Carbidopa to reduce N AND reduce L-Dopa dose
What sxs does L-Dopa primarily treat? In what two ways is L-Dopa LESS/NOT effective than other options?
Bradykinesia
- L-Dopa does NOT affect progression = loses effectiveness with time
- NOT effective for drug-induced Parkinsonism (Ex. antipsychotics and EPS)
What is the On-Off Phenomenon? What drug can be used to as a “rescue” to treat this?
- “On” = improved mobility
- “Off” = akinesia
Tx: Apomorphine (Apokyn)
What is the MOAs of MAOIs as antipsychotics?
Inhibit DA metabolism (inhibit MAO-B in CNS)
What two AEs are associated with MAOIs as antipsychotics? What drug should they NOT be combined with?
- Insomnia (Amphetamine-like)
- Serotonin Syndrome
Do NOT combine with Meperidine
What is the MOA of Entacapone (Comtan), and what does this result in?
Inhibit COMT in periphery (inhibits DA, L-Dopa metabolism)
- Increases L-Dopa pool for transport into brain
What is the primary AE associated with Entacapone (Comtan)?
Orange-colored urine
What group of drugs continue to be effective as PD progresses, and what is their MOA?
DA Receptor Agonists
- Directly stimulate DA receptors
What is the primary AE associated with Bromocriptine, and why is this?
Erythromelalgia
- Ergot derivative
What is the DOC for RLS, and what type of PD drug is this classified as (based on MOA)?
Ropinirole
- DA Receptor Agonist
What is the MOA of Amantadine, and what is an alternative use of this drug?
Increase DA neurotransmission
- Antiviral for influenza
What is the primary AE associated with Amantadine?
Livedo reticularis (reddish/blue spotting of skin)
What anticholinergic drug is used to treat PD, and what two symptoms does it specifically alleviate?
Benztropine (Cogentin)
- Muscular rigidity
- Tremor
What two findings are pathognomonic for Alzheimer’s?
- Beta-Amyloids
- Tau proteins
What is the primary neuronal issue that results in Alzheimer’s?
Degeneration of cholinergic neurons
What class of drugs can be used to treat Alzheimer’s? What are three drugs examples?
Cholinesterase (AChE) Inhibitors
- Donepezil
- Rivastigmine
- Galantamine
What two roles do Cholinesterase (AChE) Inhibitors play in the treatment of Alzheimer’s?
- Improve cognitive function
- Slow disease progression (delays progression from mild cognitive impairment to full-blown AD)
What is the MOA of Memantine, and what is its primary use?
Selective NMDA receptor antagonist (reduces glutamate effects)
- Used in LATE stage Alzheimer’s in combination with AChE-Is
What is the one CI associated with Memantine?
Combination with Meperidine
What are the primary (general) AEs associated with Cholinesterase (AChE) Inhibitors in treatment of Alzheimer’s?
GI
- N, V, D, cramps
