Pharmacology For Neuromuscular Diseases

Question 1

Parkinson’s Disease symptoms occur when about ___% of the dopamine stored in the substantia nigra of the basal ganglia is depleted

Answer 1

80

Question 2

PD worsesnw when too _____ dopamine is present and dyskinesia occurs when too _____ dopamine is present

Answer 2

Little; much

Question 3

What is one of the mainstays of treatment for Parkinson’s Disease?

Answer 3

Levadopa-carbidopa

Question 4

Antiparkinsonian drug therapies are aimed at

Answer 4

Increasing dopamine or antagonizing the effects of Ach

Question 5

T or F: Antiparkinsonian drug therapy helps to slow the progression of the disease

Answer 5

FALSE; drug therapy may slow the progression of SYMPTOMS but not the disease itself

Question 6

The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms

Answer 6

Off-on phenomenon

Question 7

Classes of Antiparkinsonian drugs

Answer 7

Dopamine replacement drugs, MAOIs, dopamine modulator, COMT inhibitors, direct-acting dopamine receptor agonists, anticholinergic drugs

Question 8

Carbidopa-levodpa indications

Answer 8

Treatment of some of the symptoms of PD

Question 9

How to take carbidopa-levodopa (Sinemet)

Answer 9

Orally on an empty stomach

Question 10

Carbidopa-levodopa (Sinemet) contraindication

Answer 10

Angle-closure glaucoma

Question 11

Carbidopa-levodopa adverse effects

Answer 11

Cardiac dysrhythmias, hypotension, chorea, muscle cramps, GI distress

Question 12

Early side effect of carbidopa-levodopa

Answer 12

N/V

Question 13

Why is carbidopa given with levodopa?

Answer 13

Carbidopa does not cross the BBB and prevents levodopa breakdown in periphery. As a result, more levodopa crosses the BBB where it can be converted to dopamine; ALSO, levodopa causes extreme nausea when taken alone

Question 14

Effects of dopamine replacement drugs such as levodopa therapy

Answer 14

Off-on phenomenon and wearing-off phenomenon

Question 15

Can dopamine be given orally?

Answer 15

NO; this is why levodopa comes in a form that can be given orally and coverted to dopamine

Question 16

Enzyme that causes the breakdown of catecholamines (like dopamine) in the body

Answer 16

Monoamine oxidase

Question 17

_________ are used to improve the therapeutic effect of levodopa by preventing its breakdown

Answer 17

MAOIs

Question 18

MAOI non-selective interact with

Answer 18

Tyramine-containing foods (cheese, dairy, red wine, chocolate, etc.)

Question 19

List two examples of MAOIs used as monotherapy or as adjunct with levodopa for PD

Answer 19

Selegiline (Eldepryl) and rasagiline (Azilect)

Question 20

MAOIs contraindications

Answer 20

Known drug allergy, concurrent use with meperidine (Demerol)

Question 21

MAOIs adverse effects

Answer 21

Hypotension, confusion, dyskinesia, somnolence, LOTS of drug interactions (warfarin, cardiac drugs, antibiotics, etc.)

Question 22

What is the only dopamine modulator for PD that is also an antiviral drug used for treatment of influenza?

Answer 22

Amantadine (Symmetrel)

Question 23

Amantidine (Symmetrel) MOA

Answer 23

Blocks reputable of dopamine into the nerve fibers

Question 24

Amantidine (Symmetrel) indications

Answer 24

Used early in course of PD, usually effective for only 6-12 months

Question 25

Amantidine (Symmetrel) contraindication

Answer 25

Known drug allergy

Question 26

Amantidine (Symmetrel) adverse effects

Answer 26

Mild: dizziness, insomnia, nausea

Question 27

List two examples of COMT inhibitors

Answer 27

Tolcapone (Tasmar) and entacapone (Comtan)

Question 28

COMT inhibitors MOA

Answer 28

Block COMT, the enzyme that catalyzes the breakdown of the body’s catecholamines

Question 29

__________ prolong the duration of action of levodopa (particularly when given w/ carbidopa) and reduce the wearing-off effect

Answer 29

COMT inhibitors

Question 30

COMT inhibitors contraindications

Answer 30

Known drug allergy; liver failure (w/ tolcapone — which is why it is not a first-line tx)

Question 31

COMT inhibitors adverse effects

Answer 31

GI upset, urine discoloration, dyskinesia

Question 32

Subclasses of Nondopamine dopamine receptor agonists (NDDRAs) for PD

Answer 32

Ergot and Nonergot derivatives

Question 33

Example of an ergot derivative NDDRA

Answer 33

Bromocriptine (Parlodel)

Question 34

Examples of Nonergot derivative NDDRAs

Answer 34

Pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro)

Question 35

All _________ work by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain

Answer 35

NDDRAs

Question 36

PD drug that works by activating presynaptic dopamine receptors to stimulate the production of more dopamine

Answer 36

Bromocriptine (Parlodel)

Question 37

Bromocriptine (Parlodel) contraindications

Answer 37

Drug allergy, used in conjunction with adrenergic drugs (Cardiovascular risk)

Question 38

Bromocriptine (Parlodel) adverse effects

Answer 38

Ataxia, depression, GI upset, visual changes

Question 39

Benefits of Nonergot NDDRAs

Answer 39

More specific Antiparkinson effects w/ fever adverse effects, used in both early and late stages of PD, may delay need for levodopa

Question 40

Nonergot NDDRAs contraindications

Answer 40

Drug allergy, not to be used concurrently w/ adrenergic drugs

Question 41

Adverse effects of Nonergot NDDRAs

Answer 41

Edema, fatigue, syncope

Question 42

Anticholinergics MOA

Answer 42

Block the effects of Ach

Question 43

Anticholinergics indications

Answer 43

Used to treat muscle tremors and muscle rigidity associated with PD

Question 44

Anticholinergic SLUDGE behaviors

Answer 44

Ach causes increased salivation, lacrimation, urination, diarrhea, GI motility, and emesis

Question 45

How to take anticholinergics

Answer 45

At bedtime; do not take with other PD drugs

Question 46

Anticholinergic drugs used for PD and EPS symptoms from antipsychotic drugs

Answer 46

Benztropine (Cogentin)

Question 47

Benztropine (Cogentin) contraindications

Answer 47

Known drug allergy; hot weather or activities that increase temp (risk for hyperthermia)

Question 48

Anticholinergic adverse effects

Answer 48

Tachycardia, confusion, disorientation, toxic psychosis, urinary retention, dry throat, constipation, N/V

Question 49

Indirect acting cholinergic drugs for myasthenia gravis

Answer 49

Acetylcholinesterase inhibitors such as Pyridostigmine (Mestinon)

Question 50

Antidote for acetylcholinesterase inhibitors

Answer 50

Atropine

Question 51

Pyridostigmine (Mestonin) MOA

Answer 51

Increases acetylcholine by inhibiting acetylcholinesterase

Question 52

Pyridostigmine (Mestonin) contraindications

Answer 52

Drug allergy, asthma, gangrene, CV disease, GI obstruction

Question 53

Pyridostigmine (Mestinon) adverse effects

Answer 53

GI upset, excessive salivation

Question 54

Pyridostigmine (Mestonin) indications

Answer 54

Used to improve muscle strength in MG crisis

Question 55

Multiple sclerosis mainstays of treatment include

Answer 55

Antispasmodics and immunosuppressants such as corticosteroids

Question 56

Synthetic protein similar in structure to myelin that helps with remyelination in patients with MS

Answer 56

Glatiramer acetate (Copaxone)

Question 57

First-line oral immunomodulator for treatment of MS

Answer 57

Fingolimod (Gilenya)

Question 58

Fingolimod (Gilenya) side effects

Answer 58

Bradycardia (especially within first 6 hr after taking it), facial flushing, GI upset

Question 59

Fingolimod (Gilenya) patient education

Answer 59

Take pulse everyday (d/t bradycardia)

Question 60

Aside from Fingolimod (Gilenya), what are other immunomodulators for MS?

Answer 60

Interferon Beta

Question 61

Patients with MS can use Medical cannabis to reduce

Answer 61

Muscle spasms