Cns Neurogenerative Pharmacology

Front 1

what kind of drugs can cross the BBB?

Back 1

lipid-soluble

Front 2

what kind of drugs can't cross the BBB?

Back 2

protein bound and highly ionized drugs

Front 3

what is tolerance?

Back 3

decreased response occurring in the course of prolonged drug use

Front 4

what is physical dependence?

Back 4

state in which abrupt discontinuation of drug use will precipitate a withdrawal syndrome

Front 5

give 2 examples that are excitatory NT (depolarization)

Back 5

ACh and Glutamic Acid

Front 6

binding of ACh to the post synaptic receptors causes the release of what?

Back 6

Na+ ions

Front 7

what is the excitatory pathway?

Back 7

stimulation of excitatory neurons results in depolarization of the postsynaptic membrane

Front 8

what is the inhibitory pathway?

Back 8

stimulation of inhibitory neurons results in HYPERPOLARIZATION of the post synaptic membrane

Front 9

name 2 inhibitory NT that causes hyperpolarization

Back 9

GABA and Glycine

Front 10

Binding of the inhibitory NT ______ or _______ causes entrance of ________ and ______ which makes it more hyperopolarizable.

Back 10

GABA, Glycine, K+ and Cl-

Front 11

What is Parkinson's disease?

Back 11

d/o of EP system= dyskinesias

Front 12

name the 3 main characteristics of Parkinson's

Back 12

tremor at rest (supinate and pronate tremor), postural instability, and bradykinesia

Front 13

patho behind Parkinson's

Back 13

1. cell death in substantia nigra results in less dopamine release in the neostriatum

2. loss of inhibitory effect of dopamine results in more production of ACh, which triggers a chain of abnormal signaling leading to impaired mobility

Front 14

what type of drugs are prescribed for Parkinson's?

Back 14

1.Dopaminergic agents

2. anticholinergic agents (block ACh receptors)

Front 15

what is the #1 drug for Parkinson's?

Back 15

Levodopa-Carbidopa (Sinemet)

Front 16

MOA of Levodopa

Back 16

Levodopa is the precursor of dopamine. able to cross the BBB into CNS and convert to dopamine

Front 17

why must Levodopa must be given with _______?

Back 17

to decrease the SE; Carbidopa

Front 18

SE of Levodopa

Back 18

anorexia, N/V, tachycardia, HYPOTENSION, psychiatric problems (depression gets worse)

Front 19

what drug only works for about 5 years so that you might want to save it at a later time when the disease is more progressed?

Back 19

Levodopa-Carbidopa (Sinemet)

Front 20

what drug can have sedative effects and cause insomnia?

Back 20

Levodopa-Carbidopa (Sinemet)

Front 21

what is the On-Off phenomenon? what drug has the On-OFF phenomenon?

Back 21

chronic therapy which the drug can potentially lead to abrupt, unpredictable, and transient motor fluctuations (from mobility to immobility)

Levodopa/Carbidopa (Sinemet)

Front 22

SE of Ropinirole (Requip) and Pramipexole (Mirapex)

Back 22

insomnia

nausea

auditory hallucinations

dizziness

constipation

ORTHOSTATIC HYPOTENSION

Front 23

what else is Pramipexole used for?

Back 23

Restless Leg Syndrome (RLS)

Front 24

MOA of Amantadine

Back 24

-increase dopamine release

-blocks cholinergic receptors

-inhibits NMDA glutamate recepetors

Front 25

what was Amantadine originally used for?

Back 25

bird flu

also effective for MS but not as effective as w/ Parkinson

Front 26

SE of Amantadine

Back 26

confusion, agitation, hallucinations

*once experiencing hallucinations, take the pt. off the drug immediately*

Front 27

What drug is good to start early tx of Parkinson's? What drug is good for later tx?

Back 27

1. Amantadine

2. Sinemet

Front 28

what drug helps control mobility of Parkinson's?

Back 28

Amantadine

Front 29

what Parkinson's drugs are not anymore?

Back 29

Congentin and Artane

Front 30

what Parkinson drug is CI for cardiovascular issues?

Back 30

Selegiline

Front 31

If the patient forgot to take Sinemet and have acute, extreme ridigity, what drug is useful at this time?

Back 31

Apomorphine (Apokyn)

Front 32

patho of Alzheimer's

Back 32

1. senile plaques (beta-amyloid accumulations)

2. neurofibrillary tangles

3. loss of cortical cholinergic

Front 33

how do you diagnose Alzheimer's?

Back 33

autopsy

Front 34

What is the most commonly used drug to tx Alzheimer's?

Back 34

Donepezil (Aricept)

Front 35

MOA:

Donepezil (Aricept)

Galatamine (Razadyne)

Rivastigmine (Exelon)

Back 35

acetylcholinesterase inhibitor= improve cholinergic transmission

Front 36

which Alzheimer's drug has a long-acting patch for pts who forget to take their meds?

Back 36

Rivastigmine (Exelon)

Front 37

SE:

Donepezil (Aricept)

Galatamine (Razadyne)

Rivastigmine (Exelon)

Back 37

-N/V/D

-anorexia

-MYALGIA

-BRADYCARDIA

-tremors

Front 38

which Alzheimer drug is a NMDA receptor antagonist?

Back 38

Memantine (Nemenda)

blocks NMDA receptor and limits Ca+ influx into the neuron

Front 39

what do you start Alzheimer's patients with? what drug do you give later when the disease has progressed or the drug is no longer working?

Back 39

1. AChesterase inhibitor (Donepezil)

2. Namenda + Achesterase inhibitor

Front 40

name the disease modifying drugs for MS

Back 40

1. Fingolimod (Gilenya)

2. Interferons- Beta 1a (Avonex) or Beta 1b (betaseron)

3. Glatiramer acetate (Copaxone)

4. Teriflunomide (Aubagio)

5. Dimetyl fumarate (Tecfidera)

Front 41

MOA of Gilenya

Back 41

alters lymphocyte migration

pill form

Front 42

why should patients tell their PCP that they are on Gilenya?

Back 42

VERY LOW WBC

Front 43

MOA of Interferons

Back 43

all help to diminish inflammatory response

Front 44

Beta 1a (Avonex)

Back 44

interferon- IM injecction qwk

Front 45

what was the 1st MS drug on the market in 1993?

Back 45

Interferon Beta 1b (Betaseron)

given subQ qod

Front 46

MOA of Copaxone

Back 46

synthetic polypeptide that resembles myelin protein and acts as a decoy for T cell to attack

Front 47

how often is copaxone given?

Back 47

daily SubQ injection

Front 48

what is the #1 drug prescribed for MS?

Back 48

Copaxone

Front 49

what drug is the only category B for MS?

Back 49

Copaxone

Front 50

MOA of Aubagio

Back 50

pyrimidine synthesis inhibitor that leads to lower concentration of active lymphocytes in CNS

Front 51

what stage is Aubagio mainly used for?

Back 51

secondary progressive- pill form

Front 52

MOA of Tecfidera

Back 52

alters cell response to oxidative stress to reduce disease progression

Front 53

SE of Tecfidera

Back 53

N/V

HEMATEMESIS→ reduce dosage

Front 54

name the MS immunosuppressants

Back 54

Natalizumab (Tysabri)

Mitoxantrone (Novantrone)

Front 55

Describe Tysabri. when do you give it?

Back 55

monoclonal antibody therapy

NOT THE 1ST LINE OF TX

IV DRUG ONCE A MONTH

GIVEN WHEN PTS ARE NOT RESPONSIVE TO OTHER DRUGS OR FOR PROGRESSED PTS

Front 56

what drug do you not give to MS pts? why?

Back 56

Novatrone. KILLS PEOPLE.