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Pharmacology Final Exam > Parkinson's Disease medications > Flashcards

Parkinson's Disease medications Flashcards

1
Q

Parkinson’s disease affects people over the age of _________

A

60

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2
Q

Parkinson’s disease affects men or women more?

A

men

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3
Q

Parkinson’s disease has a higher incidence in what race?

A

Caucasians

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4
Q

Bradykinesia:

A

Slow movements. (pt has a hard time moving)

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5
Q

Akinesia:

A

Absence of movement. Rigidity of movement.

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6
Q

Characteristics of Parkinson’s disease:

A
  • pill rolling of the hands
  • shuffling gait
  • difficulty sleeping
  • rigidity
  • tremors
  • postural instability
  • bradykinesia
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7
Q

Where is dopamine housed and released from?

A

Substantia Nigra

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8
Q

What houses the Substantia nigra and is where movement is controlled?

A

Basal ganglia

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9
Q

What are the neurotransmitters that we need to keep in balance:

A

Dopamine and acetylcholine

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10
Q

In Parkinson’s disease will dopamine be high or low?

A

Low

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11
Q

In Parkinson’s disease will acetylcholine be high or low?

A

High

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12
Q

For Parkinson’s disease what kind of medications do we want?

A

Dopaminergic and anticholinergic

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13
Q

In order for Parkinson’s disease to be diagnosed, you have to have cardinal symptoms, at least 2 out of the 4. The cardinal symptoms include:

A
  • Rigidity
  • Tremors at rest
  • Postural instability
  • Bradykinesia
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14
Q

In addition to motor symptoms you can also have additional symptoms with autonomic disturbances such as:

A
  • drooling
  • orthostatic hypotension
  • depression
  • psychosis
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15
Q

Acetylcholine is responsible for what?

A

Transferring the signals between the cells that affect our bodily function.

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16
Q

What is the goal of anticholinergic medications and what do they do?

A

Goal is to decrease acetylcholine. They control smooth muscle contractions, they are going to dilate our blood vessels, going to lower our heart rate, and going to increase bodily secretions.

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17
Q

What will Dopamine Receptor Agonists do to dopamine?

A

Help increase dopamine

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18
Q

Dopamine Receptor Agonist medication example:

A

Sinemet

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19
Q

What is Sinemet a combination of?

A

Levodopa and carbidopa

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20
Q

Why do we combine levodopa and carbidopa?

A

Levodopa helps increase our dopamine levels to the brain. But, Levodopa is metabolized easily outside of the blood brain barrier. Therefore, a small portion of the medication will get to the brain. Carbidopa helps prevent the breakdown of Levodopa and increases the concentration of dopamine to cross the blood brain barrier.

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21
Q

Sinemet is most effective within the:

A

first two years

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22
Q

Levodopa/Carbidopa (Sinemet):

A
  • highly effective, but benefits diminish over time.
  • MOST effective treatment for PD
  • PO administered, rapid absorption from small intestine.
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23
Q

Make sure patient taking Sinemet is not on what type of diet?

A

High protein diet (b/c protein inhibits the action of Sinemet)

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24
Q

Adverse effects of Sinemet:

A
  • Postural hypotension!!!!!!!!!!!
  • N/V
  • restlessness
  • agitation
  • anxiety
  • chest pain
  • dyskinesia
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25
Q

Sinemet drug interactions:

A
  • first generation antipsychotics
  • MAOIs
  • Anticholinergics
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26
Q

Sinemet and the ON and OFF EFFECT:

A

When the medication is working well and all of the sudden it doesn’t benefit you anymore.

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27
Q

Importance of taking Sinemet and to not forget?

A

If you forget to take it, then you will see symptoms come back. Need to maintain patients levels of dopamine. Give the medication on time all the time!!!!

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28
Q

Dopamine Agonists:

A
  • First-line drugs for mild to moderate PD.

- Action: direct activation of dopamine receptors in the striatum.

29
Q

Dopamine Agonist medication example (-ole):

A

Pramipexole (Mirapex)

30
Q

Pramipexole (Mirapex):

A
  • Can be used alone in early symptoms of PD.
  • Used with Levodopa in advancing PD.
  • Maximal benefits take several weeks (b/c we are changing the chemistry in our brain).
31
Q

Advantages to using Pramipexole (Mirapex):

A

It is less likely to cause movement disorders, and has a lower response failure.

32
Q

Adverse effects of Pramipexole (Mirapex):

A
  • Nausea
  • Dizziness
  • Insomnia
  • Fatigue during the day
  • Constipation
  • Weakness
  • Hallucinations
  • Impulse control problems (gambling)
33
Q

Drug example of COMT inhibitors (-capone):

A

Entacapone

34
Q

What other medication needs to be taken with Entacapone and why?

A
  • Must take Entacapone in addition to Levodopa. If taken alone it is uselss.
  • It helps increase the half life of Levodopa.
35
Q

Action of Entacapone:

A

Inhibits the COMT breakdown which helps prolong Levodopa in your system.

36
Q

Adverse effects of Entacapone:

A
  • Orange color of urine.
  • Dyskinesia
  • Sleep problems
  • Impulse control problems
  • Orthostatic hypotension.
37
Q

MAO-B Inhibitors (-giline) medication examples:

A
  • Selegiline (Eldepryl)

- Rasagiline (Azilect)

38
Q

What do MAO-B inhibitors do?

A

Helps prevent the breakdown of dopamine. This will increase dopamine levels.

39
Q

Adverse effect of MAO-B inhibitors:

A

Insomnia!!!!!!!!!

40
Q

Contraindications with MAO-B inhibitors:

A

-don’t combine with SSRI
-don’t combine with Demerol
(combination causes a decrease in BP, decrease in respirations and potential serotonin syndrome)

41
Q

MAO-B inhibitors:

A
  • considered first line drugs for treatment of PD.
  • shown to have modest improvement in motor function.
  • combination with levodopa helps reduce the wearing off effect.
42
Q

MAO-B inhibitors combined with Levodopa helps with what?

A

Helps reduce the wearing off effect

43
Q

Dopamine releaser drug example:

A

Amantadine

44
Q

Amantadine was originally developed as what?

A

an antiviral to treat the flu.

45
Q

Amantadine:

A
  • a dopamine releaser
  • stimulates dopamine release
  • can cause atropine like effects
  • can be used to combat dyskinesia of levodopa.
46
Q

Initial treatment for mild symptoms of PD use:

A

MAO-B inhibitor (Selegiline or Rasagiline)

47
Q

Initial treatment for more severe symptoms of PD use:

A 
Dopamine replacement (Levodopa)  OR 
Dopamine agonist (Pramipexole)
48
Q

True or false: the longer you use/or are on levodopa the higher the risk of you developing movement disorders?

A

True

49
Q

Non-motor symptoms and their management:

A
  • 90% of patients develop non-motor symptoms.

- Autonomic disturbances, depression, dementia, and psychosis.

50
Q

What medication is the only effective drug to treat depression in patients with PD?

A

Amitriptyline

51
Q

What is the goal of treatment for Parkinson’s disease medications?

A

To reduce symptoms (we aren’t removing or resolving the symptoms).

52
Q

Non-pharmacologic interventions for PD:

A
  • Speech therapy
  • PT and OT
  • The Michael J. Fox foundation
  • National Parkinson Foundation
  • Relief of tremors
53
Q

What treatment is controversial for PD:

A

Stem cell treatment

54
Q

What is the chance of females developing Alzheimer’s disease during the remainder of their lives at age 65.

A

1 in 6

55
Q

What is the chance of males developing Alzheimer’s disease during the remainder of their lives at age 65.

A

1 in 11

56
Q

Pathophysiology of Alzheimer’s:

A
  • Loss of acetylcholine
  • plaques of beta-amyloid
  • neurofibrillary tangles
  • loss of neuronal connections
57
Q

What is important to teach family members about medications for Alzheimer’s?

A

Medications for Alzheimer’s does not treat it. They do not significantly lower symptoms or slow the progression of the disease.

58
Q

Drug therapy for Alzheimer’s includes:

A

Cholinesterase inhibitors
NMDA receptor inhibitor
Neuropsychiatric symptoms (Risperidone and Olanzapine)

59
Q

Cholinesterase inhibitors:

A
  • Prevent the breakdown of acetylcholinesterase (so we increase acetylcholine).
  • These med delay the progression by 55 weeks.
  • Donepezil (Aricept), Galantamine (Razadyne), Rivastigmine (Exelon), Tacrine (Cognex).
  • want to administer med at bed time.
60
Q

Cholinesterase inhibitors drug interactions:

A

Antipsychotics and antihistamines

61
Q

Cholinesterase inhibitors side effects:

A
  • bronchoconstriction
  • loss of appetite
  • diarrhea
  • HA
62
Q

What would be the antidote to an overdose of Donepezil?

A

Atropine

63
Q

NMDA receptor inhibitor drug example:

A

Memantine (Namenda)

64
Q

Mechanism of action of NMDA receptor inhibitors:

A

modulates effects of glutamate at NMDA receptors. Helps slow neurotoxicity and prevents the overactivation of glutamate. (reduces effects of glutamate at NMDA receptors).

use for moderate to severe symptoms.

Slows things down in your brain in order to improve ones memory

65
Q

Drug interactions of NMDA receptor inhibitor:

A

NMDA antagonists, such as amantadine or ketamine

66
Q

Side effects of NMDA receptor inhibitor:

A
  • HA
  • constipation
  • confusion
  • dizzy
67
Q

Drug therapy for neuropsychiatric symptoms of pts who struggle with Alzheimer’s:

A
  • Risperidone

- Olanzapine

68
Q

Other possible treatments to delay onset of Alzheimer’s disease:

A
  • Statins (reverse short term and cognitive impairment)
  • Folic acid (slows down the decline)
  • Mediterranean diet (no processed foods, no meats, and no grains)
  • Light to moderate alcohol intake

Pharmacology Final Exam (1 decks)

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