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Flashcards in Pharm 12.1 Deck (70)
1

Alzheimer's disease

impairment of cognitive abilities that is gradual in on set but relentless in progression

2

alzheimer's is the most common form of

dementing illness - gradually progressive dementia affecting cognition, behaviour, and functional status

3

the prevalence of alzheimer's increases with

each decade of life

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Alzheimers etilogy

?

5

Alzhemers cures

non

6

alzheimers is assiciated with deposition of

beta amyloid in the brain tissue, abnormal phosphorylation of the intracellular tau proteins causing abnormalites of microtubule assembly and collapse fo the cytoskeleton

7

which cells in the brain are affected with alzheimers

pyramidal cells of cortes and subcortex

8

one hypothesis for AD

reduced cholinergic transmission

9

benefit of pharmacological intervention in AD

short term benefit - do not target neurodegenerative process

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treatement of AD

Anti cholinesterase inhibitors, NMDA glutamate-receptor antagonist

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AChE inhibitors

tacrine, donepezil, rivastigmine, galantamine

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NMDA glutamate-receptor antagonist

Memantine

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AChE inhibitors are used to

selectivley inhibit AChE in CNS and elevate Ach levels in CNS

14

Tacrine dose limiting side effects like

HEPATOTOXICITY

15

Donepezil half life

long

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Donepezil dose

once dailiy

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Rivastigmine and Galantamine dose

2x daily

18

donepezil, rivastigmine, galantamine sideffects

nausea, vomiting, diarrhea

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NMDA glutamate receptor antagonist are used bc

excitotoxic activation of NMDA receptors contributes to alzheimers

20

Memantine reduces

excitotoxicity by binding to NMDA receptors by non-competitive blcokade, slowing progression of disease

21

what kind of AD is memantine used

moderate to sever AD bc it reduces the rate of clinical deterioration

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what is the less toxic AD treatment

memantine

23

memantine provides

neuroprotective effects and adverse drug effects are mild like head ache and dizziness

24

Glaucoma is a major cause of

blindness

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glaucoma increases

intraocular tension

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Without treatment of increased IOT there is

damage to the retina and optic nerve

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intraocular tension is determined by

the balance btw fluid input and drainage out of the globe

28

aqueous humor is produced by_..and drained at__

by the ciliary epithelium, filtration angle at the anterior chanmber

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treat glaucoma by

reducing production of aqueous humor, increasing the drainage of aqueous humor

30

90% of drainage of aqueous humor is through

the trabecular route

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10% passes through

within the ciliary muscle into episcleral vessels (uveoscleral outflow)

32

open angle glaucoma is also callsed

chronic simple glaucoma or wide angle glaucoma

33

glaucoma therapy is aimed at

reducing the aqueous humor production and increasing the tone of trabecullae to facilitate drainage

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glaucoma treatemnt in open angle glaucoma is mainly

pharmacolgical

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closed angle glaucoma occurs when

the person has a narrow iridocorneal angle and shallow anterior chamber

36

in colsed angle glaucoma a dialated iris can

obstruct the outflow drainage pathway at the angle between the cornea and ciliary body (iridocorneal angle)

37

obstruction to the drainage of aquous humor leads to

IOT

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permanent treatment for closed angle glaucoma

surgury (irodectomy), but drugs buy you some time

39

closed angle glaucoma can present as

acute attack (painful) as an emergency condition)

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drugs for closed angle glaucoma

mannitol, pilocarpine

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mannitol in glaucoma

hyperosmolar fluid to help save eye

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pilocarpine in glaucoma

miotic to help save eye

43

beta 1 receptor present

on the base of ciliary body (beta blockers reduce aqueos humor production)

44

beta 2 receptor present

in the ciliary blood vessels

45

alpha 1 receptor present on

ciliary body blood vessels and radial muslce

46

alpha 2 receptor present on

ciliary body epithelium and the presynaptic sympathetic fibers supplying the ciliary body

47

M3 receptor present on

the circular (constrictor) smooth muscle of the iris and the ciliary muscles

48

treatment in open angle glaucoma

beta blockers, prostaglandins, carbonic anhydrase inhibitors, alpha agonists, cholinomimetics

49

beta blockers in glaucoma

timolol, betaxolol, carteolol, levobunolol, metipranolol

50

beta blockers for glaucoma work by

decreasing the production of aqueous humor by ciliary epitheliam (given as topical eye drops)

51

bc some of the drug can enter systemic absorption and cause CVS symptoms, contraindications for beta blockers are patients with

asthma, COPD, Bradycardia, heart block, heart failure

52

Prostaglandins for glaucoma

latanoprost, travoprost, bimatoprost

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prostaglandins for glaucoma work by

increasing the aqueos drainage through the alternative pathways - uveoscleral route

54

carbonic anhydrase inhibitors for glaucoma

topical and systemic

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topical carbonic anhydrase inhibitors

dorzolamide, brinzolamide

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systemic/oral carbonic anhydrase inhibitors

acetazolamide, dichlorphenamide, methazolamide

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carbonic anhydrase inhibitors for glaucoma work by

blocking the formation of aqueous humor by blocking the carbonic anhydrase enzyme required for the synthesis of it (need bicarbonate)

58

alpha 2 agonists fro glaucoma

apraclonidine, brimonidine

59

alpha 2 agonists for glaucoma work by

reducing the fromation of aqueos humor, and also exert a direct neuroprotective effect

60

chlinomimetics for glaumocma are either

direct acting, or indirect acting

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direct acting cholinomimetics glaucoma

pilocarpine, Carbachol, Demecarium

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Indirect acting cholinomimetics for glaucoma

physostigmine, echothiophate

63

cholinomimetics for glaucoma work by

contraction of cilliary muscle open the trabecular spaces so that aqueos humor drains more easily, iris pulled from angle fo anterior chamber bidining the filtration angle and opening the trabecular network, increased outflow of aqueos humor, decreased intraocular pressure

64

narrow angle glaucoma uses

mannitol/glycerol, pilocarpine/carbachol, acetazolamide, permanent treatment - laser surgery for pathway to be widened - irdotomy

65

other potential durges for glaucoma

PGE2, marijuana

66

drugs contraindicated in glaucoma (particualrly in narow angle)

antimuscuranics (ex. Atropine produces mydriasis and exacerbate problem) and alpha 1 agonists

67

conventional glaucoma surgery

trabulectomy

68

Herbal medications

Echinacea, Garlic, Ginkgo, Ginseng, Kava, Milk Thistle, St John's wort, Saw palmetto, Dehydroepiandosterone (DHEA), Melatonin, Glucosamine

69

herbal medications are available

without prescription

70

Echinacea active constituents

chicoric acid, alkamide, polysaccharides