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What are the cautions for Benztropine (cogentin) - CORRECT ANSWERS in elderly, BPH, urinary
retention, liver, renal or
GI or GU disease
What kind of a drug is Pramipexole (Mirapex)? - CORRECT ANSWERS Dopamine Receptor Agonist
What can Pramipexole (Mirapex) be used for? - CORRECT ANSWERS - Mild Parkinsonism used in
combo with Levadopa
- Restless leg syndrome
What is the main caution for Pramipexole (Mirapex) - CORRECT ANSWERS Renal Function, caution
with other drugs with renal implications
Common ADE with Pramipexole (mirapex) - CORRECT ANSWERS CNS issues: confusion, delusion,
hallucinations, impulsivity
N/V, Anorexia
What drugs do you not combined with MOA-B inhibitors (Selegiline & Azilect/ Rasagiline) - CORRECT
ANSWERS Fluoxetine or Meperidine
What is the MOA of Levadopa/Carbidopa - CORRECT ANSWERS Enhances synthesis of dopamine in
surviving neurons of the substantia nigra
Conversion of levodopa to dopamine
What is the patho of Parkinsonism? - CORRECT ANSWERS imbalance between excitatory cholinergic
neurons and greatly diminished numbers of inhibitory dopaminergic neurons
What is the pharmacological goal for Parkinson's disease? - CORRECT ANSWERS to restore
dopamine in the basal ganglia and antagonizing
the excitatory effect of acetylcholine at the muscarinic receptors
Which of these symptoms are improved with Anticholinergic (antimuscarinic) Agents in Parkinson's?
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- Tremor
- Bradykinesia
- Rigidity - CORRECT ANSWERS Tremor and Rigidity
How do anticholinergics work? - CORRECT ANSWERS Block ACh from binding to receptor sites.
What disease can Cogentin (benztropine) precipitate - CORRECT ANSWERS Narrow-angle glaucoma
Does the effect of Levadopa/Carbidopa last after the drug has left the body - CORRECT ANSWERS
No the effect ends as soon as the drug is out of the system
How long does Levadopa/Carbidopa last for a patient - CORRECT ANSWERS 3-5 years, then see
decline in response to drug
MOA of Levadopa - CORRECT ANSWERS Attempts to replace dopamine that is deficient
crosses the BBB to convert to dopamine in the braine
MOA of Carbidopa - CORRECT ANSWERS Enhances effect of levadopa by DIMINISHING the uptake of
levadopa in the GI tract and peripheral tissues
Means more of the drug gets to the CNS
What symptoms does Levodopa decrease - CORRECT ANSWERS Decreases rigidity, tremors, & other
symptoms
Should levodopa be taken with meals or on an empty stomach - CORRECT ANSWERS Empty
stomach; Meals interfere with transport into the CNS
What are the GI ADE with levodopa - CORRECT ANSWERS Anorexia, N/V
D/T stimulation of chemoreceptor trigger zone of the medulla
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What are the CV ADE of Levodopa - CORRECT ANSWERS Tachycardia, PVCs, postural hypotension
D/t dopaminergic action on the heart
What psych dx do you NOT give levodopa to - CORRECT ANSWERS Psychosis
What are the ADE CNS effects of levodopa - CORRECT ANSWERS Visual/Auditory hallucinations,
abnormal involuntary
movements -dyskinesias (effects opposite of Parkinson's symptoms )
What is the first line treatment for parkinsons - CORRECT ANSWERS Dopamine Agonists
(Carbidopa/Levodopa)
What do COMT inhibitors do? - CORRECT ANSWERS reduces motor fluctuations in advanced dx- but
increase dyskinesias (adjunctive tx)
What are the results of using Anticholinergics in Parkinson's? - CORRECT ANSWERS reduce tremor,
rigidity and drooling (limited use d/t ADE)
What are the three distinguishing features in Alzheimers - CORRECT ANSWERS 1) accumulation of
senile plaques (β-amyloid)
2) formation of numerous neurofibrillary tangles
3) loss of cortical neurons—particularly cholinergic neurons
What is the aim of pharmacological therapy in Alzheimers - CORRECT ANSWERS • improving
cholinergic transmission w/i the CNS
OR
• preventing excitotoxic actions resulting from over stimulation of NMDA-glutamate receptors
What stage of Alzheimer's do you use Memantine (Namenda) - CORRECT ANSWERS Moderate to
severe; NOT used in early stage