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Pharm Final > Parkinson's and Alzheimer Drugs > Flashcards

Parkinson's and Alzheimer Drugs Flashcards

1
Q

what are the risk factors for Parkinson’s?

A
  • increased age (typically over 60)
  • white
  • men
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2
Q

what are the signs and symptoms of Parkinson’s?

A
  • speech difficulties
  • shuffling gait
  • bradykinesia
  • muscle rigidity
  • frozen face
  • tremors
  • pilling rolling
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3
Q

what are neurotransmitters like with Parkinson’s?

A
  • low dopamine (inhibitory)

- high acetylcholine (excitatory - tremors)

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4
Q

what part of the brain isn’t functioning right with Parkinson’s?

A
  • substantia nigra - where dopamine is produced

- basal ganglia - smooth muscle movements and houses the substantia nigra

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5
Q

what % of neurons need to be lost for Parkinson’s symptoms to present?

A

70-80%

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6
Q

what is needed for a Parkinson’s diagnosis?

A

2 out of the 4 cardinal symptoms

  • tremors at rest
  • rigidity
  • bradykinesia
  • postural instability
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7
Q

what other symptoms are associated with Parkinson’s besides motor issues?

A
  • depression
  • drooling
  • impotence
  • cold intolerance
  • orthostatic hypotension
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8
Q

what 2 broad types of medications are needed for Parkinson’s?

A

dopaminergic and anticholinergic

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9
Q

what are the overall effects of an anticholinergic drug (not directly related to Parkinson’s)?

A
  • control smooth muscle
  • decrease heart rate
  • vasodilate
  • increase body secretion
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10
Q

what are 2 examples of dopamine receptor agonists?

A
  • levodopa/carbidopa (Sinemet)

- carbidopa

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11
Q

what is the purpose of levodopa and carbidopa being prescribed together?

A

together it increases the concentration of dopamine that crosses the blood-brain barrier
- levodopa mostly ends up outside the brain because it metabolized fast but carbidopa helps prevent the breakdown outside of the brain

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12
Q

what is the action of levodopa specifically? what is the action of carbidopa specifically?

A
  • levodopa - increases dopamine

- carbidopa - increase the amount of levodopa that gets to the brain

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13
Q

when do the benefits of levodopa/carbidopa (Sinemet) typically diminish?

A

2-5 years

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14
Q

what are the benefits of levodopa/carbidopa (Sinemet)?

A
  • highly effective, but benefits diminish over time

- most effective treatment for PD

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15
Q

what route is levodopa/carbidopa (Sinemet) given?

A

PO - rapid absorption by the small intestine

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16
Q

what foods should be avoided with levodopa/carbidopa (Sinemet)?

A

avoid a protein-rich diet and high acidic foods

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17
Q

what are the adverse effects of levodopa/carbidopa (Sinemet)?

A
  • POSTURAL HYPOTENSION (stay hydrated)
  • nausea and vomiting
  • chest pain
  • anxiety
  • increased heart rate
  • increased involuntary movement
  • prolongation of QRS
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18
Q

what is the on-off effect?

A

levodopa/carbidopa (Sinemet) can stop working

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19
Q

what teaching is needed with levodopa/carbidopa (Sinemet)?

A

it is time-critical - don’t miss a dose or the s/s will return

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20
Q

what is the use of a dopamine agonist?

A

first-line for mild to moderate PD

- direct activation of dopamine receptors in the striatum

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21
Q

what is an example of a dopamine agonist?

A

pramipexole (Mirapex) -ole

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22
Q

when is pramipexole (Mirapex) used?

A

used aline in early PD or with levodopa in advancing PD

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23
Q

what are the benefits of pramipexole (Mirapex)?

A
  • less likely to cause movement disorders or akinesia than Sinemet
  • less response failure than levodopa
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24
Q

what teaching is needed with pramipexole (Mirapex)?

A

maximal benefits take several weeks and it takes several weeks for pramipexole (Mirapex) to be completely out of the system

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25
Q

what are the adverse effects of dopamine agonists - pramipexole (Mirapex)?

A
  • N/V
  • dizziness
  • weakness
  • sleepiness through day
  • insomnia at night
  • hallucinationS
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26
Q

what is a major concern with dopamine agonists - pramipexole (Mirapex)?

A

impulse control like pathologic gambling due to increased dopamine

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27
Q

what is an example of COMT inhibitors (-capone)?

A

entacapone

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28
Q

entacapone is useless without what?

A

levodopa - adjunct therapy

29
Q

what are the side effects of entacapone?

A
  • orange colored urine
  • dyskinesia
  • impulse control
  • sleep issues
30
Q

what is the action of entacapone?

A

inhibits COMT to prevent levodopa breakdown

- enhances levodopa

31
Q

what are 2 examples of MAO-B inhibitors?

A

selegiline (Eldepryl) and rasagiline (Azilect)

-giline

32
Q

what is the action of MAO-B inhibitors?

A

prevent the breakdown of natural dopamine

33
Q

what is an adverse effect of MAO-B inhibitors?

A

insomnia

34
Q

what drugs are contraindicated with MAO-B inhibitors?

A
  • SSRIs - serotonin syndrome

- Demerol - decreased respiration and blood pressure

35
Q

what is considered a first-line treatment for PD?

A

MAO-B inhibitors - selegiline (Eldepryl) and rasagiline (Azilect)

36
Q

what else should be known about MAO-B inhibitors?

A
  • modest improvement in motor function

- combination with levodopa can reduce the wearing-off effect

37
Q

what is an example of a dopamine releaser?

A

amantadine

38
Q

what is the action of a dopamine releaser?

A

stimulates dopamine release

39
Q

what are the side effects of dopamine releasers?

A

can cause atropine-like effects

  • chest pain
  • cough
  • dryness
  • eye dilation
40
Q

what are dopamine releasers used for?

A
  • originally used for the flu
  • can be used to combat dyskinesia of levodopa
  • more for mild PD
41
Q

what anticholinergic drugs are used for PD?

A

benztropine (Cogentin)

42
Q

what drugs are used for mild symptoms of PD?

A

MAO-B inhibitors: selegiline or rasagiline

43
Q

what drugs are used for more severe symptoms of PD?

A

dopamine replacement (levodopa) or dopamine agonist (pramipexole)

44
Q

true or false: the longer you are on levodopa the more movement issues there are

A

true

45
Q

how many patients develop nonmotor symptoms with PD?

A

90% - autonomic disturbances, depression, dementia, and psychosis

46
Q

what drug is effective in treating depression with PD?

A

amitriptyline

47
Q

what are other adverse effects of PD?

A
  • falls
  • stress and anxiety
  • dementia
  • sleep
48
Q

what are other nontraditional drug treatments for PD?

A
  • speech therapy
  • PT and OT
  • deep brain stimulation
  • stem cell
49
Q

what is the pathophysiology for Alzheimer’s?

A
  • loss of acetylcholine
  • plaques of beta-amyloid
  • neurofibrillary tangles
  • loss of neural connections
50
Q

with Alzheimer’s is acetylcholine levels high or low?

A

low

51
Q

what is the action of cholinesterase inhibitors?

A

prevents the breakdown of acetylcholine

52
Q

what are examples of cholinesterase inhibitors?

A
  • donepezil (aricept)
  • galantamine (razadyne)
  • rivastigmine (exelon)
  • tacrine (cognex)
53
Q

what cholinesterase inhibitor can be used for all stages of Alzheimer’s?

A

donepezil (Aricept)

54
Q

what cholinesterase inhibitors can be used for mild to moderate s/s of Alzheimer’s?

A
  • galantamine (razadyne)
  • rivastigmine (exelon)
  • tacrine (cognex)
55
Q

when should cholinesterase inhibitors be taken?

A

at night

56
Q

what is the use of cholinesterase inhibitors?

A

doesn’t stop the progression of Alzheimer’s but delays it for 55 weeks

57
Q

what are drug interactions with cholinesterase inhibitors?

A
  • TCA’s
  • antipsychotics
  • antihistamines
58
Q

what are the side effects of cholinesterase inhibitors?

A
  • bronchoconstriction
  • diarrhea
  • decreased appetite
  • bradycardia
59
Q

what is the antidote for donepezil (Aricept)?

A

atropine (helps battle acetylcholine)

60
Q

what are the side effects of donepezil (Aricept) overdose?

A
  • N/V
  • decreased HR
  • drooling
  • sweating
  • fatigue
61
Q

what is an example of an NMDA inhibitor?

A

memantine (Namenda)

62
Q

what is NMDA inhibitor used for?

A

moderate to severe Alzheimer’s

63
Q

what is the action of NMDA inhibitors?

A
  • reduces glutamate at NMDA receptors
  • slows neural toxicity to prevent over the action of glutamate receptors
  • slows down activity in the brain to improve memory
64
Q

what are drug interactions with NMDA inhibitors?

A

NMDA antagonists: such as amantadine or ketamine

65
Q

what are the side effects of NMDA inhibitors?

A
  • headache
  • constipation
  • confusion
  • dizziness
66
Q

what percentage of Alzheimer’s patients experience neuropsychiatric symptoms? what are the symptoms?

A

80%

  • depression
  • aggression
  • impulsiveness
  • hallucinations
  • apathy
67
Q

what are two examples of atypical antipsychotic drugs used for Alzheimer’s?

A
  • risperidone

- olanzapine

68
Q

what are other possible treatments to delay the onset of AD?

A
  • statins
  • folic acid
  • Mediterranean diet
  • light to moderate alcohol intake

Pharm Final (5 decks)

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