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Flashcards in Exam 2 Neuro Deck (67)
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1

Medications used to treat Alzheimer’s

Cholinesterase inhibitors
NMDA receptor antagonist
Combination

2

Cholinesterase inhibitors

Rivastigmine
Donepezil
Galantimine

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NMDA receptor antagonist

Memantine

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Combination Rx for alzheimers

Donepezil + memantine

5

MOA Cholinesterase inhibitors

Selectively inhibit cholinesterase (enzyme that hydrolyzes or inactivates Ach) in CNS.
Increase Ach concentrations in cerebral cortex

6

Benefit of cholinesterase inhibitors

May slow deterioration of cognitive function. Preserves memory, learning, attention

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Route of administration for donepezil

PO, ODT

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Route of administration for rivastigmine

PO, transdermal patch

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Route of administration for galantamine

PO

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Adverse effects for all cholinesterase inhibitors

Diarrhea, nausea/vomiting, bradycardia, dizziness, syncope, urinary incontinence, hypersalivation, sweating

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Adverse effect of donepezil

Insomnia

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Adverse effect of rivastigmine

Hepatotoxicity

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Adverse effect of galantamine

Weight gain

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Drug interactions of cholinesterase inhibitors

Anticholinergic drugs

15

Cholinesterase inhibitor adverse effects pneumonic

DUMBELS - diarrhea, urination, miosis, bronchospasm, Messi, lacrimation, salivation

16

Cholinergic crisis s/s - pneumonic

SLUDGE - salivation, lacrimation, urination, defecation, gastric upset, emesis

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MOA of memantine

NMDA receptor antagonist. Attenuates excitotoxic effects of glutamate (neuroprotective)

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Adverse effects for memantine

Constipation, headache, confusion, dizziness, hallucinations, hypertension

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NMDA receptor antagonist characteristics

Indicated for moderate to severe disease, can be used in combination with cholinesterase inhibitors

20

Parkinson’s mortality is due to

Immobility - aspiration PNA, clotting disorder

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Parkinson’s without treatment

Progress to akinetic state 5-10 years

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S/s Parkinson’s

Severe loss of dopaminergic neurons in substantia negra
Presence of Lewy bodies - creates imbalance of acetylcholine and dopamine

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Pharmacologic targets for Parkinson’s disease

See slide 2 on page 9; neuro ptt 1

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Extrapyramidal symptoms in Parkinson’s

Bradykinesia, muscular rigidity, resting tremor, postural instability, tics

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Presentation of Parkinson’s disease

Extrapyramidal symptoms, speech disturbances, anxiety

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Dopaminergic agents used for Parkinson’s disease

Levodopa, amantadine

27

Levodopa MOA

Biosynthetic precursor of dopamine. Increases concentration of dopamine in the brain

28

Metabolism of levodopa

Metabolized in peripheral tissue by decarboxylase and catechol-O-methyl transferase (COMT). Less than 1% of Rx reaches brain if given as monotherapy. Need decarboxylase inhibitor and COMT inhibitor

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Characteristic of levodopa

ALWAYS given in combination with carbidopa

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Adverse effects of levodopa

N/V (take antacid 30m prior), orthostatic hypotension, sedation, depression, delirium, paranoia, delusions, hallucinations, motor fluctuations