Psychopharmacology Old Age Flashcards
T/F accepted practice in the management of patients with Parkinson’s disease (PD) is to delay treatment until the onset of disabling symptoms
T
Examples of dopamine receptor agonists
Bromocriptine, ropinirole, cabergoline, apomorphine
Dopamine receptor agonists FOUR ix prior to tx and why?
echocardiogram
ESR
creatinine
chest x-ray
pulmonary, retroperitoneal and cardiac fibrosis
What to warn pts about re dopamine receptor agonists?
impulse control disorders
excessive daytime somnolence
Which is more likely to cause hallucinations in elderly levodopa/DRA
Dopamine receptor agonists
Why is levodopa combined with a decarboxylase inhibitor
prevent peripheral metabolism of levodopa to dopamine
How long does levodopa take to work?
2 yrs
Unwanted s/e of levodopa?
dyskinesia (involuntary writhing movements)
‘on-off’ effect
dry mouth
anorexia
palpitations
postural hypotension
psychosis
drowsiness
MAO-B (Monoamine Oxidase-B) inhibitors example
Selegiline
MAO-B (Monoamine Oxidase-B) inhibitors work by
inhibits the breakdown of dopamine secreted by the dopaminergic neurons
how does Amantadine work
probably increases dopamine release and inhibits its uptake at dopaminergic synapses
Entacapone, tolcapone are?
COMT (Catechol-O-Methyl Transferase) inhibitors
what is COMT
enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy
Which medication is used for drug-induced parkinsonism rather than idiopathic Parkinson’s disease
Antimuscarinics
Centrally-acting antihypertensives (e.g. methyldopa, reserpine, and clonidine) can cause
depressive symptoms
What is the mechanism of Donepezil
Reversible acetylcholinesterase inhibitor
What is the mechanism of Tacrine
Reversible acetylcholinesterase inhibitor
What is the mechanism of Rivastigmine
Reversible acetylcholinesterase inhibitor and butyrylcholinesterase inhibitor
What is the mechanism of Galantamine
Selective, competitive and reversible inhibitor of acetylcholinesterase. In addition, galantamine enhances the intrinsic action of acetylcholine on nicotinic receptors, probably through binding to an allosteric site of the receptor.
What is the mechanism of Memantine
Non-competitive NMDA antagonist
What is the mechanism of
What is the mechanism of
Medications Linked to Mood Changes
Centrally-acting antihypertensives (e.g. methyldopa, reserpine, and clonidine) can cause depressive symptoms.
Interferon-a is capable of inducing depressive symptoms.
Digoxin is capable of inducing depressive symptoms.
Corticosteroids can cause depressive, manic, and mixed symptoms with or without psychosis.
Antidepressants can precipitate mania.
Medications Linked to Psychosis
Anti-Parkinsons Medications (e.g. bromocriptine, amantadine, selegiline, anticholinergics (e.g. trihexyphenidyl, benztropine, benzhexol), and levodopa).
Corticosteroids
Medications Linked to Anxiety
Stimulants
β adrenergic inhalers
Which Anti psychotic has a high effect on prolonging the q.T c interval
Pimozide
Whixh dementia medication has been shown to have a neuroprotective effect, particularly in patients with moderate to severe Alzheimer’s disease
Memantine
