Psychopharmacology Old Age

Question 1

T/F accepted practice in the management of patients with Parkinson’s disease (PD) is to delay treatment until the onset of disabling symptoms

Answer 1

T

Question 2

Examples of dopamine receptor agonists

Answer 2

Bromocriptine, ropinirole, cabergoline, apomorphine

Question 3

Dopamine receptor agonists FOUR ix prior to tx and why?

Answer 3

echocardiogram
ESR
creatinine
chest x-ray

pulmonary, retroperitoneal and cardiac fibrosis

Question 4

What to warn pts about re dopamine receptor agonists?

Answer 4

impulse control disorders
excessive daytime somnolence

Question 5

Which is more likely to cause hallucinations in elderly levodopa/DRA

Answer 5

Dopamine receptor agonists

Question 6

Why is levodopa combined with a decarboxylase inhibitor

Answer 6

prevent peripheral metabolism of levodopa to dopamine

Question 7

How long does levodopa take to work?

Answer 7

2 yrs

Question 8

Unwanted s/e of levodopa?

Answer 8

dyskinesia (involuntary writhing movements)
‘on-off’ effect
dry mouth
anorexia
palpitations
postural hypotension
psychosis
drowsiness

Question 9

MAO-B (Monoamine Oxidase-B) inhibitors example

Answer 9

Selegiline

Question 10

MAO-B (Monoamine Oxidase-B) inhibitors work by

Answer 10

inhibits the breakdown of dopamine secreted by the dopaminergic neurons

Question 11

how does Amantadine work

Answer 11

probably increases dopamine release and inhibits its uptake at dopaminergic synapses

Question 12

Entacapone, tolcapone are?

Answer 12

COMT (Catechol-O-Methyl Transferase) inhibitors

Question 13

what is COMT

Answer 13

enzyme involved in the breakdown of dopamine, and hence may be used as an adjunct to levodopa therapy

Question 14

Which medication is used for drug-induced parkinsonism rather than idiopathic Parkinson’s disease

Answer 14

Antimuscarinics

Question 15

Centrally-acting antihypertensives (e.g. methyldopa, reserpine, and clonidine) can cause

Answer 15

depressive symptoms

Question 16

What is the mechanism of Donepezil

Answer 16

Reversible acetylcholinesterase inhibitor

Question 17

What is the mechanism of Tacrine

Answer 17

Reversible acetylcholinesterase inhibitor

Question 18

What is the mechanism of Rivastigmine

Answer 18

Reversible acetylcholinesterase inhibitor and butyrylcholinesterase inhibitor

Question 19

What is the mechanism of Galantamine

Answer 19

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.

Question 20

What is the mechanism of Memantine

Answer 20

Non-competitive NMDA antagonist

Question 21

What is the mechanism of

Question 22

What is the mechanism of

Question 23

Medications Linked to Mood Changes

Answer 23

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.

Question 24

Medications Linked to Psychosis

Answer 24

Anti-Parkinsons Medications (e.g. bromocriptine, amantadine, selegiline, anticholinergics (e.g. trihexyphenidyl, benztropine, benzhexol), and levodopa).
Corticosteroids

Question 25

Medications Linked to Anxiety

Answer 25

Stimulants
β adrenergic inhalers

Question 26

Which Anti psychotic has a high effect on prolonging the q.T c interval

Answer 26

Pimozide

Question 27

Whixh dementia medication has been shown to have a neuroprotective effect, particularly in patients with moderate to severe Alzheimer’s disease

Answer 27

Memantine