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54/64 Final Content > Pharmacology For Neuromuscular Diseases > Flashcards

Pharmacology For Neuromuscular Diseases Flashcards

1
Q

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

A

80

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2
Q

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

A

Little; much

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3
Q

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

A

Levadopa-carbidopa

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4
Q

Antiparkinsonian drug therapies are aimed at

A

Increasing dopamine or antagonizing the effects of Ach

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5
Q

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

A

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

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6
Q

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

A

Off-on phenomenon

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7
Q

Classes of Antiparkinsonian drugs

A

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

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8
Q

Carbidopa-levodpa indications

A

Treatment of some of the symptoms of PD

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9
Q

How to take carbidopa-levodopa (Sinemet)

A

Orally on an empty stomach

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10
Q

Carbidopa-levodopa (Sinemet) contraindication

A

Angle-closure glaucoma

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11
Q

Carbidopa-levodopa adverse effects

A

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

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12
Q

Early side effect of carbidopa-levodopa

A

N/V

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13
Q

Why is carbidopa given with levodopa?

A

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

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14
Q

Effects of dopamine replacement drugs such as levodopa therapy

A

Off-on phenomenon and wearing-off phenomenon

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15
Q

Can dopamine be given orally?

A

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

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16
Q

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

A

Monoamine oxidase

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17
Q

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

A

MAOIs

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18
Q

MAOI non-selective interact with

A

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

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19
Q

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

A

Selegiline (Eldepryl) and rasagiline (Azilect)

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20
Q

MAOIs contraindications

A

Known drug allergy, concurrent use with meperidine (Demerol)

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21
Q

MAOIs adverse effects

A

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

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22
Q

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

A

Amantadine (Symmetrel)

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23
Q

Amantidine (Symmetrel) MOA

A

Blocks reputable of dopamine into the nerve fibers

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24
Q

Amantidine (Symmetrel) indications

A

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

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25
Q

Amantidine (Symmetrel) contraindication

A

Known drug allergy

26
Q

Amantidine (Symmetrel) adverse effects

A

Mild: dizziness, insomnia, nausea

27
Q

List two examples of COMT inhibitors

A

Tolcapone (Tasmar) and entacapone (Comtan)

28
Q

COMT inhibitors MOA

A

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

29
Q

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

A

COMT inhibitors

30
Q

COMT inhibitors contraindications

A

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

31
Q

COMT inhibitors adverse effects

A

GI upset, urine discoloration, dyskinesia

32
Q

Subclasses of Nondopamine dopamine receptor agonists (NDDRAs) for PD

A

Ergot and Nonergot derivatives

33
Q

Example of an ergot derivative NDDRA

A

Bromocriptine (Parlodel)

34
Q

Examples of Nonergot derivative NDDRAs

A

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

35
Q

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

A

NDDRAs

36
Q

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

A

Bromocriptine (Parlodel)

37
Q

Bromocriptine (Parlodel) contraindications

A

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

38
Q

Bromocriptine (Parlodel) adverse effects

A

Ataxia, depression, GI upset, visual changes

39
Q

Benefits of Nonergot NDDRAs

A

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

40
Q

Nonergot NDDRAs contraindications

A

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

41
Q

Adverse effects of Nonergot NDDRAs

A

Edema, fatigue, syncope

42
Q

Anticholinergics MOA

A

Block the effects of Ach

43
Q

Anticholinergics indications

A

Used to treat muscle tremors and muscle rigidity associated with PD

44
Q

Anticholinergic SLUDGE behaviors

A

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

45
Q

How to take anticholinergics

A

At bedtime; do not take with other PD drugs

46
Q

Anticholinergic drugs used for PD and EPS symptoms from antipsychotic drugs

A

Benztropine (Cogentin)

47
Q

Benztropine (Cogentin) contraindications

A

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

48
Q

Anticholinergic adverse effects

A

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

49
Q

Indirect acting cholinergic drugs for myasthenia gravis

A

Acetylcholinesterase inhibitors such as Pyridostigmine (Mestinon)

50
Q

Antidote for acetylcholinesterase inhibitors

A

Atropine

51
Q

Pyridostigmine (Mestonin) MOA

A

Increases acetylcholine by inhibiting acetylcholinesterase

52
Q

Pyridostigmine (Mestonin) contraindications

A

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

53
Q

Pyridostigmine (Mestinon) adverse effects

A

GI upset, excessive salivation

54
Q

Pyridostigmine (Mestonin) indications

A

Used to improve muscle strength in MG crisis

55
Q

Multiple sclerosis mainstays of treatment include

A

Antispasmodics and immunosuppressants such as corticosteroids

56
Q

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

A

Glatiramer acetate (Copaxone)

57
Q

First-line oral immunomodulator for treatment of MS

A

Fingolimod (Gilenya)

58
Q

Fingolimod (Gilenya) side effects

A

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

59
Q

Fingolimod (Gilenya) patient education

A

Take pulse everyday (d/t bradycardia)

60
Q

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

A

Interferon Beta

61
Q

Patients with MS can use Medical cannabis to reduce

A

Muscle spasms

54/64 Final Content (4 decks)

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