Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

pharm III exam 1 > Parkinson's and Alzheimers > Flashcards

Parkinson's and Alzheimers Flashcards

1
Q

what are the 4 major clinical features of parkinson’s disease

A
  1. bradykinesia
  2. muscular rigidity
  3. resting tremor
  4. impairment of postural balance, gait
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what class is Selegiline (Deprenyl®) in

A
  • MAO-B inhibitor
    • inhibit MAO-B in CNS
    • reduces striatal metabolism of DA
    • does not affect peripheral metabolism of DA by MOA-A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what class is Rasagiline (Azilect®) in

A

MAO-B inhibitor

  • inhibit MAO-B in CNS
  • function: reduces striatal metabolism of DA
  • does not affect peripheral metabolism of DA by MOA-A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what class is Tolcapone (Tasmar®) in

A

COMT inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what class is Entacapone (Comtan®) in

A

COMT inhibitor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the Dopamine receptor agonists

A
  • Bromocriptine (Parlodel®)
  • Pramipexole (Mirapex®)
  • Ropinirole (Requip®)
  • Apomorphine (Apokyn®)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what class is Amantadine (Symmetrel®) in

A

dopamine releasers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what class is Benztropine (Cogentin®) in

A

anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what class is Trihexyphenidyl (Artane®) in

A

anticholinergic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List the L-Dopa drugs used in parkinson’s disease

A
  • Levodopa (Dopar®; Larodopa®)
  • Carbidopa (Lodosyn®)
  • Carbidopa/levodopa (Sinemet®)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

List the drugs to tx alzheimers dz

A
  • Donepezil (Aricept®)
  • Rivastigmine (Exelon®)
  • Galantamine (Reminyl®)
  • Memantine (Namenda®
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes parkinson’s dz

A
  • characterized by the degeneration of dopamine (DA) neurons projecting from the substantia nigra (SN) to the corpus striatum (nigrostriatal pathway).
    • symptoms = 70- 80% decrease in striatal dopamine neurons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What happens to DA/ACh balance in parkinson’s ? what is the overall effect

A
  • Degeneration of DA neurons in the SN leads to an imbalance between DA and acetylcholine (ACh), such that the ACh pathways are now dominant.
    • DA pathways normally inhibit GABA output from the striatum, whereas acetylcholine stimulates it.
    • Loss of DA thus leads to overactivity of inhibitory GABA neurons
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is responsible for metabolism of dopamine

A
  • MAO-B
  • COMT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MOA of L-Dopa (Levodopa; dopar; larodopa)

A
  • increase dopamine levels
  • “replacement” therapy
  • L-dopa crosses BBB and is converted into DA in the neuron
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

peripheral effects of L-Dopa (Levodopa; dopar; larodopa)

A
  • severe nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

clinical uses of L-Dopa

A
  • improves PD for 3-4 years
  • effectiveness will go down over time
  • does not affect progression, DA neurons continue to degenerate
  • not effective in drug induced parkinsonism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

why does L-Dopa need to be administered in high doses

A
  • only 1-3% gets into the CNS
    • ​short half life: taken 3-4 x /day
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MOA of Carbidopa

A
  • dopa decarboxylase inhibitor that does not cross the blood brain barrier
    • Therefore, it inhibits the synthesis of DA from l-dopa in the periphery, but does not affect DA synthesis in the brain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

effect of combining L-Dopa with Carbidopa (sinemet)

A
  • decreases dose of L-Dopa needed
  • decreases peripheral effects -> nausea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

side effects of L-Dopa with Carbidopa (sinemet)

A
  • Nausea/emesis (still present)
    • don’t take antiemetics that block DA D2 (prochlorperazine)
  • dyskinesias
  • psychosis is possible -> tx with atypical antipsychotics
22
Q

What is the on-off phenomenon

A
  • only occurs in patients who have been treated with l-dopa; may result from brain adaptation
  • “off” = akinesia- due to falling drug levels
  • “on” = improved mobility accompanied by dyskinesia
23
Q

tx of on-off phenomenon

A
  • increase frequency of L-dopa doses
  • adjust diet
  • apomorphine (D2 agonist) used as “rescue”
    • temporary relief
24
Q

MOA of MAO-B inhibits in tx of parkinsons

A
  • inhibit dopamine metabolism
    • inhibit MAO-B in CNS
    • reduces striatal metabolism of DA
25
Q

MAO-A are responsible for metabolism of dopamine where

A

in peripheral system

26
Q

adverse effects of MAO-BI

A
  • insomnia
27
Q

drug interactions with MAO-BI

A
  • severe hypertension if combined with other MAOIs
  • Do NOT combine with Meperidine
  • if combined with TCAs or SSRI -> serotonin syndrome
28
Q

MOA of COMT inhibitors in tx of parkinsons

A
  • inhibit DA and L-dopa metabolism
29
Q

MOA of Tolcapone

A
  • inhibits COMT in CNS and periphery
    • not used often- associated with hepatic failure
30
Q

MOA of Entacapone

A
  • inhibits COMT in periphery only
    • increases pool of l-dopa for transport into brain
31
Q

unique side effects of COMT inhibitors

A
  • orange color in urine
32
Q

MOA of DA receptor agonists in tx of parkinsons

A
  • stimulate DA receptors
    • primarily DA D2
    • act directly on receptors so continue to be effective as the disease progresses
  • used in combination with L-dopa during “on-off” periods
33
Q

Bromocroptine is an Ergot derivative and thus associated with what side effect

A
  • Erythromelalgia
    • itchy and burning feet
34
Q

What are the dopamine receptor agonists of choice for tx of parkinsons. What are they used for?

A
  • Ropinirole
  • Pramipexole

*monotherapy in mild PD; soothing response to L-dopa in late PD

35
Q

DOC restless leg syndrome

A

Ropinirole

36
Q

MOA of Ropinirole

A
  • pure DA D2 agonist
37
Q

use of apomorphine

A
  • temprorary relief “rescue” of off periods in patients on L-dopa therapy
  • typically injected
38
Q

side effects of apomorphine

A
  • nausea
    • pt should take antiemetic prior to introduction
39
Q

List the side effects of dopamine agonists

A
  • N/V
  • posutral hypotension, cardiac arrhythmias
  • mental distrubances (inc dopa -> inc risk of psychosis)
40
Q

MOA of Amantadine in tx of parkinsons

A
  • antiviral used for influenza that increase Dopamine neurotransmission
  • used to tx eraly or mild cases of PD
41
Q

side effects of Amantadine

A
  • livedo reticularis: reddish/blue spotting of skin
  • toxic psychosis and convulsions with overdose
42
Q

MOA of Benzotropine and Trihexyphenidyl in tx of parkinsons

A
  • anticholinergics: restores DA/ACh balance in striatum
  • improves rigidity, tremor
    • little effect of bradykinesia
43
Q

list the risk factors for alzheimers

A
  • age
  • genetics: small risk
  • gender: female
  • lack of education
  • head injury
44
Q

autopsy of alzheimer brain shows

A
  • neuritic plaques: B amyloids
  • neurofibrillary tangles: tau proteins
    • ​toxic effect on acetylcholine
45
Q

Degeneration of what leads to alzhiemers

A
  • degeneration of cholinergic neurons (Ach)
    • from the nucleus basalis of Meynert which project to the cerebral cortex and hippocampus
    • involved in memory and cognition
46
Q

MAO of Donepezil

A
  • cholinesterase inhibitor
  • inhibit metabolism of ACh, increase amount of ACh in the nerve terminal
47
Q

MOA of Rivastigmine

A
  • cholinesterase inhibitor
  • inhibit metabolism of ACh, increase amount of ACh in the nerve terminal
48
Q

MOA of Galantamine

A
  • cholinesterase inhibitor
  • inhibit metabolism of ACh, increase amount of ACh in the nerve terminal
49
Q

cholinesterase inhibitors (AChE inhibitors) are metabolized by

A

CYP450

50
Q

side effects of cholinesterase inhibitors

A
  • peripheral effects of cholinergic side effects
    • N/V
    • diarrha
    • stomach cramps
51
Q

use of AChE inhbitors in the tx of alzheimers

A
  • taken once/day
  • increase brain activity and improves cognitive symptoms
  • may slow progression of dz
52
Q

MOA of Memantine

A
  • NMDA receptor antagonist (channel blocker)
  • blocks pathological activation of NMDA receptors
    • reduces excitotoxic effect of glutamate
    • slow degeneration

pharm III exam 1 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions