Neurodegenerative Disease Flashcards Preview

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Flashcards in Neurodegenerative Disease Deck (45):
1

Levodopa

Parkinsons

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Levodopa MOA

metabolic precursor to Dopamine. Becomes dopamaine to restore post-synaptic concentration of dopamine. Activates post-synaptic D1 and D2 receptors

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Carbidopa

inhibits dopa decarboxylase to allow levodopa to enter the BBB

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Levodopa contraindications

MAOI use, history of malignant melanoma, narrow angle glaucoma. Monitor LFT

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Levodopa ADR

Dyskinesias, "on-off" effect, Nausea, anorexia, hypotension, confusion, insomnia, nightmares, schizophrenic like syndrome

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Dopamine Agonists

apomorphine, bromocriptine, pergolide, pramipexole, ropinirole, rotigotine

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Dopamine Agonists ADR

N/V, anorexia, hypotension, cardiac arrythmias, HA, confusion, hallucinations, sedation, pulmonary fibrosis

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Ergot Dopamine Agonists

Bromocriptine and Cabergoline. D2 receptor agonists

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NonErgot Dopamine Agonists

Pramipexole, Ropinerole, Rotigotine (patch), Apomorphine

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Pramipexole indications

advanced Parkinsons and restless leg syndrome

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Ropinerole indications

monotherapy in mild parkinsons and restless leg syndrome

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Rotigone ADR

sudden somnolence

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Apomorphine receptor type

D1/D2

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Pramipexole receptor type

D3. some D2/D4

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Ropinerole receptor

D2

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Apomorphine indications

subQ injection for temporary relief of "off" periods

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Apormorphine ADR

dyskinesias, drowsiness, sweating, hypotension

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Selegiline MOA

monoamine oxidase- B inhibitors

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Selegiline indications

effective as monotherapy or in combination with levodopa for parkinsons. enables reduction in levodopa

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Selegiline ADR

blocks MAO-A at high doses, fatal hyperthermia

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Rasagiline MOA

irreversible MAO-B inhibitor

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Rasagiline indications

early treatment of Parkinsons and as adjunct with Levodopa

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Rasagiline metabolism

extensive liver metabolism. metabolized at CYP1A2.

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Rasagiline Drug interactions

meperidine, dextramethorphan, St. Johns Wort, cyclobenzaprine, ciprofloxacin

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Catechol-O-Methyltransferase inhibitors

Tolcapone, entecapone

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COMT inhibitors MOA

inhibits metabolism of dopamine. increase availability of Ldopa

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COMT indications

adjunct treatment for Parkinsons with levodopa

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COMTI ADR

increased plasma concentration of Ldop (dyskinesias, nausea, confusion), Diarrhea, abd pain, orthostatic hypotension, sleep disorders, orange urine discoloration. Tolcapone may be hepatotoxic

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COMT pearls

do not use MAO-A and COMT together. MAO-B may be okay. Entacapone=P450 inhibitor. Taper dosing for discontinuation

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Stalevo

Levodopa + Carbidopa + entacapone

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Amantadine

Antiviral drug with anti-parkinsonian properties

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Amantadine ADR

primarily CNS- restlessess, depression, irritability, insomnia, agitation, excitement, hallucinations, confusion, seizures. HA, edema, postural hypotension, HF, GI

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Anticholinergics MOA

dopamine def augment excitatory cholinergic system. blocks this system

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Anitcholinergics

Trihexyphenidyl and Benztropine

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AA of Neuro guidelines

Selegiline first, Levodopa or dopamine agonist, Alternative- exercise, speech therapy

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Cholinesterase inhibitors Indications

First line in Alzheimers

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Cholinesterase inhibitors

Donezepil, Rivastigmine, Galantamine

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Donezepil ADR

Cholinergic side effects , NVD, insomnia, fatigue, muscle cramps

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Donezepil interactions

metabolized by P450

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Rivastigmine ADR

NVD and weight loss, dyspepsia, sinusitis, dizziness

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Galantamine MOA

dual MOA. Competitive inhibition of acetylcholinesterase and allosteric modulation of presynaptic and postsynaptic nicotinic receptors

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Galantamine ADR

N, weight loss, agitation and diarrhea

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NMDA receptor Antagonists

Memantine

44

Memantine

noncompetitive NMDA receptor antagonist. increased glutamate release in CNS produces excitotoxic reactions and cell death, idea is to block this.

45

Memantine ADR

agitation, Diarrhea, insomnia, dizziness, HA, Hallucinations