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Pharm Lehne Ch 20-25

CNS Drugs for Parkinson's, Alzheimer's, MS, Epilepsy & Muscle Spasms

How is the CNS different from the PNS with regard to neurotransmitters? (ch 20) PNS has 3 compounds: acetylcholine, norepinephrine, and epinephrine, but CNS has at least 21 compounds that serve as neurotransmitters
Lipid-soluble agents and specific transport systems- cross blood-brain barrier? (ch 20) Yes
Protein-bound drugs and highly ionized drugs- can cross blood-brain barrier? (ch 20) No
Are infants more or less sensitive to CNS drugs than older children or adults? (ch 20) Infants are much more sensitive to CNS drugs than are older children and adults
T/F We do not fully understand the brain in either health or disease (ch 20) True
What are some of the adaptive changes during prolonged CNS drug exposure? (ch 20) increased therapeutic effects, decreased side effects, tolerance, physical dependence
What type of disorder is Parkinson's Disease? (ch 21) slowly progressive neurodegenerative disease
What is the most common degenerative disease of neurons? (ch 21) Alzheimer's Disease
What is the second most common degenerative disease of neurons? (ch 21) Parkinson's Disease
What are cardinal motor symptoms of Parkinson's Disease? (ch 21) tremor, rigidity, postural instability, slowed movement
What are common nonmotor symptoms of Parkinson's Disease? (ch 21) autonomic disturbances, sleep disturbances, depression, psychosis, dementia
What are early symptoms of Parkinson's disease? (ch 21) loss of smell, excessive salivation, clumsiness of the hands, worsening of handwriting, bothersome tremor, slower gait, reduced voice volume
What is the underlying cause of motor symptoms in Parkinson's Disease? (ch 21) loss of dopaminergic neurons in the substantial nigra
What is the most effective drug for Parkinson's Disease? (ch 21) Levidopa, given in combination with Carbidopa (eventually becomes ineffective)
Motor symptoms in PD result from damage to what system? (ch 21) Motor symptoms result from damage to the extrapyramidal system, a complex neuronal network that helps regulate movement
What are dyskinesias? (ch 21) Dyskinesia = disorder of movement
What dyskinesias characterize PD? (ch 21) tremor at rest, postural instability, bradykinesia
What is bradykinesia? (ch 21) slowed movement
What contributes to the motor symptoms that characterize PD? (ch 21) overactivity of GABAergic neurons (excitatory influence of ACh that goes unopposed b/c degeneration of neurons in substantia negra that supply dopamine to striatum)
How many neurons (that supply dopamine to striatum) must be lost before PD becomes clinically recognizable? (ch 21) 70-80%
Levidopa - Adverse Effects (ch 21) nausea & vomiting, dyskinesias (give amantadine?), postural hypotension, psychosis (clozapine, quetapine), anxiety, agitation, memory & cognitive impairment, nightmares, darken sweat and urine
Levidopa - Drug Interactions (ch 21) First Gen Antipsychotic Drugs- decrease effects, MAO Inhibitors -> hypertensive crisis, Anticholinergics- enhance response to levodopa
Levodopa - Food interactions (ch 21) high-protein meals can reduce therapeutic responses to levodopa (spread protein throughout the day)
contraindication for Levidopa (ch 21) malignant melenoma
What is the action of carbidopa? (ch 21) Carbidopa prevents decarboxylation of levodopa in intestine and PNS- preserves levodopa so more can cross the BBB
Pramipexole (ch 21) DA receptor agonist, will not convert outside brain, doesn't need help, protein okay. *improves motor, good for restless leg
Pramipexole - adverse effects? (ch 21) daytime somnolence, hallucinations, self-rewarding behaviors
Apomorphine (ch 21) rescue treatment not given by mouth (acute tx fro trough)
Entracapone (ch 21) COMT inhibitor used with levodopa, inhibits metabolism of levodopa before brain. can cause yellow/orange urine
Selegiline (ch 21) MAO-B inhibitor used with levodopa, benefit decreases after 1-2 yr
Anticholinergics with Levodopa (ch 21) reduce tremors but not bradykinesia, better for younger, not old. *potentially inappropriate for use in geriatric patients (benztropine, trihexyphenidyl)
Disease characterized by progressive memory loss, impaired thinking, neuropsychiatric symptoms, inability to perform routine activities of daily living (ch 22) Alzheimer's disease
Where does neuronal degenerations start in early Alzheimer's Disease? (ch 22) hippocampus (memory), cerebral cortex (speech, perception, reasoning)
What are acetylcholine levels like for Alzheimer's patients? (ch 22) 90% below normal
neuritic plaques in Parkinson's Disease (ch 21) Lewy bodies
neuritic plaques in Alzheimer's Disease (ch 22) beta-amyloid, + neurofibrillary tabgles (tau twists)
risk factors for Alzheimer's (ch 22) age, 90% 65 or older
Cholinesterase Inhibitors (ch 22) donepezil, galantamine, rivastigmine approved for tx Alzheimer's
Donepezil, Galantamine, Rivastigmine (ch 22) cholinesterase inhibitors approved for tx of Alzheimer's, increase availability of ACh, tx benefits 1 in 12, s/e nausea, vomiting, dyspepsia, diarrhea, dizziness, headache, bronchoconstriction *caution with COPD, can cause bradycardia
Cholinesterase Inhibitors- interactions (ch 22) first gen antihistamines, tricyclic antidepressants, conventional antipsychotics
Memantine (ch 22) NMDA receptor antagonist for moderate to severe Alzheimer's Disease, dizziness, headache, confusion, constipation
What kind of disorder is multiple sclerosis? (ch 23) chronic, inflammatory, autoimune disorder that damages myelin sheath of neurons in the CNS, causing a wide variety of sensory, motor, and cognitive defects
What are paresthesias? (ch 23) numbness, tingling, pins & needles
What are 4 types of MS? (ch 23) relapsing-remitting (90%), secondary progressive, primary progressive, progressive-relapsing
Created by: cskrivanek