Pharmacology 1

Question 1

what is parkinson disease?

Answer 1

is a chronic, progessive, neurodegenerative disease

Question 2

side effects of parkinson disease?

Answer 2

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

Question 3

Nonpharmacologic choices for parkinsons’s disease?

Answer 3

-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

Question 4

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

Answer 4

-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)

Question 5

what does levodopa do?

Answer 5

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

Question 6

MOA of levodopa?

Answer 6

-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

Question 7

SE of levodopa?

Answer 7

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

Question 8

Interactions of levodopa?

Answer 8

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

Question 9

what drugs are dopamine agonists?

Answer 9

Bromocriptine, pramipexole, ropinirole, rotigotine, apomorphine

Question 10

what is dopamine agonists used for?

Answer 10

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

Question 11

what can Bromocriptine cause?

Answer 11

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

Question 12

SE of dopamine agonists?

Answer 12

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

Question 13

Interactions of dopamine agonists?

Answer 13

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

Question 14

Parkinsonism-hyperpyrexia syndrome?

Answer 14

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

Question 15

Monoamine oxidase B inhibitors drugs?

Answer 15

Selegilline
Rasegilline
Safinamide

Question 16

selegilline MOA?

Answer 16

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

Question 17

what is rasagilline used for?

Answer 17

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

Question 18

What does safinamide do?

Answer 18

irreversible inhibitor of MAO-B
Modulator of glutamate

Question 19

SE of monoamine oxidase B inhibitors?

Answer 19

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

Question 20

Interactions of monoamine oxidase B inhibitors?

Answer 20

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)

Question 21

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

Answer 21

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

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

Question 22

SE of N-methyl-D-aspartate antagonists?

Answer 22

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

Question 23

interactions of N-methyl-D-asparatate antagonsits?

Answer 23

anticholinergic agents may increase effects

Question 24

drugs of anticholinergics?

Answer 24

benztropine, ethoproprazine and trihexyphenidyl

Question 25

what does anticholinergics have a major effect on?

Answer 25

tremor and little effect on bradykinesia

Question 26

is anticholinergics a first-line treatment

Answer 26

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

Question 27

what does anticholinergics cause a risk to?

Answer 27

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

Question 28

SE of anticholinergics?

Answer 28

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

Question 29

what drugs are COMT inhibitors?

Answer 29

Entacapone, tolcapone

Question 30

MOA of COMT inhibitors?

Answer 30

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

Question 31

SE of COMT inhibitors?

Answer 31

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

Question 32

Interactions of COMT inhibitors?

Answer 32

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

Question 33

treatment of nonmotor issues?

Answer 33

-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

Question 34

Psychosis is common in PD?

Answer 34

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

Question 35

Dementia is common in patients with PD?

Answer 35

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

Question 36

How should sublingual nitroglycerin not be dispensed to the patient?

Answer 36

Properly repackaged in a prescription vial

Question 37

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

Answer 37

Vardenafil

Question 38

How do diuretics help lower BP?

Answer 38

Decrease blood volume reducing CO

Question 39

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

Answer 39

Parenteral

Question 40

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

Answer 40

IV and subcutaneous (SQ)

Question 41

why is it important t not confuse LMWH and heparin?

Answer 41

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

Question 42

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

Answer 42

Tapazole

Question 43

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

Answer 43

Blurred vision

Question 44

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

Answer 44

Cytokines

Question 45

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

Answer 45

ability of the virus to penetrate the PNS

Question 46

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

Answer 46

Oseltamivir

Question 47

Asthma can be managed using which of the following combinations?

Answer 47

Lifestyle modifications and medications

Question 48

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

Answer 48

Zafirlukast

Question 49

what is needed for the bacterial synthesis of DNA?

Answer 49

folic acid

Question 50

UVB levels are highest during midday?

Answer 50

False

Question 51

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

Answer 51

False

Question 52

Antivirals are no virucidal, they are virustatic

Answer 52

True