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Pharmacology II-Final > Pharmacology 1 > Flashcards

Pharmacology 1 Flashcards

1
Q

what is parkinson disease?

A

is a chronic, progessive, neurodegenerative disease

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2
Q

side effects of parkinson disease?

A

Nonmotor features such as dementia, psychosis, automomic dysfunction (excessive sweating, bladder frequency/urgency, orthostasis) often become more disabling features as the disease progesses

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3
Q

Nonpharmacologic choices for parkinsons’s disease?

A

-provide patient education via bookds, websites and local and national parkinson societies
-stress the importance of staying active and having a regular excercise routine
-Encourage awareness of the important roles of health professionals such as speech, physical and occupational therapists and home care as the disease becomes more advanced.
-Some patients may benefit from surgery

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4
Q

Drugs used to help relieve symtoms of parkinson’s disease?

A

-levodopa
-dopamine agonists (Bromocriptine, pramipexole, ropinirole, rotigotine, apomorphine)
-Monomaine Oxidase B inhibitors (Selegilline, rasagiline, safinamide)
-N-methyl-D-aspartate (NMDA) antagonists (Amantadine)
-Anticholinergics (Benztropine, ethopropazine and trihexyphenidyl)
-COMT inhibitors (Entacapone, tolcapone)

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5
Q

what does levodopa do?

A

It is a prodrug converted to dopamine peripherally
-peripheral dopamine cannot cross blood-brain barrier and ineffective for treatment of PD

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6
Q

MOA of levodopa?

A

-combined with a dopa decarboxylase inhibitor (carbidopa or benserazide)
inhibit peripheral transformation to dopamine thus enhancing districution to brain, reducing amount of levodopa reqiured for optimal therapeutic benefit and minimizing acute side effects

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7
Q

SE of levodopa?

A

nausea, vomiting, orthostatic hypotension, dyskinesias, hallucinations, confusion

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8
Q

Interactions of levodopa?

A

antihypertensives, diuretics, tricyclin antidepressants may increase hypotensive action
-may be taken with food to reduce nausea; should be taken on empty stomach in more advanced disease to help manage motor fluctuations

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9
Q

what drugs are dopamine agonists?

A

Bromocriptine, pramipexole, ropinirole, rotigotine, apomorphine

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10
Q

what is dopamine agonists used for?

A

effective as monotherapy in early stages of PD and as adjunctive therapy with levodopa more advanced motor complications

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11
Q

what can Bromocriptine cause?

A

pulmonary fibrosis, the newer, non-ergot dopamined agonists (pramipexole, ropinirole, rotigotine) are better choices

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12
Q

SE of dopamine agonists?

A

Gi upset, orthostatic hypotension, somnolence, confusion, hallcinations, nausea, vomiting, sudden slwwp attacks, caution with driving or operating dangerous machinery

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13
Q

Interactions of dopamine agonists?

A

avoid combining with 5HT3 antagonists due to risk of severe hypotension and loss of consciousness.
Antihypertensives, diurtics, vasodilators, tricyclic antidepressants may increase risk of severe hypotension

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14
Q

Parkinsonism-hyperpyrexia syndrome?

A

is a potentially fatal complication of PD treatment assocaited with abrupt reduction or discontiunation of dopaminergic drugs.

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15
Q

Monoamine oxidase B inhibitors drugs?

A

Selegilline
Rasegilline
Safinamide

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16
Q

selegilline MOA?

A

Irreversible inhibitor of monomaine oxidase B
may slow the progession of PD
Does not deplay development of dyskinesia or fluctuations assocaited with chonic levodoap therapy

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17
Q

what is rasagilline used for?

A

used as intial treatment to imporve motor symtoms and for patients with more advanced disease to help with wearing off
no evidence slows disease progession

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18
Q

What does safinamide do?

A

irreversible inhibitor of MAO-B
Modulator of glutamate

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19
Q

SE of monoamine oxidase B inhibitors?

A

insomnia, confusion, hallucinations, increased dyskinesia, nausea,orthostatic hypotension and other types of autonomic dysfunction

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20
Q

Interactions of monoamine oxidase B inhibitors?

A

Avoid concurrent use with serotonergic and other CNS modulators due to increased risk of serotonin syndrome and or hypertensive crisis (TCA, MAO-A inhibitors, SSRIs, SNRI)

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21
Q

What is the treatment for N-methyl-d-aspartate antagonist? moa?

A

insufficient evidence to support amantadine in treatment of early PD but improves dyskinesia

-may release dopamine from the presynaptic terminals or block its reuptake

22
Q

SE of N-methyl-D-aspartate antagonists?

A

leg edema, erythema and livedo reticularis
may increase confusion and should not be used in patients with cognitive deficits
avoid in pregnancy
nausea, constipation, dry mouth, insomnia, anxiety, imparied concentration

23
Q

interactions of N-methyl-D-asparatate antagonsits?

A

anticholinergic agents may increase effects

24
Q

drugs of anticholinergics?

A

benztropine, ethoproprazine and trihexyphenidyl

25
Q

what does anticholinergics have a major effect on?

A

tremor and little effect on bradykinesia

26
Q

is anticholinergics a first-line treatment

A

no since limited efficacy and side effects (dry mouth, urinary retention, constipation)

27
Q

what does anticholinergics cause a risk to?

A

risk of parkinsonism-hyperpyrexia syndrome with abrupt discontiunation; taper gradually

28
Q

SE of anticholinergics?

A

dry mouth, blurred vision, constipation, urinary retention, precipitation of angle-closure glaucoma, confusion, memory impairment

29
Q

what drugs are COMT inhibitors?

A

Entacapone, tolcapone

30
Q

MOA of COMT inhibitors?

A

inhibitor of catechol-O-methyltransferase
-prevent peripheral metabolism of levodopa
-increases its availability to the brain
-no effect if not used in conjunction with levodopa

31
Q

SE of COMT inhibitors?

A

relate to increased dopaminergic activity such as dyskinesia, confusion and or hallucinations.
-nausea, sleep disorder, anorexia, diarrhea, organge/brown urine

32
Q

Interactions of COMT inhibitors?

A

hypertensive crisis with nonselective MAOIs (phenelzine, tranycypromine, linezolid)
-risk of parkinsonism-hyperpyrexia syndrome with abrupt discontiunation; taper gradually
drug holidays not recommended

33
Q

treatment of nonmotor issues?

A

-depression is common in PD
-Keep in mind lack of facial expression in PD does not necessarily indicate sadness or depression
-SSRIs and TCA
-TCA used cautiously (anticholinergic effects more likely to induce delirium especially in memnory-impaired patients
-may aggravate orthostatic hypotension, risk of falls

34
Q

Psychosis is common in PD?

A

Typically more advanced disease
All meds for motor symptoms can contribute to psychosis in a dose-related fashion
As PD progesses, medication often reduced or withdrawn because of worsening cognitive status
-anticholinergics withdrawn first then selegilline, rasagilline, amantadine, dopamine agonsits and COMT inhibitors until only levodopa then reduce dose of levodopa
-Antipsychotics (quetiapine, clozapine) sometimes used
Clozapine appears lowest risk and shown clear benefit
with exception of quetiapine and clozapine, antipsychotics should be avoided in PD psychosis

35
Q

Dementia is common in patients with PD?

A

Cholinesterase inhibitors (donepezil, rivastigmine) have modest impact on improving dementia
-careful observation for deterioration in motor function reqiured

36
Q

How should sublingual nitroglycerin not be dispensed to the patient?

A

Properly repackaged in a prescription vial

37
Q

a fatal drop in blood pressure can occur when ___ is administered to patients who are taking nitroglycerin?

A

Vardenafil

38
Q

How do diuretics help lower BP?

A

Decrease blood volume reducing CO

39
Q

Glycoprotein IIb/IIIa inhibitors work by blocking the final pathway of platelet aggregation and are the only __ antiplatelet drugs?

A

Parenteral

40
Q

Which routes of administration can be used to administer heparin and low-molecular weight-heparin?

A

IV and subcutaneous (SQ)

41
Q

why is it important t not confuse LMWH and heparin?

A

LMWH is dosed less frequently than heparin and so confusing them could increase adverse effects

42
Q

which thyroid drug may produce a dangerous drop in white blood cells that increases the risk for serious infection?

A

Tapazole

43
Q

IF TCA’s block cholinergic receptor, which of the follwoing would you suspect to be a side effect?

A

Blurred vision

44
Q

which of the following proteins is relased as a response to injury and produces pain-causing inflammation?

A

Cytokines

45
Q

which of the following factors will not influence the outcome of antiviral therapy?

A

ability of the virus to penetrate the PNS

46
Q

___ would be prescribed for the treatment of H1N1 and H3N3 strains of influenza, but some strains may be resistant?

A

Oseltamivir

47
Q

Asthma can be managed using which of the following combinations?

A

Lifestyle modifications and medications

48
Q

which of the following leuotriene antagonists must be taken on an empty stomach?

A

Zafirlukast

49
Q

what is needed for the bacterial synthesis of DNA?

A

folic acid

50
Q

UVB levels are highest during midday?

A

False

51
Q

Chronic pain may persist for years and can be adequately controlled in all pain patients by pharmaceuticals?

A

False

52
Q

Antivirals are no virucidal, they are virustatic

A

True

Pharmacology II-Final (14 decks)

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