Pharm - Lecture 2

Front 1

1) What is the physiology behind alzheimer's disease?

2) What is the pharmacotherapy of AD

Back 1

1) you have the formation of neurofibrillary tangles and plaques leading to loss of function of cholinergic neurons (choline acetyltransferase = acetyl choline) in the hippocampus

- there is chronic inflammation leading to memory loss, confusion, unable to remember friends

2) Focus is on increasing ACh in hippocampus AND antagonize NMDA receptors

Front 2

How does DONEZIPIL aid in alzheimer's disease?

- name the side effects

- interactions

- contraindications

Back 2

It is a drug that inhibits the acetylcholinesterase enzyme from breaking down acetylcholine.

SE: increase GI activity leading to N, V, D, positive symptoms like anxiety and depression

I: other parasympathomimetics

C: COPD (Ach promotes mucous secretion and narrows the bronchi = breathing is harder)

Front 3

How does antioxidants (Vitamine E) aid in Alzheimer's disease?

How does anti-inflammatory Cox-2 inhibitor aid in Alzheimer's disease?

Back 3

* Both of these drugs aid in the delay of the formation of inflammation

Vit E: reduces inflammation

Cox 2 inhibitor: stops the increase of prostaglandins = decreasing inflammation

Front 4

How does Memantine aid with Alzheimer's disease?

Back 4

It is an NMDA receptor antagonist which slows the development of Alzheimer's disease by decreasing Ca into the cell.

Front 5

1) What is the physiological behind Parkinson's Disease?

2) Name some signs and symptoms

3) What is the pharmacology behind this?

Back 5

You have a loss of dopamingeric neurons originating in the substantial nigra and terminating in the striatum. This means you have a decrease of inhibition from dopamine and constant excitation from acetyl choline.

2) This leads to tremors and shaking. Some non-motor issues are anxiety and depression.

3) You want to increase the dopamine and decrease acetyl choline. You need to have a balance b/w the two for tone.

Front 6

1) How does L-Dopa aid with Parkinson's disease?

2) How long does it take to become effective?

Back 6

1) It is a DA precursor drug. It can cross BBB unlike dopamine and it metabolized there by dopa decarboxylase.

2) 6 months

** Remember to come slowly or parkinsonism.

Front 7

1) How does Carbidopa aid in Parkinson's disease?

2) Name the side effects, interactions, contraindications.

Back 7

1) Blocks dopa decarboxylase peripherally so more L-Dopa can cross the BBB

2) SE: Too much dopamine leading to involuntary mvmt, sporadic winking, orthostatic hypotension.

I: TCAs, MAOIs, phenytoin (anticonvulsant), warfarin (antipsychotic), digoxin

C: renal, liver disease

Front 8

1) How does a dopamine agonist aid in Parkinson's ?

2) How does selegiline aid in Parkinson's disease?

3) How does amantidine aid in Parkinson's disease?

4) How does entacapone aid in Parkinson's disease?

Back 8

1) Bind to dopamine receptor increasing dopamine output.

2) It is a MAO-B inhibitor - it inhibits the enzyme the breaks down dopamine

3) stimulate the release of dopamine from nerve terminals (you need functional neurons so early on)

4) An antagonist for COMT = breaks down NE and dopamine

Front 9

1) When would an benztropine be used for Parkinson's ?

2) How does it work?

3) Name the side effects, interactions and contraindications?

Back 9

1) When there are no more functional neurons for dopamine release so you focus on acetylcholine release

2) It is a Cholinergic antagonist = decreases acetyl choline in the basal ganglia

3) SE: anticholinergic effects like (dilated pupils, dry mouth, urinary retention, C, N, V)

I: MAOIs, TCAs

C: narrow angle glaucoma, BPH, dysrhythmias

Front 10

1) What are the signs and symptoms of Schizophrenia?

2) What is the pathophysiology behind schizophrenia?

Back 10

1) Symptoms can be divide into positive and negative. Positive = hallucinations, delusions, disorganized thoughts. Negative= lack of interest in daily activities, lack of motivation

2) You have excessive dopamine release in the basal ganglia. This means you want to antagonize DA2 receptors.

* Small window for dosage since it can cause motor abnormalities = parkinson's disease

Front 11

1) How do Phenothiazines aid with schizophrenia?

2) Side effects, interactions and contraindications

Back 11

1) These affect the positive symptoms of. They antagonize dopamine 2 and serotonin receptors.

2) SE Non Motor: anticholinergic (muscarinic) = sedation, lack of libido, weight gain

Motor: Dystonia (spams), akathisia (can't relax), dyskinesia (bizarre face positioning), Neuroleptic malignant syndrome: high fever, muscle rigidity, sweating.

I: TCAs, anti seizure meds (lower threshold)

* The non-motor side effects are more pronounced

Front 12

1) How do none phenothanzine aid with schizophrenia?

Back 12

1) Block positive signs and symptoms by antagonizing dopamine

2) SE Non Motor: less sedation and hypotension than phenothiazines

Motor: Dystonia (spams), akathisia (can't relax), dyskinesia (bizarre face positioning), Neuroleptic malignant syndrome: high fever, muscle rigidity, sweating.

* These are less non-motor than motor side effects

Front 13

1) How does atypical antipsychotics aid with schizophrenia? List the

2) List the side effects, interactions and contraindications

Back 13

1) Blocks both positive and negative side effects. Loosely blocks dopamine 2, serotonin and acetyl choline and alpha adrenergic receptors.

SE: weight gain, type 2 diabetes = increase in blood glucose, bone marrow depression

C: leukopenia, CNS depression

I: CNS depressants, antineoplastics

Front 14

How do dopamine systems stabilizers work?

Back 14

The compete with dopamine for the receptor sites and produces a smaller effect