Parkinson's/Alzheimer's (Exam #1)

Question 1

What four major sxs are seen with Parkinson’s Disease (PD)?

Answer 1

• Bradykinesia
• Muscular rigidity
• Resting tremor
• Impaired balance/gait

Question 2

Which DA pathway is affected with PD, and which sub-pathway is OVER vs. UNDER active? What does this ultimately result in?

Answer 2

Loss of DA neurons in Nigrostriatal pathway (SNPC)

• Indirect pathway = OVER active
• Direct pathway = UNDER active

Results in decreased glutamate into cortex

Question 3

What is the MOA of L-Dopa (Levodopa), and how does this occur?

Answer 3

Increase DA levels

- L-Dopa crosses BBB and is converted into DA in neuron

Question 4

What are the two major AEs associated with L-Dopa (Levodopa)?

What drug can be combined with L-Dopa to reduce these AEs? What does the addition of this drug also allow for?

Answer 4

AEs = peripheral effects

• N
• V

Ad Carbidopa to reduce N AND reduce L-Dopa dose

Question 5

What sxs does L-Dopa primarily treat? In what two ways is L-Dopa LESS/NOT effective than other options?

Answer 5

Bradykinesia

• L-Dopa does NOT affect progression = loses effectiveness with time
• NOT effective for drug-induced Parkinsonism (Ex. antipsychotics and EPS)

Question 6

What is the On-Off Phenomenon? What drug can be used to as a “rescue” to treat this?

Answer 6

• “On” = improved mobility
• “Off” = akinesia

Tx: Apomorphine (Apokyn)

Question 7

What is the MOAs of MAOIs as antipsychotics?

Answer 7

Inhibit DA metabolism (inhibit MAO-B in CNS)

Question 8

What two AEs are associated with MAOIs as antipsychotics? What drug should they NOT be combined with?

Answer 8

• Insomnia (Amphetamine-like)
• Serotonin Syndrome

Do NOT combine with Meperidine

Question 9

What is the MOA of Entacapone (Comtan), and what does this result in?

Answer 9

Inhibit COMT in periphery (inhibits DA, L-Dopa metabolism)

- Increases L-Dopa pool for transport into brain

Question 10

What is the primary AE associated with Entacapone (Comtan)?

Answer 10

Orange-colored urine

Question 11

What group of drugs continue to be effective as PD progresses, and what is their MOA?

Answer 11

DA Receptor Agonists

- Directly stimulate DA receptors

Question 12

What is the primary AE associated with Bromocriptine, and why is this?

Answer 12

Erythromelalgia

- Ergot derivative

Question 13

What is the DOC for RLS, and what type of PD drug is this classified as (based on MOA)?

Answer 13

Ropinirole

- DA Receptor Agonist

Question 14

What is the MOA of Amantadine, and what is an alternative use of this drug?

Answer 14

Increase DA neurotransmission

- Antiviral for influenza

Question 15

What is the primary AE associated with Amantadine?

Answer 15

Livedo reticularis (reddish/blue spotting of skin)

Question 16

What anticholinergic drug is used to treat PD, and what two symptoms does it specifically alleviate?

Answer 16

Benztropine (Cogentin)

• Muscular rigidity
• Tremor

Question 17

What two findings are pathognomonic for Alzheimer’s?

Answer 17

• Beta-Amyloids

- Tau proteins

Question 18

What is the primary neuronal issue that results in Alzheimer’s?

Answer 18

Degeneration of cholinergic neurons

Question 19

What class of drugs can be used to treat Alzheimer’s? What are three drugs examples?

Answer 19

Cholinesterase (AChE) Inhibitors

• Donepezil
• Rivastigmine
• Galantamine

Question 20

What two roles do Cholinesterase (AChE) Inhibitors play in the treatment of Alzheimer’s?

Answer 20

• Improve cognitive function

- Slow disease progression (delays progression from mild cognitive impairment to full-blown AD)

Question 21

What is the MOA of Memantine, and what is its primary use?

Answer 21

Selective NMDA receptor antagonist (reduces glutamate effects)
- Used in LATE stage Alzheimer’s in combination with AChE-Is

Question 22

What is the one CI associated with Memantine?

Answer 22

Combination with Meperidine

Question 23

What are the primary (general) AEs associated with Cholinesterase (AChE) Inhibitors in treatment of Alzheimer’s?

Answer 23

GI

- N, V, D, cramps