Neurodegenerative diseases

Question 1

Drug classes in treatment for Alzheimees

Answer 1

1. Cholinesterase Inhibitors
2. NMDA receptor Antagonist

Question 2

Cholinesterase inhibitors

Answer 2

1. Donepezil (Aricept)
2. Rivastigmine (Exelon)
3. Galantamine (Razadylne)

Question 3

NMDA receptor antagonist

Answer 3

Memantine (Namenda)

Question 4

Mechanism of action for cholinesterase inhibitors

Answer 4

1. Prevents action of acetylcholinesterase
2. this increases acetlycholine in the synapse

Question 5

Nausea

Bronchospasm

Answer 5

Cholinesterase inhibitors

Question 6

Headache, Dizziness, Diarrhea

Answer 6

Cholineaterase inhibitors

and

NMDA receptor antagonists

Question 7

1. sedation
2. fatigue
3. hypertension
4. rash
5. weight gain
6. urinary frequency
7. anemia

Answer 7

NMDA receptor antagonists- Memantine

Question 8

Memantine (Namenda) mechanism of action

Answer 8

1. Block leaky channels to reduce calcium induced excitotoxicity
2. Block leaky channels to reduce background noise and make signals relatively stronger
3. Blocks the pathalogical activation of NMDA receptors

Question 9

What is drug therapy for parkinsons aimed at

Answer 9

increasing dopamine or decreasing Acetylcholine to balance the two

Question 10

Three mechanisms of action of dopiminergic agents

Answer 10

1. increase amounts of dopamine in th Striatum
2. incresed delivery or decreased degredation of dopamine
3. Mimic the effects of dopamine - dopamine agonists

Question 11

what is the mechanism of action of anticholonergic agents

Answer 11

Prevent cholonergic inhibition of dopamine release

Question 12

First line of therapy for Parkinsons

Answer 12

Levadopa

Question 13

80% of paitines show improvement, and 20% Regain normal function with levadopa therapy, but what else is very improtant about this therapy

Answer 13

Its effects wer off over time (2-3 years) likely due to advanced neuro degeneration

Question 14

Levadopa mechanism of action

Answer 14

levadopa is converted to dopamine increasing dopamine in the striatum

Question 15

Levadopa is converted to ____________providing dopamine in the striatum, this happens in the _________________. Levadopa is only needed in the _________ and large amounts of levadopa in the __________ causes problems. This is why Levadopa is dosed with ___________ a ________________ and ___________a ___________ which causes sthe same amount of Levadopa to reach the brain with a ____________ dose. ___________ is added when ________________ wanes.

Answer 15

1. dopamine
2. periphery and the brain.
3. brain
4. periphery
5. Carbadopa a peripheral decarboxylase inhibitor
6. Entacopne a COMT inhibitor
7. smaller
8. Entacapone
9. Levadopa/Carbadopa

Question 16

Acute side effects of Levadopa

Answer 16

Disappear after a few week s and include nausea, anorexia and hypotension

Question 17

Sede effects of Levadopa

Answer 17

1. involutary movements
2. on-off effects (hypokinesia and improvements)
3. Psychosis - schizophrinia like symptoms with excess domamine

Question 18

Adverse drug interaction with Levadopa

Answer 18

MAO Inhibitors- will cause an overload of dopamine and NE

Question 19

Levadopa when given alone is degraded by

Answer 19

Mosty decarboxylases and a little by COMT causing ittle to get to the brain

Question 20

When levadopa is given with a DDC inhipibitor (Decarboylase inhibitor) ____________.

Answer 20

Dopamine is still broken down by COMT and not as much gets to the brain

Question 21

Optimization of levadopa happens when

Answer 21

Levadopa is given with a DDC inhibitor and a COMT inhibitor - this allows for the most amount of the drug to get to the brain

Question 22

Dopamine agonists

Answer 22

Pramipexole and Ropinirole

Question 23

Highly selective for D2/D3 receptors

Answer 23

Pramipexole and Ropinirole

Question 24

may cuase halucinations and compulsive behaviors

Answer 24

Pramipexole and Ropinirole

Question 25

Increases dopamine in the synapes

Answer 25

Selegiline

Question 26

MAO-B inhibitor

Answer 26

Selegiline

Question 27

Because _________ is an MAO-B inhibitor it is not involed in \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. It specifically decreases \_\_\_\_\_\_\_\_\_\_\_\_. and does not have the \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 27

1. Selegiline 2. NE metabolism 3. Dopamine degredation 4. unwanted effects of non-selctive MAOIs

Question 28

Enhances dopamine release into the synapse

Answer 28

Amantadine

Question 29

Anticholinergic drug used for parkinsons

Answer 29

Benzotropine

Question 30

MOA for anticholinergic drug for parkinsons

Answer 30

Benzotropine - causes a **blockade** of muscarinic receptors **relieving the inhabition** of dopaminergic neurons causing **more** dopamine release

Question 31

Muscarinic receptors

Answer 31

in striatum where they **inhibit dopamine release** from dopamine neurons

Question 32

Benzotropine side effects

Answer 32

Anticholinergic - Anti SLUDG 1. dry mouth 2. dry eyes 3. urinary retention 4. constipation

Question 33

Clearance can be reduced by increasing urinary pH - ie giving bicarbonate

Answer 33

Memantine

Question 34

Prolongtion of Succinylcholine

Answer 34

Cholinesterase inhibitors - Donepexil, Rivastigmine, Galamtamine

Question 35

Assess for anticholinergic siede effects especially HR

Answer 35

Anticholinergic drugs like Benztropine - Decreased HR

Question 36

avaoid drugs that impact cholinergic tone like TCA's

Answer 36

Anticholinergic drugs - Benztropine

Question 37

Evaluate for anticholinergic-like side effects

Answer 37

Amantadine

Question 38

Rule out congestive heart failure side effect

Answer 38

Amantadine

Question 39

1. MUST receive q6-12 hours 2. Administer 20 minutes pre-op and intraop to avoid SUDDEN sloss of effect and neuromuscular/respiratory failure

Answer 39

Levadopa decarboxylase inhibitors

Question 40

effects include 1. cardiac dysrhythmias 2. adrenergic stimulation 3. orthostatic hypotension 4. GI

Answer 40

Levadopa decarboxylase inhibitors

Question 41

Side effects include 1. CV 2. hypotension 3. pleuropulmonary fibrosis

Answer 41

Synthetic dopamine agonists -Pramipexole and ropinirole

Question 42

AVOID Ephedrine and Mepreidine

Answer 42

Selegiline (MAO-B inhibitor)

Question 43

Use extreme caution with vasoactive medications

Answer 43

Selegiline (MAO-B inhibitor)

Question 44

Pronounced effect with neuromuscular blockers, sedative agent, diuretics

Answer 44

Selegiline (MAO-B inhibitor)