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Flashcards in Neuro Drugs Deck (35):
1

Medications for Cognitive Impairment

Cholinesterase inhibitors
NMDA receptor antagonist

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Donepezil (Aricept)

Cholinesterase inhibitors

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Rivastigmine (Exelon)

Cholinesterase inhibitors

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Galantamine (Razadyne)

Cholinesterase inhibitors

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Cholinesterase inhibitors mechanism of action

Block the breakdown of acetylcholine (Ach) in the synaptic cleft
Increase availability of acetylcholine to postsynaptic Ach receptors

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Cholinesterase inhibitors
indications

Alzheimer’s disease
Parkinson’s disease dementia
Lewy body dementia (off label)

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Cholinesterase inhibitors side effects

Gastrointestinal: N/V, diarrhea, cramps
Anorexia, weight loss
Urinary incontinence
Salivation, lacrimation
Bradycardia / syncope

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Memantine (Namenda)

NMDA Receptor Antagonist

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Memantine Mechanism of action

Noncompetitive NMDA receptor antagonist
May reduce abnormal glutamatergic activity

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Memantine indication

Alzheimer’s disease – moderate to severe

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Memantine side effects

Dizziness
Headache
Confusion
Constipation

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motor symptoms of PD due to

dopamine deficiency

loss of nigrostriatal dopaminergic neurons in substantial nigra

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dopamine deficiency causes

less activation of direct pathway
less inhibition of indirect pathway
inhibits movements

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levodopa given concurrently with

carbidopa

causes nausea and vomiting due to peripheral metabolism in area postrema

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sinemet

25 mg carbidopa/100 mg levodopa

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levodopa side effects

Nausea / vomiting
Sleepiness
Hallucinations
Orthostatic hypotension

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levodopa unique side effects

wearing off
dyskinesias

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levodopa induced dyskinesias

Abnormal involuntary movements caused by levodopa
Often are choreiform (dance-like)

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Pramipexole (Mirapex)

Dopamine agonists

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Ropinirole (Requip)

Dopamine agonists

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Rotigotine (Neupro)

Dopamine agonists

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Dopamine agonists mechanism

Directly stimulate postsynaptic (and presynaptic) dopamine receptors

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advantages of dopamine agonists mechanism

less wearing off
less dyskinesias

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disadvantages of dopamine agonists mechanism

Less effective
More orthostatic hypotension, psychosis, and daytime sleepiness
“Sleep attacks” (falling asleep w/o warning)
Pedal edema
Impulse control disorders

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dopamine agonist withdrawal symptoms

mimics cocaine withdrawal

Fatigue/malaise
Anxiety/panic
Depression/dysphoria
Irritability /agitation
Sleep disturbance
Suicidality
Drug cravings
Nausea / vomiting
Orthostatic hypotension
Diaphoresis
Generalized pain
Restlessness

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non-dopaminergic medications fo PD

Anticholinergics
Amantadine
Monoamine oxidase (MAO-B) inhibitors
Catechol-O-methyltransferase inhibitors*

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anticholinergic side effects

Memory impairment
Confusion / psychosis
Constipation
Urinary retention
Dry mouth
Dry eyes
Blurry vision

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amantadine (symmetrel) side effects

Anticholinergic side-effects
Edema
Orthostatic hypotension
Livedo reticularis (rash)

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MAO-B inhibitors side effects

Nausea
Insomnia
Hallucinations
Orthostatic hypotension

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COMT inhibitors use

reduce wearing off. not effective as mono therapy

work synergistically with carbidopa

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indications of DBS

parkinson's disease
essential tremor
dystonia

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huntington's disease pathology

Death of specific striatal medium spiny neurons in the indirect pathway
Loss of striatal projections to the globus pallidus externa
Disinhibition of the thalamus

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dopamine depleters and blockers

Reduce dopaminergic function in the basal ganglia, and tend to reduce movement
Useful in the treatment of chorea and other hyperkinetic movement disorders

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side effects of haloperidol

Drug-induced parkinsonism
Acute dystonic reactions
Akathisia (restlessness)
Cardiac arrhythmias (QT prolongation)
Neuroleptic malignant syndrome

35

treatment of chorea in HD

Tetrabenazine (Xenazine)

Blocks the vesicular monoamine transporter-2 (VMAT2), which transports monoamines into synaptic vesicles
Depletes monoamines, including dopamine, serotonin, and norepinephrine