Pharm, Dementia, Kinder Flashcards Preview

Year 2 Psych exam I > Pharm, Dementia, Kinder > Flashcards

Flashcards in Pharm, Dementia, Kinder Deck (37):
1

What are the ACHEI approved for dementia

donepezil
galantamine
rivastigmine
Tacrine

2

adverse effects of ACHEI

diffuse
CV, GI, eye, respiratory, urinary, CNS, NMJ

3

groups of cholinesterase inhibitors

alcohols
carbamic acid esters
organophosphates

4

structure of alcohol cholinesterase

quaternary amonium
+ charged
like edrophonium
noncovalent short lied

5

structure of crbamic acid ester cholinesterase inhibitor

quaternary or tertiaty ammonium groups (+ or neutral)
stigmines

6

binding of carbamic ester acids

2 steps

7

organophosphate structure of cholinesterase inhibitors

charged neutral
highly lipid soluble resulting in CNS toxicity
covalent irreversible binding

8

PK of qauternary charged ACHEI

reslativley insoluble in lipids
pareneteral preferred
no CNS

9

PK tertiary uncharged ACHEI

well absorbed all sires, CNS distribution, more toxic than quaternary carbamates

10

what drugs used for dementia are tertiary and uncharged ACHEI

donepezil, tacrine, rivastigmine, galantamine

11

why are organophosphates dangerous

readily abosrbed everywhere
distributed all parts of body

12

toxic organosphosphate, how do we recover

need to make more ACHE
oxime regenerator compound

13

"aging" process

after intial binding of organophosphates the enzyme will break a bond of inhibitor and further strenghten the phosphorus enzyme bond

14

continued inhibition of ACHE in NMJ

depolarizing NMJ blockade to nondepolarizing blockade (like succinylcholine)

15

uses of aCHEI

glaucoma, postoperative atony of bladder or GI
NMJ
alzheimers
dementia

16

tacrine withdrawn because

hepatotoxicity

17

DDI ACHE

nondepolarizing NMJ blockin agents (will diminish blockade)
succinycholine (prolong blockade)
cholinergic agonists (enhance)
beta blockers (bradycardia)
systemic corticosteorids (enhance mm weakness)

18

initial signs ACHE I intoxication

miosis
salivation
sweating
bronchial constriction
vomiting diarrhea

19

poisoning of lipid soluble ACHEI

confusion, ataxia, generalized convulsions, coma and respiratory paralysis

20

death by ACHEI

respiratory failure

21

Dx mild intoxication ACHE

ACHE activity in plasma and RBC

22

antidote for chilergic posisoning

atropine mACHR antagonist

23

atropine ineffective against

peripheral NMstimulation nACHR

24

pralidozime

cholinesterase reactivator to regenerate ACHE

25

does pralidoxie cross bbb

no

26

metabolism donepezil

CY2D6 and 3A4

27

donepezil used for what alzheimer dementia levels

mild to mod and severe
PD and lewy body too (off label)

28

adverse effects donepezil

GI especially on intiation
urinary incontinence, viivd dreams, bradycardia, syncope

29

half life donepezil

70 hours
daily dosing

30

galantamine used for

mild to mod alzheimer dementia
off label severe dementia or PD or lewy body

31

adverse effects galantamine

GI, dizziness, weight loss,
bradycardia and syncope
depression fatigue somnolence

32

metabolism rivastigmine

esterase hydrolysis

33

rivastigmine used for

mild to mod AD
severe AD in transdermal patch
Parkinsons dementia
and lewy body (off label)

34

side effects rivastigmine

high incidence nausea vomiting diarrhea in oral form
less with transdermal patch
brady cardia and syncope

35

MOA memantine

antagonist NMDA R glutamate
binds Mg site with longer time and so blocks only the excessive stimulation

36

use mematnine

mod to severe AD dementia

37

adverse effects memantine

well tolerated
fewer side effects
dizziness, confusion, hallucinations
increase agitation and delusional behaviors in some