Part 1 - Neuropharmacology

Question 1

What are the medications used for Parkinson’s Disease?

Answer 1

Levodopa, Carbidopa, (both increase dopamine)

Dopamine Agonists: Pergolide (PERMAX), Pramipexole (MIRAPEX)

MAO Inhibitors:
Selegiline (ELDEPRYL)

COMT Inhibitors:
Talcapone (TASMAR)
Entacapone (COMTAN)

Question 2

Side effects of Levodopa? (Drug responsible for synthesis & degradation of dopamine)

Answer 2

GI, CV, Abnormal movements, psychiatric effects.

Drug incompatibilities and interactions.

• Pryidoxine
• Antipsychotic drugs

Question 3

Side effects of Carbidopa (drug is a peripheral decarboxylase inhibitor; always used in combination with L-Dopa)

Answer 3

Does not penetrate the BBB
Decreases peripheral side effects of L-DOPA
Decreases required dose of L-DOPA

Question 4

What are the 4 considerations of therapy in patients with PD?

Answer 4

“Wearing off” effect
“ON-OFF” phenomenon
“Drug Holidays” do not help
Depression needs treatment

Question 5

What are the 2 direct Dopamine Agonists?

Answer 5

Pergolide (PERMAX), Pramipexole (MIRAPEX)

Question 6

What are the central mechanisms of the 2 direct Dopamine Agonists?

Answer 6

Dopamine agonist - increases dopamine effects in basal ganglia

Question 7

What are the side effects of the 2 direct Dopamine Agonists? (Drugs are used in combo with L-DOPA)

Answer 7

Ataxia, dystonia, akathesias, abnormal gait, hypertonia.

Question 8

What do COMT and MAO Inhibitors do in general?

Answer 8

Synthesis and Degradation of Dopamine

Question 9

What are the two common COMT Inhibitors?

Answer 9

Talcapone (TASMAR)

Entacapone (COMTAN)

Question 10

What do COMT inhibiors do specifically?

Answer 10

Increases the duration action of L-DOPA

Question 11

What are the adverse drug effects of COMT Inhibitors?

Answer 11

Abdominal pain, anorexia, confusion, lightheadedness, fever, hallucinations, INVOLUNTARY MUSCLE MOVEMENTS, severe diarrhea

Question 12

What is the one common MAOI?

Answer 12

Selegiline (ELDEPRYL)

• Selective for MAO-B
• -Selective for Dopamine

Question 13

What does MAOI do?

Answer 13

May slow the progression of the disease

Question 14

What are the adverse drug effects of MAOIs?

Answer 14

Changes in behavior (mood swings, irritability, confusion, agitation)

Also: Dyskinesias, headache, palpitations

**Use with caution with anti-depressants, decongestants, stimulants

Question 15

What are the 3 different Anticholinergics listed in the PPT?

Answer 15

Trihexyphenidyl (ARTANE)
Benztropine (COGENTIN)
Diphenhydramine (BENEDRYL)

*Avoid in the elderly - decreases acytelcholine instead of increasing dopamine.

Question 16

Drugs that worsen PD and movement and older patients

Answer 16

Anti-psychotic drugs:

Haloperido (HALDOL) and chlorpromazine (THORAZINE)

Used for treatment of behavioral disorders

Actions - Central
Mechanism - Blockade of dopamine receptors
Effects - Parkinson-like, Tremor, Akithisia, akinesia.

Question 17

Drugs that treat spasticity:

Answer 17

Baclofen, Botolinium toxin type A (BOTOX), Tizanidine (ZANAFLEX),

Question 18

Drugs that are skeletal muscle relaxants:

Answer 18

Antispasmotics:

Chlorzoxazone (PARAFLEX, PARAFON FORTE), Cyclobenzaprine (FLEXORIL), DANTRALENE (DANTRIUM), Metaxalone (Skelaxin),

Question 19

Anti-Histamines

Answer 19

Diphenhydramine (BENADRYL), Chlorpheniramine

Question 20

Benzodiazepines (muscle inhibition)

Answer 20

Diazepam (VALIUM, others)
Alprazolam (XANAX)
Clonazepam (KLONOPIN)
Lorazepam (ATIVAN)
Midazolam (VERSED)

Question 21

Anti-epileptic drugs

Answer 21

Valproic acid (DEPAKOTE), Phenytoin (DILANTIN), Carbamazepine (TEGRETOL)

Question 22

Stimulants

Answer 22

Amphetamine (ADDERALL), methylphenidate (RITALIN)

Bupropion (WELLBUTRIN)?

Question 23

Anticonvulsants

Answer 23

Phenytoin (DILANTIN)
Carbamazepine (TEGRETOL)
Valproic Acid (DEPAKOTE)
Ethosuximide (ZARONTIN)
Gabapentin (NEURONTIN)
Lamotrigine (LAMICTAL)

Question 24

Amphetamine, Methylphenidate

Answer 24

Release of norepinephrine, serotonin and dopamine

Increases attention, decreases impulsivity while producing stimulation in ADHD

Question 25

NE reuptake inhibitor

Answer 25

Atomoxetine (STRATTERA)

Question 26

ANTIPSYCHOTICS

Answer 26

1st generation (Typical) Chlorpromazine (THORAZINE) Thioridazine (MELLARIL) Haloperidol (HALDOL) ``` 2nd generation (Atypical) Clozapine (CLOZARIL) Risperidone (RISPERDAL) Quetiapine (SEROQUEL) Olanzepine (ZYPREXA) ```

Question 27

Anti-depressants

Answer 27

Tricyclic Antidepressants (TCAs) Nortriptyline (PAMELOR) Amitriptyline (ELAVIL) Desipramine (NORPRAMIN) ``` Selective Serotonin Reuptake Inhibitors (SSRIs) Fluoxetine (PROZAC) Paroxetine (PAXIL) Sertraline (ZOLOFT) Citalopram (CELEXA) Escitalopram (LEXAPRO) Fluvoxamine (Luvox) ``` ``` Heterocyclics Venlafaxine (EFFEXOR) - SNRI Duloxetine (Cymbalta) Bupropion (WELLBUTRIN) Trazodone (DESYREL) ``` Herbals St. John’s Wort Monoamine Oxidase Inhibitors (MAOIs) Tranylcypromine (PARNATE)

Question 28

Anti-manic

Answer 28

Lithium (ESKALITH) Carbamazepine (TEGRETOL) Valproic Acid (DEPAKENE) Lamotragine (LAMICTAL)

Question 29

SSRIs

Answer 29

Fluoxetine (PROZAC), paroxetine (PAXIL), sertraline (ZOLOFT), fluvoxamine (LUVOX)

Question 30

Drug that is potent in blocking reuptake of both norepinephrine and serotonin [SNRI]

Answer 30

Venlafaxine (Effexor)

Question 31

Drug of choice in the treatment of manic/depressive disorder

Answer 31

Lithium

Question 32

Anti-convulsants in mania

Answer 32

Valproate (DEPAKOTE) First choice Carbamazepine (TEGRETOL) Lamotragine (LAMICTAL) Gabapentin (NEURONTIN)

Question 33

Sedative-Hypnotics

Answer 33

Barbiturates Phenobarbital (LUMINAL) ``` Benzodiazepines Diazepam (VALIUM, others) Alprazolam (XANAX) Clonazepam (KLONOPIN) Lorazepam (ATIVAN) Midazolam (VERSED) ``` BZ1 Agonists Zolpidem (AMBIEN) Zaleplon (SONATA) Eszopiclone (LUNESTA) Buspirone (BUSPAR)

Question 34

Non-benzodiazepine Benzodiazepine Receptor Agonists

Answer 34

Zolpidem (Ambien, Ambien CR) Zaleplon (Sonata) Eszopicone (Lunesta) – longer acting

Question 35

Melatonin

Answer 35

Ramelteon (Rozerem)

Question 36

MEDICATIONS THAT TREAT SEIZURES!

Answer 36

``` Anti-epileptic drugs: Valproic acid (DEPAKOTE), Phenytoin (DILANTIN), Carbamazepine (TEGRETOL) ``` Gabapentin (NEURONTIN) - used for seizure disorders Lamotrigine (LAMICTAL) - Solo or adjunctive med for generalized or partial seizures, may be effective against absence seizures