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Pharm 2 > Alzheimers, PD > Flashcards

Alzheimers, PD Flashcards

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1
Q

class: Levodopa (Dopar®)
Levodopa/carbidopa (Sinemet®)
Levodopa/carbidopa intestinal gel (Duodopa®)

A

Dopamine precursors

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2
Q

class: Apomorphine (Apokyn®)
Bromocriptine (Parlodel®)
Pramipexole (Mirapex®)
Ropinirole (Requip®)
Rotigotine (Neupro®)

A

dopamine agonists

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3
Q

class: Benztropine (Cogentin®)
Trihexyphenidyl (Artane®)

A

Anticholinergic agents (muscarinic receptor antagonists)

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4
Q

class: Selegiline (Eldepryl®)
Rasagiline (Azilect®)
Safinamide (Xadago®)

A

Monoamine oxidase B inhibitor

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5
Q

class: Tolcapone (Tasmar®)
Entacapone (Comtan®)

A

Catechol O-methyl transferase (COMT) inhibitor

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6
Q

levodopa response diminished in ___ years

A

3-5

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7
Q

pt counseling for levodopa

A

take on empty stomach

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8
Q

carbidopa function

A

Carbidopa inhibits peripheral dopa decarboxylase
§ Allows more levodopa to enter CNS
§ Carbidopa does not cross BBB, blocks dopa decarboxylase from converting levodopa to
dopamine in the plasma, allowing more levodopa to cross BBB

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9
Q

AEs:
GI: n/v, anorexia, acid production
Cardiovascular – orthostatic hypotension, tachycardia, arrhythmias à increased peripheral
catecholamines
§ Behavioral – agitation, confusion, depression, anxiety, delusion, hallucinations, compulsive
behavior
§ Dyskinesia – choreoathetosis (superimposed on normal involuntary movements of PD)
§ Response fluctuations – “on vs off” phenomenon, end of dose akinesia

A

Levodopa/carbidopa

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10
Q

Levodopa/carbidopa interactions

A

MAO-A inhibitors w/in 2 wks, vitamin B6

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11
Q

Levodopa/carbidopa cautions

A

Psychotic pts
§ CVD/arrhythmia hx
§ Glaucoma
§ Melanoma
§ PUD

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12
Q

Ergot derivative Dopamine Receptor Agonist

A

Bromocriptine

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13
Q

MOA: D2 receptor agonists

A

opamine Receptor Agonists

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14
Q

AEs: hypotension, nausea (pre-treat w/ anti-emetic), dyskinesia, somnolence

A

Apomorphine (Apokyn)

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15
Q

anti emetic for use w/ apomorphine

A

Trimethobenzamide 300mg PO/IM TID
o Start 3 days before initiating apomorphine, continue 2 months then reassess need

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16
Q

med interactions: apomorphine

A

AVOID ondansetron à hypotension and LOC
• AVOID dopamine antagonists (promethazine and metoclopramide) à dec effectiveness

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17
Q

AEs:
o GI: N/V, loss of appetite, anorexia
o CV: orthostatic hypotension
o Dyskinesia – similar to levodopa, reduce total dose of dopaminergic drugs
o Behavioral – confusion, hallucinations, somnolence, impulse control disorders
§ Previous tendency or new phenomena
§ Gambling, shopping, etc

A

dopamine Receptor Agonists

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18
Q

dopamine Receptor Agonists cautions

A

Cardiac dz, psychosis hx, CNS depressant use

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19
Q

Monoamine Oxidase B Inhibitors for PD: low or high dose?

A

low

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20
Q

AEs:
o Insomnia à administer early in the day, less likely w/ rasagiline
o Dizziness, orthostatic hypotension
o GI distress
o Dyskinesia
o At therapeutic doses, less likely to cause HTN crisis or serotonin syndrome

A

Monoamine Oxidase B Inhibitors

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21
Q

MOA: lowers peripheral metabolism of dopamine/levodopa
o Preserves levodopa à decreases clearance, more enters CNS à prolonged effect, less dosage used
o Reduces response fluctuations à increase “on” time, decrease “off” time

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A

Catechol-O-Methyl Transferase Inhibitor

22
Q

AEs: typically attributed to increase in levodopa exposure
o GI – N/V/D
o CV – orthostatic hypotension
o Compulsive behaviors possible

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A

Catechol-O-Methyl Transferase Inhibitor

23
Q

Catechol-O-Methyl Transferase Inhibitor cautions

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A

Psychosis, hx of melanoma, CNS depressant use

24
Q

main effect of anticholinergic agents

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A

improves resting tremor

25
AEs: constipation, xerostomia, urinary retention, confusion, blurred vision, tachycardia
Anticholinergic Agents
26
Anticholinergic Agents cautions
Elderly o CV dz o Prostatic dz o Glaucoma
27
Amantadine (Symmetrel) as monotherapy for PD?
no
28
MOA: NMDA receptor antagonist o Blocks glutamate transmission, enhances dopamine release, blocks acetylcholine o Weak anti-Parkinson’s’ action (bradykinesia, rigidity, tremor) that typically lasts a few weeks
Amantadine (Symmetrel)
29
pharm targets for alzheimers
Improving cholinergic neurotransmission o Inhibiting acetylcholinesterase Inhibition of NMDA receptor-mediated excitotoxicity; limits glutamate
30
class: Donepezil (Aricept®) Rivastigmine (Exelon®) Galantamine (Razadyne®)
Cholinesterase Inhibitors
31
class: Memantine (Namenda®)
NMDA antagonist
32
AEs: o N/V/D à do not give anticholinergic medications for management of symptoms o SLUDGE = salivation, lacrimation, urination, diarrhea, GI upset, emesis
Cholinesterase Inhibitors
33
AEs: § N/V/D, SLUDGE § HA, insomnia, muscle cramps § Bradycardia, syncope, dizziness
Donepezil (Aricept)
34
Donepezil (Aricept) interactions
CYP3A4 substrate metabolism
35
wait ___ before switching to different cholinesterase inhibitor
3-6 months
36
Donepezil (Aricept) dose increases
4-6 weeks between 5 and 10mg increment o 3 months between 10-23mg increment
37
which cholinesterase inhibitor comes in transdermal patch
Rivastigmine
38
Rivastigmine dosing
2 weeks for oral dose adjustment, 4 weeks for patch dose adjustment
39
AEs: § n/v/d, SLUDGE (less w/ transdermal patch) § Anorexia, dizziness, fatigue § Parkinson’s Exacerbation • b/c if dopamine neurons are lost ACh is imbalanced and we are adding more ACh o Too much ACh
Rivastigmine
40
MOA: Nicotinic receptor modulator à releases additional ACh § Increases glutamate and serotonin
Galantamine
41
Galantamine dosing
4 weeks between dose adjustments
42
indications: Memantine
mod-severe AD
43
Memantine dose adjustments
1 week between dose adjustments
44
AEs: o Dizziness, HA, confusion o Somnolence o Weight gain o Hallucinations o Aggression
Memantine
45
tell pt to take MAO-B inhibitors when?
am bc of insomnia
46
MAO-B inhibitor causing the least insomnia
rasagiline
47
classes to treat AZ
Cholinesterase Inhibitors NMDA Antagonist
48
classes to treat PD and suffixes
Dopamine Precursors (-dopa) Dopamine Receptor Agonists (ole, tine) Monoamine Oxidase B Inhibitors (line, amide) Catechol-O-Methyl Transferase Inhibitor (pone) Anticholinergic Agents (pine, dyl)
49
main levodopa SEs
nausea, agitation, confusion, dyskinesia
50
main dopamine receptor agonist SEs
Behavioral à confusion, hallucinations, somnolence, impulse control disorders § Previous tendency or new phenomena § Gambling, shopping, etc

Pharm 2 (29 decks)

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