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Pharm III Exam 1 > Parkinsons And Alzheimers (Lauren🌭) > Flashcards

Parkinsons And Alzheimers (Lauren🌭) Flashcards

1
Q

What causes Parkinson’s disease?

A
  1. Loss of dopamine neurons in Substantial Nigeria
  2. Overactivity of indirect pathway, Underactivity of direct pathway
  3. Increased GABA in thalamus
  4. Decreased glutamate input into cortex
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2
Q

What do dopamine and acetylcholine have to do with Parkinson’s?

A

Dopamine normally inhibits Acetylcholine’s excitatory effect on GABAergic output.

In Parkinson’s, there is the loss of Dopamine’s inhibition. And too much acetylcholine activity

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3
Q

Why can’t we just give dopamine to Parkinson’s patients?

A

Dopamine doesn’t cross the BBB

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4
Q

Why do we give L-Dopa to Parkinson’s patients?

A

It is a dopamine precursor that CAN cross the BBB and be converted into dopamine

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5
Q

How does L-Dopa help Parkinson’s?

A

It helps with the bradykinesia (slowness of movement)

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6
Q

Can you give L-Dopa forever?

A

No, the effectiveness will go down over time, and will only help symptoms for 3-4 years

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7
Q

Does L-Dopa stop the progression of Parkinson’s?

A

No, dopamine neurons will continues to degenerate.

You need dopamine neurons to convert L-dopa into dopamine, so thats why it won’t work forever

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8
Q

Can we use L-dopa in drug-induced Parkinson’s?

A

No. Not effective. Will not help treat extrapyramidal symptoms

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9
Q

You need a (small/large) dose of L-dopa to treat Parkinson’s

A

Large

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10
Q

Why do you need to give such high doses of L-Dopa for Parkinson’s?

A

Only 1-3% gets into the CNS

Where does the other 99% go….

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11
Q

What are the side effects of L-Dopa and what causes them?

A

“Peripheral effects”

Nausea/vomiting

Caused by the high amount of L-dopa in the periphery and GI tract that gets converted to dopamine.

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12
Q

Is there anything we can do to decrease the dose of L-Dopa and decrease the peripheral effects and nausea of L-Dopa

A

Yes you can combine it with Carbidopa

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13
Q

What effect does adding Carbidopa to L-Dopa have?

A

Inhibits dopa-decarboxylase in the periphery/GI

Conversion of L-Dopa to dopamine is inhibited in the periphery, but not in brain

= decreased dose of L-dopa needed

=decreases peripheral effects/nausea (does not completely eliminate though)

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14
Q

What are the side effects of L-dopa/Carbidopa?

A

nausea/vomiting

Postural hypotension

Arrhythmias

Hypertension

Dyskinesias**

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15
Q

Which is more likely to cause dyskinesias: L-Dopa alone, or L-Dopa/Carbidopa combo

A

L-Dopa/Carbidopa combo. Treat by reducing L-Dopa

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16
Q

What is meant by the on-off phenomenon of Parkinson’s treatment?

A

On- L-dopa is working and mobility is improved

Off- Falling drug levels cause akinesia

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17
Q

What drug can we give to “RESCUE” Parkinson’s patients out of the “off” phase?

A

Apomorphine (Apokyn)

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18
Q

What is the only contraindication to L-Dopa mentioned in the review?

A

Psychosis/Schizophrenia

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19
Q

What kind of Parkinson’s patient would be SUPER hard to treat?

A

If they had Parkinson’s AND schizophrenia

Not enough dopamine vs too much…reason why L-Dopa is contraindicated in psychosis

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20
Q

What are the 3 Parkinson’s drugs that inhibit Dopamine metabolism?

A

Selegiline (Deprenyl)

Rasagiline (Azilect)

Safinaminde (Xadago)

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21
Q

How do Selegiline (Deprenyl), Rasagiline (Azilect), and Safiniminde (Xadago) inhibit DA metabolism?

A

Inhibit MAO-B in the CNS to reduce striata metabolism of DA

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22
Q

Which MAO is inhibited by Selegiline (Deprenyl), Rasagiline (Azilect), and Safiniminde (Xadago)?

A

MAO-B in the CNS

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23
Q

Do Selegiline (Deprenyl), Rasagiline (Azilect), and Safiniminde (Xadago) have any effect on the peripheral metabolism of dopamine by MAO-A in the periphery?

A

No

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24
Q

How do Selegiline (Deprenyl), Rasagiline (Azilect), and Safiniminde (Xadago) affect sleep?

A

They can cause insomnia due to “Amphetamine like” metabolites

Best to take MAO-B inhibitors in the morning and at noon

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25
Q

What drugs can you NOT combine with MAO-B inhibitors?

A

Meperidine

TCAs

SSRIs

26
Q

Why can’t you combine MAO-B inhibitors with meperidine, TCAs, or SSRIs

A

SEROTONIN SYNDROME

27
Q

What does COMT do?

A

It metabolizes Dopaline and L-dopa

28
Q

What two drugs are COMT inhibitors?

A

Tolcapone (Tasmar)

Entacapone (Comtan)

29
Q

What is the difference between Tolcapone (Tasmar) and Entacapone (Comtan)?

A

Tolcapone (Tasmar)- inhibits COMT in the CNS and the periphery

Entacapone (Comtan)- inhibits COMT in periphery only

30
Q

What is the benefit of Entacapone (Comtan) inhibiting COMT in the periphery only?

A

Increases pool of L-dopa for transport in the brain

31
Q

What is the very interesting side effect of Tolcapone (Tasmar) and Entacapone (Comtan)?

A

Orange Urine

32
Q

What 4 drugs are Dopamine agonists?

A

Bromocriptine (Parlodel)

Ropinorole (Requip)

Pramipexole (Mirapex)

Apomorphine (Apokyn)

33
Q

What drugs are used as first-line therapy for Parkinson’s and in combo with L-Dopa during “on-off” periods?

A

Dopamine receptor agonists (Bromocriptine, Ropinirole, Pramipexole, Apomorphine)

34
Q

Will dopamine receptor agonists be effective as Parkinson’s disease progresses

A

Yes, since they act directly on the receptor

35
Q

Which dopamine receptor agonist is an Ergot derivative?

A

Bromocriptine (Parlodel)

36
Q

What is the weird side effect of Bromocriptine (Parlodel)?

A

Erythromelalgia (Red, swollen, itchy feet)

🦶🏻🦶🏻🦶🏻🤡

37
Q

Which drug is used for temporary relief/RESCUE of off-periods in patients on L-Dopa therapy?

A

Apomorphine (Apokyn) đźš‘

38
Q

What are the side effects of Dopamine agonists?

A

Postural hypotension

Ergot derivative- digital vasospasm

Arrhythmias- discontinue drug

Dyskinesias- similar to L-dopa, reduce dose

39
Q

What drug increases Dopamine release?

A

Amantadine (Symmetrel(

40
Q

Which drug in the treatment of Parkinson’s is an antiviral?

A

Amantadine (Symmetrel)

41
Q

What is the weird side effet of Amantadine (Symmetrel)?

A

Livedo reticularis- reddish/blue spotting on skin

42
Q

What drug can cause livedo reticularis (reddish/blue spotting on skin)?

A

Amantadine (Symmetrel)

43
Q

What two anticholinergics can be used in the treatment of Parkinson’s?

A

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

44
Q

Do anticholinergics have a large effect on Parkinson’s?

A

Mild anti-Parkinson activity

45
Q

There are 4 drugs on the market for Alzheimer’s and 3 of them do the same thing. What do they do?

A

Inhibit Acetylcholine metabolism

46
Q

What is wrong with the Alzheimer brain?

A

B-Amyloid plaques and Tau proteins build up and cause the degeneration of cholinergic neurons

47
Q

Which neurons are degenerated in the brain of someone with alzheimer?

A

Cholinergic

48
Q

What three Alzheimer’s drugs are cholinesterase inhibitors?

A

Donepezil (Aricept)

Rivastigmine (Exelon)

Galantamine (Reminyl)

49
Q

What is the MOA of Donepezil (Aricept), Rivastigmine (Exelon), and Galantamine (Reminyl)?

A

They inhibit metabolism of ACh, which increases the amount of ACh in the nerve terminal

50
Q

What are the side effects of cholinesterase inhibitors?

A

Your usual cholinergic side effects- SLUDGE

GI, Nausea, vomiting, diarrhea

51
Q

What drug class will help to slow the progression of Alzheimer’s and will give the patient more time before they have to go into full-time care?

A

Acetylcholinesterase inhibitors

Donepezil, Rivastigmine, Galantamine

52
Q

What is Memantine (Namenda) used for

A

Late stage Alzheimer’s in combination with an Aetylcholinesyerase inhibitor

53
Q

What is the MOA of Memantine (Namenda)?

A

Blocks overactive NMDA receptors, which reduces the excitotoxic effect of glutamate and slows degeneration

54
Q

What drug is contraindicated to combine with memantine (Namenda)

A

Meperidine

55
Q

A patient being treated for Parkinson’s complexing that his feet are hurting and turning red. Which drug is he most likely taking?

A

Bromocriptine (Parlodel)

Brooooooo my feet hurt

56
Q

Selegiline in the treatment of Parkinson’s:

A. Inhibits DA receptors

B. Inhibits MAO-B

C. Inhibits MAO-A and MAO-B

D. Inhibits COMT

E. Inhibits dopa decarboxylase

A

B

57
Q

What enzyme is inhibited by Carbidopa?

A

Dopa-decarboxylase

58
Q

Which drug acts on NMDA receptors to improve Alzheimer’s symptoms?

A

Memantine

59
Q

A patient has been taking L-Dopa/Carbidopa to treat Parkinson’s symptoms, but now the drugs are becoming less effective, why?

A

Degeneration of DA neurons

60
Q

Which of the following is NOT a mechanism for anti-Parkinson drugs:

A. Activate DA receptors

B. Increase DA levels

C. Inhibit DA reuptake

D. Inhibit DA metabolism

E. Block ACh receptors

A

C. Inhibit DA reuptake

61
Q

A patient is prescribed donepezil for treatment of Alzheimer’s disease. Which side effect is she MOST likely to complain about?

A. Constipation

B. Nausea

C. Sedation

D. Dry mouth

E. Postural hypotension

A

B. Nausea

Pharm III Exam 1 (4 decks)

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