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Pharm 225B > CNS 1 -PD, AD, Epilepsy > Flashcards

CNS 1 -PD, AD, Epilepsy Flashcards

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1
Q

Dopamine replacement
Parkinson’s Disease

A

levodopa/carbidopa

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2
Q

Dopamine agonist (4)`
Parkinson’s Disease

A

pramipexole
ropinerole
bromocriptine- ergot alkaloid, rare use
rotigotine (patch)

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3
Q

COMT inhibitors (2)
Parkinson’s Disease

A

entacapone
tolcapone

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4
Q

Dopamine releaser
Parkinson’s DIsease

A

amantadine

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5
Q

MAO-B inhibitor (2)
Parkinson’s Disease

A

selegiline
rasagiline

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6
Q

Anticholinergics (3)
Parkinson’s Disease

A

trihexyphenidyl (artane)
benzotropine (cogentin)
biperadin (akineton)

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7
Q

Levodopa
PD

A

immediate precursor of dopamine
- transported across BBB via amino acid transporters and converted to dopamine in the brain

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8
Q

Levodopa MOA
PD

A

increase amount of dopamine in the brain
(giving dopamine back)

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9
Q

Carbidopa MOA
PD

A

inhibits peripheral decarboxylase
- maximizing L-dopa delivery to the brain

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10
Q

Entacapone MOA
PD

A

inhibits COMT (catechol- O- methyltransferase)
- maximizing L-dopa delivery to the brain
- increases plasma t1/2 of L-dopa -> increasing availability

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11
Q

L-dopa AE
PD

A

N/V
loss of effectiveness
dyskinesias
psychosis
postural hypotension

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12
Q

Dopamine agonists (D2) uses
PD

A
  • monotherapy in younger pts, also for RLS
  • adjunctive therapy w/ L-dopa (orthostatic HTN, dyskinesias)
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13
Q

Non-ergot derivatives (3)
PD

A

pramipexole (mirapex)
ropinirole (requip)
apomorphine (apokyn) - SQ

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14
Q

Non-ergot derivatives AE
PD

A

nausea
sleep attacks
insomnia
compulsive behaviors

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15
Q

Ergot derivatives (1)
PD

A

bromocriptine

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16
Q

MAO-B inhibitors MOA
PD

A

inhibit metabolism, prolong L-dopa effects
- may have neuroprotective effects

selegine (eldepryl), rasagiline (azilect)

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17
Q

Amantadine (symmetrel) antiviral PD

A

MOA: stimulates dopamine release
blocks dopamine reuptake
blocks cholinergic and glutaminergic receptors

uses: dyskinesias

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18
Q

Amantadine (symmetrel) antiviral AE
PD

A

insomnia
agitation
irritability
hallucinations
restlessness

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19
Q

Antimuscarinic (anticholinergic) MOA
PD

A

block relative excess cholinergic fxn in basal ganglia
uses: tremors, rigidity

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20
Q

Antihistamine (1)
PD

A

diphenhydramine (benadryl)

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21
Q

Acetylcholinetrerase inhibitors (AChE-Is)
AD

A

donepezil (aricept)

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22
Q

AChE-Is MOA
AD

A

increase cholinergic transmission by reducing ACh metabolism

uses: symptomatic therapy for mild to moderate AD

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23
Q

AChE-Is AE
AD

Study These Flashcards
A

N/V
diarrhea
bradycardia
lightheadedness
insomnia
vivid dreams

24
Q

Memantine (namenda) MOA
AD

Study These Flashcards
A

blocks CA+ influx into neurons caused by excessive glutamate signaling

uses: symptomatic therapy for moderate to severe AD

25
Memantine (namenda) AE AD
lightheadedness confusion headache
26
Anti-epileptic drugs (AED) MOA
1. ion channel blockade - blockade of voltage-gated Ca+ channels - prolonged inactivation of Na+ channels 2. GABA potentiation - direct action on GABA receptor - indirect GABA effect -> decrease reuptake or metabolism, increase release
27
Phenytoin (dilantin) MOA AED
suppresses action potential through inactivation of Na+ channels uses: partial or generalized tonic clonic seizures
28
Phenytoin (dilantin) AE AED
cerebellar-vestibular symptoms: nystagmus ataxia diplopia vertigo arrhythmias hypotension gingival hyperplasia BBW: Steven's Johnson syndrome (SJS)
29
Phenytoin (dilantin) drug interactions
phenytoin may decrease by diazepam, cimetidine, alcohol, valproic acid
30
Carbamazepine (tegretol) MOA AED
inactivates Na+ channels uses: drug of choice for partial seizures and may be first for generalized tonic-clonic seizures
31
Carbamazepine (tegretol) AE AED
vertigo ataxia diplopia blurred vision (cerebellar-vestibular) small risk of small bone marrow suppression water retention induction of hepatic enzymes BBW: Steven's johnson syndrome (SJS)
32
Valproic Acid (depakene, depakote) MOA AED
blocks Na+ and Ca+ channels, also gaba effects uses: first line for all seizure types, bipolar disorder, migraine prevention
33
Valproic Acid (depakene, depakote) AE
N/V anorexia hepatotoxicity pancreatitis rash wt gain hair loss tremor or bone marrow suppression hepatic enzyme inhibitor - not recommended for pregnant women
34
Ethosuximide (zarontin) MOA AED
inhibits Ca+ channels in thalamic neurons uses: drug of choice for absence seizures
35
Ethosuximide (zarontin) AE
N/V anorexia
36
phenobarbitol MOA AED
potentiates GABA signaling through direct receptor binding uses: effective for generalized tonic-clonic and partial seizures, primarily used in children
37
Aducanumab (aduhelm)
MOA: monoclonal antibody therapy that removes amyloid uses: AD to lower amyloid levels in AD brain, does not slow the decline of cognitive fxn AE: urticaria, angioedema
38
phenobarbitol AE AED
marked sedation but some tolerance develops irritability hyperactivity in children agitation confusion in elderly respiratory depression induces hepatic enzymes
39
topiramate (topamax) MOA AED
blocks Na+ and Ca+ channels potentiates GABA and blocks glutamate receptors uses: partial and generalized seizures, Lennox-Gastaut, monotherapy, migraine prophylaxis
40
topiramate (topamax) AE AED
cerebellar/vestibular: ataxia, diplopia, dizziness CNS: somnolence, cognitive slowing, nervousness GI: nausea, vomiting, anorexia metabolic acidosis kidney stones hypohydrosis glaucoma
41
levetiracetam (keppra) MOA AED
not fully understood that it involves a synaptic vesicle protein SV2A may modulate release of glutamate and GABA - not metabolized by CYP
42
levetiracetam (keppra) uses AED
myoclonic seizures primary gen tonic-clonic partial- onset seizures migraine bipolar new onset pediatric epilepsy
43
Other anti-epileptic drugs (4)
oxycarbazepine (trileptal) lamotrigine (lamictal) gabapentin (neurotin) pregabalin (lyrica)
44
Treatment drugs for status epilepticus
Initial drug: benzodiazepine (IV lorazepam or diazepam) 2nd drug: IV fosphenytoin or phenytoin
45
Sedative hypnotic drugs
barbiturates benzodiazepines BZ-like drugs also used as: anti-anxiety anticonvulsants sedation/anesthesia hypnotic muscle relaxation alcohol withdrawal
46
Benzodiazepines (BDZs) MOA
enhance inhibitory activity of GABA by binding to benzodiazepine site on receptor
47
BDZ antagonist
flumanzenil (IV/IM)
48
Benzodiazepines (BDZs) AE
excessive or additive sedation w/other CNS depressants confusion anterograde amnesia abuse potential tolerance and cross tolerance w/ETOH
49
Zaleplon (sonata)
more selective because binds only to GABA receptors with alpha-1 subunits - rapid absorption, short half life
50
Zolpidem (ambien)
binds BZ site selectively with minimal muscle relaxing and effects - rapid onset, oral spray and sublingual tablets AE: drowsiness, complex sleep behaviors (driving, cooking, sex)
51
Exzopiclone (lunesta)
not restricted to short term use 12 mo. AE: unpleasant taste, HA, complex sleep behaviors, rebound insomnia
52
Suvorexant (belsomra)
dual orexin receptor antagonist (DORA) uses: helps for sleep, reduce insomnia
53
Ramelteon (rozerem)
melatonin receptor agonist uses: helps for sleep, reduce insomnia AE: dizziness, fatigue
54
Antidepressants (4)
venlafaxine paroxetine escitalopram duloxetine
55
Busprione (buspar)
MOA: partial agonist 5HT1a also D2 activity, selective anxiolytic, not a benxodiazepine uses: anxiety
56
Propofol
MOA: promotes GABA release AE: hypotension, can be abused
57
ketamine- esketamine (spravato)
MOA: S-Enantiomer of ketamine with analgesic anesthetic and antidepressant activities uses: major depression disorders

Pharm 225B (9 decks)

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