Parkinson & Alzheimer Flashcards
Which type of drugs can cross the blood-brain barrier? Which type cannot?
Lipid-soluble agents and drugs can crass. Protein-bound drugs and highly ionized drugs cannot.
Who is more sensitive to CNS drugs and why?
Infants because the blood-brain barrier is not fully developed at birth.
Which neurotransmitter is decreased, and which is increased in Parkinson Disease?
Dopamine is decreased, acetylcholine is increased.
What is Levodopa/Carbidopa, and what is the MOA?
Dopamine replacement drug. Levodopa is converted to dopamine in the brain and then activates dopamine receptors. Carbidopa blocks destruction of levodopa in the periphery.
What medication can increase the effectiveness of levodopa/carbidopa?
Amantadine, apomorphine, pramipexole, and anticholinergic drugs
What are common side effects of levodopa/carbidopa?
Abnormal movements and psychiatric disturbances, dyskinesias, CV effects, dark sweat and urine, activate malignant melanoma.
What food interactions can affect levodopa/carbidopa?
High protein meals reduce therapeutic responses.
What are first-line drugs for PD?
Dopamine agonists
What is the difference between ergot and non-ergot derivative?
Ergot - less selective and can cause blockage of serotonergic and alpha-adrenergic receptors.
Non-ergot - highly selective for dopamine receptors.
What are the goals of therapy for Alzheimer Disease?
To improve symptoms and reverse cognitive decline. At best, drugs currently in use may slow loss of memory and cognition and prolong independent function.
What are first-line agents for AD?
Donepezil, galantamine, and rivastigmine (Cholinesterase inhibitors)
Memantine (neuronal receptor blocker)
What are side effects of cholinesterase inhibitors?
Dyspepsia, dizziness, ha, bronchoconstriction, fainting, tremors, anorexia, weight loss
What drug interactions are associated with cholinesterase inhibitors?
TCAs, first-generation antihistamines, and anticholinergics can reduce effects
Timing for adjusting doses of donepezil? Galantamine?
Donepezil: slowly after 1-3 months
Galantamine: slowly after 4 weeks
What labs should be monitored with memantine? When should it be discontinued?
Renal and liver function. D/c with large change in renal function or severe alterations in liver function.
