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Flashcards in Dementia Drugs Deck (41)
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1

what condition is responsible for the largest fraction of dementia cases

- Alzheimer's disease

2

the movement symptoms of Huntington's disease result largely from aberrations in the _____ pathway

what happens in this pathway

- nigrostriatal dopaminergic


- releases dopamine into the striatum
- modulates signaling through the direct and indirect movement pathways of the basal ganglia

3

early stage Huntington disease is characterized by ______ in dopamine levels

- increase

4

drugs used to treat Huntington Disease

- Tetrabenazine
- Aripiprazole

5

MOA of Tetrabenazine

- inhibit VMAT transporter which transports dopamine into presynaptic vesicles
- reduces amount of dopamine released

6

MOA of Aripiprazole



may also treat

- dopamine antagonist
- directly compete with dopamine for binding to dopamine receptors on the postsynaptic cell

- agitation and psychotic symptoms

7

toxicities of Aripiprazole

- extrapyramidal symptoms
- neuroleptic malignant syndrome
- gynecomastia
- amorrhea
- sexual disfunction
- metabolic syndrome
- anti-cholinergic toxicities
- orthostatic hypotension
- sedation
- prolonged QT

8

Parkinson's disease is characterized by

- loss of dopaminergic neurons in nigrostriatal pathway

9

the pharmacotherapy goal of Parkinson's disease is _____ that for Huntington disease

- opposite

10

MOA of L-DOPA (Levodopa)


what do we give it with

- can cross the BBB where it is then converted into dopamine

- Carbidopa

11

MOA of Carbidopa



can it cross the BBB

- inhibitor of DDC which converts levodopa into dopamine in peripheral tissues
- increases amount of drug that reaches the brain

- cannot cross the BB so so doesn't not interfere with conversion of levodopa to dopamine in the brain

12

MOA of Entacapone

when do we add this to the treatment regimen

- inhibits COMT which breaks down levodopa

- after therapeutic effects of levodopa and carbidopa begin to fluctuate or wear off

13

what is the wearing off phenomenon with levodopa

- fewer neurons available in later stages of disease to convert levodopa to dopamine

14

toxicities of levodopa

- nausea/vomiting (chemoreceptor trigger zone)
- orthostatic hypotension (medulla)
- psychosis (mesocortical pathway)

15

MOA of Tolcapone

- COMT inhibitor

16

toxicities of Entacapone

- diarrhea

17

toxicities of Tolcapone

- diarrhea
- hepatotoxicity

18

levodopa interacts with which drugs




why?

- nonselective MAOIs
- isocarboxazid
- phenelzine
- trianylcipromine

- increase dopamine levels to a dangerous point

19

MOA of bromocriptine

- dopamine agonist in striatum

20

MOA of pramipexole

- dopamine agonist in striatum

21

MOA of Ropinirole

- dopamine agonist in striatum

22

toxicities of Bromocriptine

useful in treating

- prolactin suppression from pituitary gland
- cardiac valve fibrosis

- prolactinomas and other endocrine disorders

23

toxicities of pramipexole and ropinirole

- sedation
- somnolence
- sleep attacks

24

MOA of selegiline

- monoamine oxidase B inhibitor
- blocks breakdown of dopamine in neurons

25

MOA of rasagiline

- monoamine oxidase B inhibitor
- blocks breakdown of dopamine in neurons

26

MOA of amantadine

- helpful for treating influenza
- stimulates release of dopamine from nigrostriatal neurons

27

toxicities of amantadine

- dizziness
- insomnia
- somnolence
- hallucinations

28

MOA of benztropine
- trihexiphenidyl

- direct antagonist of acetylcholine
- reduces contribution from cholinergic stratal neurons
- re-establish balance between acetylcholine and dopamine signaling in the striatum

29

toxicities of anti-cholinergics

- dry mouth
- tachycardia
- constipation
- urinary retention

30

what drugs are good for treating mild PD symptoms in young patients

- MAOi OR
- amantadine OR
- anti-cholinergic (avoid in older patients)