Neurodegenerative Disease

Question 1

Levodopa

Answer 1

Parkinsons

Question 2

Levodopa MOA

Answer 2

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

Question 3

Carbidopa

Answer 3

inhibits dopa decarboxylase to allow levodopa to enter the BBB

Question 4

Levodopa contraindications

Answer 4

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

Question 5

Levodopa ADR

Answer 5

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

Question 6

Dopamine Agonists

Answer 6

apomorphine, bromocriptine, pergolide, pramipexole, ropinirole, rotigotine

Question 7

Dopamine Agonists ADR

Answer 7

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

Question 8

Ergot Dopamine Agonists

Answer 8

Bromocriptine and Cabergoline. D2 receptor agonists

Question 9

NonErgot Dopamine Agonists

Answer 9

Pramipexole, Ropinerole, Rotigotine (patch), Apomorphine

Question 10

Pramipexole indications

Answer 10

advanced Parkinsons and restless leg syndrome

Question 11

Ropinerole indications

Answer 11

monotherapy in mild parkinsons and restless leg syndrome

Question 12

Rotigone ADR

Answer 12

sudden somnolence

Question 13

Apomorphine receptor type

Answer 13

D1/D2

Question 14

Pramipexole receptor type

Answer 14

D3. some D2/D4

Question 15

Ropinerole receptor

Answer 15

D2

Question 16

Apomorphine indications

Answer 16

subQ injection for temporary relief of “off” periods

Question 17

Apormorphine ADR

Answer 17

dyskinesias, drowsiness, sweating, hypotension

Question 18

Selegiline MOA

Answer 18

monoamine oxidase- B inhibitors

Question 19

Selegiline indications

Answer 19

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

Question 20

Selegiline ADR

Answer 20

blocks MAO-A at high doses, fatal hyperthermia

Question 21

Rasagiline MOA

Answer 21

irreversible MAO-B inhibitor

Question 22

Rasagiline indications

Answer 22

early treatment of Parkinsons and as adjunct with Levodopa

Question 23

Rasagiline metabolism

Answer 23

extensive liver metabolism. metabolized at CYP1A2.

Question 24

Rasagiline Drug interactions

Answer 24

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

Question 25

Catechol-O-Methyltransferase inhibitors

Answer 25

Tolcapone, entecapone

Question 26

COMT inhibitors MOA

Answer 26

inhibits metabolism of dopamine. increase availability of Ldopa

Question 27

COMT indications

Answer 27

adjunct treatment for Parkinsons with levodopa

Question 28

COMTI ADR

Answer 28

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

Question 29

COMT pearls

Answer 29

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

Question 30

Stalevo

Answer 30

Levodopa + Carbidopa + entacapone

Question 31

Amantadine

Answer 31

Antiviral drug with anti-parkinsonian properties

Question 32

Amantadine ADR

Answer 32

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

Question 33

Anticholinergics MOA

Answer 33

dopamine def augment excitatory cholinergic system. blocks this system

Question 34

Anitcholinergics

Answer 34

Trihexyphenidyl and Benztropine

Question 35

AA of Neuro guidelines

Answer 35

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

Question 36

Cholinesterase inhibitors Indications

Answer 36

First line in Alzheimers

Question 37

Cholinesterase inhibitors

Answer 37

Donezepil, Rivastigmine, Galantamine

Question 38

Donezepil ADR

Answer 38

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

Question 39

Donezepil interactions

Answer 39

metabolized by P450

Question 40

Rivastigmine ADR

Answer 40

NVD and weight loss, dyspepsia, sinusitis, dizziness

Question 41

Galantamine MOA

Answer 41

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

Question 42

Galantamine ADR

Answer 42

N, weight loss, agitation and diarrhea

Question 43

NMDA receptor Antagonists

Answer 43

Memantine

Question 44

Memantine

Answer 44

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

Question 45

Memantine ADR

Answer 45

agitation, Diarrhea, insomnia, dizziness, HA, Hallucinations