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Quiz 3
Neurology exam ttuhsc
146
Anatomy
Professional
09/03/2013

Additional Anatomy Flashcards

 


 

Cards

Term
There are two main types of depression:
Definition
 major depressive disorder, and bipolar disorder 
Term

involves drastic mood swings from extreme highs to extreme lows and will be discussed at another time.

Definition
Bipolar disorder 
Term
Depression is an ___disorder or ___disorder
Definition
Affective ; Mood 
Term
Describe major depressive disorder
Definition
. Major depression occurs when these and other “negative” emotions interfere with the ability to function in everyday normal life
Term
Depression is often associated with these 4 medical conditions, including 
Definition

hypothyroidism

nutritional deficiencies

neurological and psychiatric disorders

Term
. In defining a clinical condition as depression, it is important to ascertain if the depression is caused by another medical condition, such as ____
Definition
hypothyroidism
Term
One subtype of depression is _____, in which the condition also presents with behaviors such as hallucinations and disturbed sense of reality
Definition
psychotic depression
Term
3 types of depression
Definition

Dysthymia - less severe, not disabling form; can be chronic (month - years); predisposes you to MDD

 

Seasonal affective disorder - alters circadian rhythm; sleep deprivation

 

Postpartum depression - 

Term
Circadian rhythms also appear to be altered in MDD. Sleep deprivation has successfully resulted in mood elevation in some patients, but the depression returns after a night of recovery sleep
Definition
Seasonal Affective Disorder 
Term

less severe, less disabling form of depression that shows a prolonged time course(months to years). Predisposes an individual to MDD.

Definition
Dysthymia
Term
Triggers for depression
Definition

Depression is often triggered by a combination of genetic, psychological and environmental factors.


low self-esteem

 women > men

age 25-44

substance abuse

Term
   Depression is a ____disorder and it is likely the etiology varies amongst the population of depressed patients
Definition

heterogeneous 



For examples, there is some evidence that women experience depression differently than men. This along with the higher risk in women is suggestive of different etiologies. 

Term
Explain the common variant hypothesis and how it relates to depression disorder.
Definition
Common variant hypothesis states that depression is a polygenic disease that is caused by a common group of alleles (variants) that are known to cause diseases in humans, such as T2DM and hyperlipidemia (polygenic traits)
Term
3 genes identified in depression disorder include ____
Definition
  1. 5HT transporter (5-HTT, SERT) 


A polymorphism was identified in the promoter of SERT that is a 44 bp insertion/deletion. This affects expression of the gene with the short allele (S) producing less SERT than the L allele. S/S homozygotes are at greater risk of developing MDD.


2. Trp Hydroxylase-2 (TPH2):  A hypomorphic allele in the enzyme that catalyzes the rate-limiting step in 5HT synthesis in brain


3. Brain-derived Neuronotrophic Factor (BDNF): This protein regulates synaptic plasticity and neuronal survival/differentiation. It is reduced in hippocampus by stress



Term
This protein regulates synaptic plasticity and neuronal survival/differentiation. It is reduced in hippocampus by stress.
Definition
Brain-derived Neuronotrophic Factor (BDNF
Term
A hypomorphic allele in the enzyme that catalyzes the rate-limiting step in 5HT synthesis in brain
Definition
Trp Hydroxylase-2 (TPH2)
Term
Explain the monoamine hypothesis
Definition

the efficacy of SSRIs and NRIs gave rise to the monoamine hypothesis, which states that depression is due serotonergic and noradrenergic hypofunction.

Term

____has a role in behaviors such as attention and vigilance; also seems to be critically involved in the processes of hunger and satiety through innervation of the hypothalamus.

Definition
Norepinephrine
Term
Low ____has been tied to aggression and impulsive behavior (suicide).
Definition
5HT (measured as 5HIAA in CSF) 
Term
____also has an important role in the regulation of the hypothalamus, including behaviors relating to eating; also influences sleep behavior, libido, body temperature, and by its conversion to melatonin in the pineal gland, circadian rhythms. 
Definition
5HT 
Term

    The importance of monoamines is also underscored by the fact that _____can induce depression


Definition

Reserpine (rauwolfia serpentine) 

 

causes monoamines to be released from synaptic vesicles and destroyed, thus causing depletion of the neurotransmitters.

Term
What are 2 caveats that weakens the monoamine hypothesis?
Definition

1. There is no specific brain region that controls mood.

 

2. Antidepressants take weeks to work, but since the concentrations of 5HT and NE increase immediately, that means that 5HT and NE presence are not all that is needed to achieve the antidepressant effects (needs neural remodeling?)

 

The delay in response is suggestive of a genomic response, that is, changes in gene regulation that alter the pattern of receptors and ion channels in the affected neurons. Another possibility is the delay occurs because structural changes occur, such as neuronal plasticity, and these take time (and genomic changes).

Term
Which brain regions are involved in emotion?
Definition

Limbic system and prefrontal cortex.  

Term
This is the region at the anterior pole of cerebral cortex, rostral to motor areas. It functions in planning, motivation and working memory.  It functions in the “elaboration of thoughts”. This includes the ability to predict and plan for the future, analyze the consequences of planned actions. It has “executive control” over stereotyped actions.
Definition
Pre-frontal cortex
Term

Dysfunction of ____leads to inability to solve complex problems, lack of motivation, lack of focus, impulsivity and inappropriate social interactions.

Definition
prefrontal cortex
Term
____ is a set of interconnected structures that function together in emotion and behavior
Definition
The limbic system
Term
____is the efferent axis of the limbic system. It regulates autonomic function and endocrine function and many basic behaviors such as eating, sleeping, etc. 
Definition
Hypothalamus 
Term

Activation of the ____system is associated with pleasure, “warm fuzzy” feelings. Activation of _____is associated with anxiety, fear and anger.

Definition
parasympathetic ; sympathetics 
Term
The ____also controls display of emotional behavior. 
Definition

hypothalamus 

 lateral hypothalamus = elicit a rage display

ventromedial hypothalamic nuclei =  elicits satisfaction.


 

 

Term
Many of the physiological processes affected by depression are controlled by the ____
Definition
hypothalamus
Term
What is the Dexamethasone Suppression Test?
Definition

The Dexamethasone Suppression Test has been used to test hypothalamic function in MDD. Treatment with dexamethasone would be expected to reduce ACTH levels and thereby cortisol levels. Some patients, termed nonresponders, do not suppress cortisol production upon dex treatment. The DST may be a way of separating patients into different groups, but the utility has yet to be demonstrated.

Term

____is involved in inner emotions such as joy, anger, hope, fear, and anxiety, and applies emotion to cortical information.

 

Definition
Amygdala 
Term

____is best known for its role in memory consolidation. It has other roles including positional memory and timing mechanisms and inhibition of hypothalamic function.

Definition
Hippocampus 
Term

This the so-called “reward center” which is activated by DA neurons located in ventral tegmentum. It responds to novelty and applies positive reinforcement to thoughts and actions.

Definition
Accumbens
Term

This region of cortex functions to provide emotional awareness.

 

Definition
Cingulate Cortex
Term
The volume of ____and certain areas in prefrontal cortex is reduced in MDD
Definition
hippocampus 
Term

Cerebral metabolic rate of ____metabolism is lower in cortical regions making up this network in MDD. Antidepressant treatment can reverse the deficiency.

Definition
glucose 
Term
Describe the neurogenic hypothesis
Definition

This adult neurogenesis is important for hippocampal function, such as formation of new memories. Many years ago, it was shown that elevated cortisol levels cause hippocampal atrophy (Cushing’s disease) and recent experiments have demonstrated that cortisol impairs hippocampal neurogenesis. Neuroinflammation also impairs neurogenesis. On the other hand, exercise and antidepressants enhance hippocampal neurogenesis and elevated BDNF levels mediate this enhancement. By itself, BDNF is an important regulator of hippocampal function. 

Term

List the brand names:

fluoxetine

paroxetine

sertraline

citalopram

escitalopram

venlafaxine

desvenlafaxine

duloxetine

bupropion

mirtazapine

vilazodone

selegiline patch 

Definition

(a) fluoxetine – Prozac

(b) paroxetine – Paxil

(c) sertraline – Zoloft

(d) citalopram – Celexa

(e) escitalopram – Lexapro

(f) venlafaxine – Effexor

(g) desvenlafaxine – Pristiq

(h) duloxetine – Cymbalta

(i) bupropion – Wellbutrin

(j) mirtazapine – Remeron

(k) vilazodone – Viibryd

(l) selegiline patch – EmSam.

Term
Describe the importance of the DSM-5 in psychiatry care.
Definition

q  Diagnostic and Statistical Manual of Mental Disorders, 5th Edition

 

q  Most widely accepted and important diagnostic reference used in the care of mentally ill patients

 

q  General information on all mental disorders recognized by the American Psychiatric Association

·         Age of onset

·         Clinical course

·         Complications

·         Predisposing factors

·         Prevalence

·         Differential diagnoses

·         Diagnostic criteria

Number of symptoms/time course required

Term
describe the mental status examination
Definition

q  Direct patient interview

q  Combined with other components of patient work-up (hx of illness, physical exam, appropriate lab work, medical/psych history) to give full picture of the presenting psychiatric problem

q  Appearance

·                                                      Age, dress, grooming, hygiene, use of cosmetics

·                                                      Facial expressions

·                                                      General state of physical health

q  Attitude

·      Cooperative, mute, hostile, paranoid, guarded, withdrawn

q  Motor Activity

·      Overactivity, underactivity, catatonia

q  Speech/Language/Eye Contact

·      Does speech flow in a logical goal-directed manner?

·      Blocking – stops speaking without any obvious reason (hallucinations/delusions intrude?)

·      Circumstantial – lacks clear direction but patient eventually answers question

·      Tangential – ultimate point is never made

·      Perservation – repetition of an answer to multiple questions

·      Flight of ideas – jumps from one idea to the next rapidly.

·      Pressured speech – talking very fast to where interviewer has difficulty interrupting.

q  Mood

·      Depressed, euphoric, euthymic

q  Affect

·      Appropriate, reactive, blunted, restricted, flat, labile

q  Thought content/process

·      Hallucinations, delusions, paranoia

·      Organized , answers thought-out, goal-directed

·      Disorganized, superficial

q  Insight/Judgment

·      Awareness of mental illness and impact of illness

·      Ability to make appropriate decisions

q  Neuropsychiatric Evaluation

·      Sensorium – level of consciousness

·      Attention and Concentration

·      Intelligence

·      Memory

 

·      Orientation

Term

Medical Conditions that Cause Depression

Definition

- Hypothyroidism                                                        - Alzheimer’s disease

- ¯vitamin B12 or folate                                             - Parkinson’s disease

- Severe anemia                                                           - Malignant disease

- Infections                                                                  - Autoimmune disorders

- Post-stroke                                                                - Menopause

- Heart failure                                                              - Electrolyte imbalance

 

-Coronary artery disease

Term

Substance Disorders that Cause Depression

Definition

-    Alcoholism                                                               - Marijuana use and dependence

-    Nicotine dependence                                               - Opiate abuse and dependence

 

-    Stimulant abuse and dependence

Term

Medications that Cause Depression

Definition

Beta blockers                                                  - Benzodiazepines

- Opioids                                                                     - Clonidine

- Barbiturates                                                              - Anticonvulsants

- Reserpine                                                                  -Interferon

 

-    Oral contraceptives                                                  - Isotretinoin

Term
SIGECAPS
Definition

S - How is your SLEEP?  How many hours?

I - Are you still INTERESTED in your normal daily activities?

G - Do you have feelings of - GUILT/worthlessness/hopelessness?

Describe your ENERGY.

C - Do you have problems with CONCENTRATION or memory?

A - How is your APPETITE?

P - Do you feel agitated or have problems with getting motivated? (PSYCHOMOTOR retardation/agitation)

 

S- Any thoughts of wanting to harm yourself? (SUICIDE)

Term

q  Short-term studies have shown an increased risk of suicidal thinking and behavior with antidepressant therapy in people under the age of ____

Definition
<24 yrs
Term

Highest risk of suicidal behavior was found to be during the ____.

Definition
first 30 days of therapy
Term

q  All antidepressants carry this black box warning.

Definition
Risk of suicide
Term

Why is it important to treat depression?

Definition

q  Increases quality of life

q  Decreases suicide risk

 

q  Decreases morbidity and mortality of other disease states

Term

5 Treatment Options for depression

Definition

q  Psychotherapy

q  Electroconvulsive Therapy (ECT)

q  Light Therapy

q  Vagal Nerve Stimulation

 

q  Pharmacotherapy

Term

According to the American Psychiatric Association (APA) Treatment, what are the initial pharmaco treatment fo depression

 

Definition

o  Choose SSRI, SNRI, bupropion, or mirtazapine

o  Titrate to a therapeutic dose and assess for efficacy in 4-6 weeks

 

SSRIs:   Serotonin Selective  Reuptake  Inhibitors

               (e.g., fluoxetine, sertraline, paroxetine)

 

SNRIs:   Serotonin Norepiphrine Reuptake Inhibitors

 (e.g., duloxetine, venlafaxine)

Mirtazapine= Noradrenergic SpecificSerontonergicAntidpressants (NSSA)


Buproprion = Norepinephrine Dopamine  Reuptake Inhibitors (NDRI)


Term
According to the American Psychiatric Association (APA) Treatment, what steps do you take if you experience partial response to antidepressants?
Definition

·         Partial Response

o  Step 1:    Increase dose if not at maximum dose

 

o  Step 2:    Add psychotherapy if patient is not already participating and agrees   AND/OR

§   Add augmentation agent

·      Modest to good evidence

o                        A non-MAOI antidepressant with a different mechanism of action

o                        Lithium

o                        Thyroid hormone (T3 or T4)

o                        2nd generation antipsychotics



·      Less supporting evidence

o                        Folic acid

o                        Omega 3 Fatty Acids

o                        Anticonvulsant

o                        Stimulants

 

 

Term
According to the American Psychiatric Association (APA) Treatment, what steps do you take if you experience no response to antidepressants?
Definition

o  Discontinue the initial antidepressant and try another non-MAOI antidepressant

§   May switch to another drug within the same class or one with a different mechanism of action

 

o  MAOI should be reserved as last line therapy but should not be forgotten

Term

For treatment of depression ____should be reserved as last line therapy but should not be forgotten

 

Definition
MAOI 
Term

7 Factors Influencing Drug Selection

Definition

q  History or familial history of response

q  Concurrent diseases

q  Concurrent medications

q  Adverse effects

q  Compliance

q  Cost

 

q  Neurotransmitter specificity

Term
Name 6 SSRI and their brand names
Definition

Fluoxetine (Prozac)

Paroxetine (Paxil)

Sertraline (Zoloft)

Fluvoxamine (Luvox)

Citalopram (Celexa)

Escitalopram (Lexapro)

Term
Main ADR of SSRIs
Definition

·         Serotonin adverse effects - GI side effects, sleep disturbances, initial agitation, anorexia, sexual dysfunction

Term

 This SSRI holds a warning for prolonged QT interval – doses > 40mg not recommended and try to avoid CYP 2C19 inhibitors (e.g. omeprazole)

Definition
Citalopram 
Term
This 2 SSRI have no CYP interaction
Definition
Citalopram and Escitalopram
Term
SSRI should never be combined (contraindicated) with ___ or ____
Definition
MOAI or other serotonergic agents
Term
4 SSRI that can be used in pediatrics are:
Definition

  Fluoxetine (prozac) , Fluvoxamine (Luvox), Sertraline (Zoloft), Escitalopram (Lexapro)



FFSE

 

Term
All SSRI can be used in pregnancy except:
Definition
Paroxetine (Paxil) - increased risk of pulmonary HTN
Term
Name 3 SNRI and give their brand names
Definition

Venlafaxine (Effexor)

Duloxetine (Cymbalta)

 

Levomilnacipran (Fetzima)

 

VDL

Term
How are SSRI dosed?
Definition
Once daily dosing, take with food, take in the morning
Term
Names some major ADR of SNRIs
Definition

q  Norepinephrine adverse effects – tachycardia, elevated BP, insomnia, tremor, sweating, pseudo-anticholinergic adverse effects (urinary retention, dry mouth, constipation)

 

 

q  Serotonin side effects

Term

____ is A SNRI associatedf with elevated LFT

 

 

____ is A SNRI associatedf with QT prolongation

Definition

Duloxetine (Cymbalta) = LFT

 

Venlafaxine (Effexor) = QT prolongation

Term
Name the 4 SNRI and their brand names
Definition

Venlafaxine (Effexor)

·      Desvenlafaxine (Pristiq) – active metabolite of venlafaxine (more noradrenergic compared to venlafaxine)

 

Duloxetine (Cymbalta)

 

 

Levomilnacipran (Fetzima)

Term
4 contraindications with SNRI use
Definition

1. Avoid MAOI

2. other serotonergics

3. other sympathomimetics and stimulant - raise NE

4. Can decrease effects of antihypertensives

Term
The only SNRI that is a CYP inhibitor
Definition
duloxetine (Cymbalta) - inhibits 2D6
Term
SNRI are beneficial for these 4 groups of ptns
Definition
  • Patients with apathy, low motivation
  • Patients suffering from hypersomnia
  • Obese patients
  • Pain patients

 

Term
SNRI are bad for these 2 groups of ptns
Definition

Patients with HTN

Ptn with cardiovascular disease 

Term
ADR of Bupropion
Definition

q  Decreases seizure threshold (higher than 450mg/day)

 

q  Norepinephrine adverse effects – tachycardia, HTN, insomnia, tremor, wt loss, sweating, pseudo-anticholinergic adverse effects (dry mouth, constipation, urinary retention)

 

 

q  Dopamine adverse effects – psychotic symptoms, bad dreams

Term
2 drug class that decrease seizure threshold ...causing more seizures
Definition

1. Bupropion

2. TCAs

Term
Name 3 main ADR of bupropion.
Definition

q  Decreases seizure threshold (higher than 450mg/day)

 

q  Norepinephrine adverse effects – tachycardia, HTN, insomnia, tremor, wt loss, sweating, pseudo-anticholinergic adverse effects (dry mouth, constipation, urinary retention)

 

 

q  Dopamine adverse effects – psychotic symptoms, bad dreams

Term
4 C/I for bupropion
Definition

q  Use with monoamine oxidase inhibitors is contraindicated

 

q  Use caution with medications that augment dopamine (Parkinson’s Meds)

 

q  Use caution with medications that increase NE levels

 

 

q  Use caution with other medications that lower seizure threshold

Term
For bupropion dosing, only sustained release is preferred over extended release.
Definition

False - Sustained and Extended release products preferred


q  Extended release (XL) product is taken once daily in the morning.

 

 

q  Sustained release (SR) product is taken twice daily. Do not take pm dose right before bedtime.  Separate doses by at least 8 hours and do not exceed > 200mg per dose.

Term
Who would benefit most from bupropion?
Definition
  • No serotonin side effects       
  • Smokers
  • Patients with low motivation/energy
  • Obese patients

 

 

Term
Do not use bupropion in these patients:
Definition
  • Patients predispose to seizures
  • Anorexia Nervosa
  • Cardiovascular disease

 

Term
Name the 6 TCAs; which are 2ndary or tertiary amines
Definition


Secondary amines – nortriptyline (Pamelor), desipramine (Norpramin) 


Tertiary amines – amitriptyline (Elavil), imipramine (Tofranil), doxepin (Adapin), clomipramine (Anafranil)

Term
ADR of TCAs
Definition

q  Norepinephrine adverse effects – tachycardia, elevated BP

q  Serotonin adverse effects – GI upset, sexual dysfunction

q  Anticholinergic adverse effects (due to M1 blockade)

q  Sedation and weight gain (due to H1 blockade)

q  Orthostatic Hypotension (due to alpha-1 blockade)

q  Arrhythmias (due to Na+ and K+ channel blockade in the cardiac tissue)

 

q  Decreases seizure threshold

Term

This class of antidepressants cause arrhythmia (due to Na+ and K+ channel blockade in the cardiac tissue) and Orthostatic Hypotension (due to alpha-1 blockade)

 

Definition
TCA
Term
Which 2 TCA can be used in children 6 years or older?
Definition

Imipramine(Tofranil)  and desipramine ((Norpramine)


Term

    Withdrawal symptoms in the infant have been reported with this antidepressant class

Definition
TCA
Term
Benefits of TCA
Definition
  • Patients with migraine headaches
  • Patients with insomnia
  • Patients with decreased appetite
  • Patients with neuropathic pain

 

Term
Do not use TCA if:
Definition
  • History of arrhythmias
  • Cardiac disease
  • Elderly
  • Suicidal patients
  • Predisposed to seizures

 

Term
This agent causes rare cases of agranulocytosis and increased liver transaminases
Definition
Mirtazapine (Remeron)
Term
This agent cis known to increase cholesterol
Definition
Mirtazapine (Remeron)
Term
C/I of Mirtazapine
Definition

q  Use with monoamine oxidase inhibitors is contraindicated


Sedating medications


Use caution with medications that increase NE


Use caution with other serotonergic medications


Decreases the effectiveness of clonidine

Term
Benefits of Mirtazapine
Definition

Less serotonin side effects

Patients with loss of appetite

 

Patients with insomnia

Term
Brand name of Viladozone
Definition
Viibryd
Term
ADR of viibryd
Definition
GI upset
Term
C/I of Mirtazapine
Definition

Obese patients

Patients with elevated cholesterol

 

Patients with hypersomnia

Term
Two antidep that cause orthostatic depression
Definition
MAOI  & TCA
Term
Avoid food with tyramine with this class of antidep
Definition
MAOI
Term
C?I of MAOI agents
Definition

q  Use with other antidepressants is absolutely contraindicated

 

q  Use with other serotonergic medications is contraindicated

 

q  Use with other medications that increase NE and dopamine is contraindicated

 

 

q  May decrease the effect of clonidine and guanethidine

Term

q  no longer a first line agent, absolutely contraindicated in patients who have difficulty understanding or remembering medication instructions.

Definition
MAOI
Term
Describe these phases of treatment: Acute phase, continuation phase, maintenance phase.
Definition

q  Acute Phase:   6-10 weeksGoal is to reach remission


 

q  Continuation Phase: 4-9 months after remission is achieved; Prevent relapse


 

q  Maintenance Phase: 12 months - ???? Prevent recurrences

 

Term

q  symptoms of depression are no longer present

Definition
Remission
Term
return of symptoms within 6 months after remission
Definition
Relapse
Term

episode of depression, which occurs years after normal functioning returns

Definition
Recurrence
Term
T/F: Risk of recurrence increases as the number of depressive episodes decrease.
Definition
False: Risk of recurrence increases as the number of depressive episodes increases
Term
Recurrence of depression is highest after __  episodes
Definition

o  1st episode (50% recurrence)

 

 

o  3 or more episodes (90% recurrence) – Lifetime management

Term

  Elderly should be dosed at____ dose for ____ week(s) then increase to therapeutic dose if side effects are not seen.

Definition
 ½ of normal; 2
Term

qRemission is associated with ___ and ___

Definition

less disability;

lower risk of relapse


Term
Primary Therapeutic Goal in PD
Definition
Increase dopaminergic action in striatum 
Term
Secondary Therapeutic Goal in PD
Definition
Decrease endogenous acetylcholine actions
Term
Why can’t we just administer dopamine to the PD patient?
Definition
1.It is completely destroyed during digestion
2.It cannot be absorbed by the wall of the gut
3.It must be given I.V.

 

4.Even then, it cannot cross the blood brain barrier 
Term
Most effective drug for parkinsonian symptoms 
Definition
Levodopa (L-dopa)
Term
Transporter needed for levodopa.
Definition
large neutral amino acid transporter (LAT)
Term

T/F: L-dopa is the active form of dopamine

 
Definition
•False: L-dopa itself is inert:  therapeutic and adverse effects from its conversion to the active agent, dopamine 
Term
Problem with levodopa
Definition
Problem: rapid peripheral decarboxylation to dopamine without a decarboxylase inhibitor.
oInitially high doses were required à many side effects
oCurrently, L-dopa is always combined with decarboxylase inhibitor

 

oThese inhibitors act peripherally (carbidopa)
Term
Side effect of levodopa:  
Definition
Side effects:  nausea, dyskinesias, hallucinations, postural hypotension 
Term
Long-term treatment with levodopa leads to ______
Definition
motor complications:
oWearing off and “on/off” response fluctuations (end-of-dose)
oDyskinesias (involuntary movements at peak-of-dose)

 

oFreezing (start hesitation, “feet stuck to the floor”)
Term
Oral l-dopa bioavailability can be doubled if administered with _______
Definition
decarboxylase inhibitor
Term
Absorption delayed and/or reduced in the presence of food
Should be taken with food during the first weeks of therapy to minimize side effects

 

Protein rich meals can impair absorption
Definition
L-dopa
Term
Name and MOA of decarboxylase inhibitors
Definition

Cardidopa: Inhibits the peripheral metabolism of L-dopa to dopamine, which increases amount of L-dopa

 

Term

Sinemet = ___+ _____

 

Lodosyn = _____

Definition

Sinemet = carbidopa + L-dopa

 

Lodosyn = carbidopa only

Term

Name the 3 peripheral NS enzyme inhibitor that increase dopamine.

 

Definition

Tolcapone & Entacapone = COMT inhibition

Carbidopa = AADC

Term

Name the 3 central NS enzyme inhibitor that increase dopamine.

 
Definition

selegiline (low dose) & Rasagiline = MAO-B


Tolcapone = COMT

Term
2 important functions of COMT
Definition
Adjunct to levodopa/carbidopa

 

Diminish response fluctuations 
Term
Inhibits COMT centrally and peripherally
Selective and reversible inhibitor
Side effects:  jaundice, upset
stomach, extreme tiredness, hepatotoxicity
Blood tests important  especially
during first 6 months, hepatic
function monitoring
Black box warning: Tolcapone use has been
associated with a risk of
potentially fatal, acute
fulminant liver failure.
Tolcapone is reserved for
patients with motor
fluctuations that are not
responding to other therapies

 

Long duration of action (T1/2 4
hours)
Definition
Tolcapone (Tasmar)
Term
oInhibits COMT peripherally
oSelective and reversible inhibitor
oPreferred over Tolcapone (no severe adverse effects)
oUsed in combination with carbidopa/L-dopa
oSide effects:  nausea, orthostatic hypotension;                       confusion, hallucinations, urine discoloration

 

oCan be taken with selective MAO-B inhibitor selegiline, not with general MAO inhibitor
Definition
Entacapone
Term
MAO-____ preferentially
deaminates serotonin, epinephrine and norepinephrine => unwanted serious side effects
Definition
MAO - A
Term
MAO-___ is responsible for oxidative
deamination of dopamine in the brain
Definition
MAO-B Iinhibition is desired in parkinson's disease
Term
Often recommended as 1st drug of choice
oEspecially in patients under 65

 

oEarly PD: monotherapy  -
modest improvement of motor
function
Definition
Selegiline (eldepryl, Emsam, zelapar) - MAO-B inhibitor
Term
Metabolites of selegiline
Definition
oAmphetamine & methamphetamine
Term
Which dopaminergic agent has neuroprotective activity
Definition
Selegiline - MAO-B inhibitor
Term
Benefits of rasagiline over selegiline
Definition
Not metabolized to amphetamines (main metabolite aminoindan)
Term
In parkinson's ____pathway is activated while ____pathway is inactivated.
Definition

Indirect pathway (D2)

Direct pathway (D1) 

Term
Dopamine receptor agonist regulate movement via 2 pathways
Definition

Activate direct pathway (D1)

 

Inactivate indirect pathway (D2)

Term
Used as initial therapy, especially in young patients; or adjunct to L-dopa
Definition
Dopamine agonist - oRopiniroleandPramipexole
Term
Faster initiation compared to ergot agents
D2 class receptor selectivity (D2, D3, D4)
6 hr half life
Hepatic metabolism (CYP1A2)
Duration of action is 8-24 hrs
Effective in treating on/off effects
Side effects: 
oSomnolence may be severe; though rare
oHallucinations & confusion 

 

oOrthostatic hypotension 
Definition
D@ agonist - Ropinirole (Requip)
Term
The  oldest and most potent dopamine agonist in clinics
oHigh affinity for D4 receptors
oModerate affinity for D2, D3, and D5
oLow affinity for D1 receptors
Aporphine alkaloid derivative; no narcotic properties
s.c. injections; orally – very poor bioavailability
Rescue medication
oUseful for patients with intermittent “off” periods
oAdministration of s.c.apomorphine triggers “on” response within 20 min.
Side effects
oNausea (highly emetogenic!!!!), orthostatic hypotension, somnolence, yawning

 

oRare: hypersexuality or other behavioral disturbances, skin nodule formation
Definition
D2 agonist - Apomorphine (Apokyn) 
Term
Selective D2 receptor agonist
Half life: 5-7 hours
24 hrtransdermal patch
Since 2006 approved in Europe
Since May 2007 approved in US
March 2008 recall on patches, because of crystals and no longer available in the US

 

Patch was reformulated and reintroduced in                              2012
Definition
Rotigotine (Neupro)
Term
Improve symptoms of parkinsons disease through  effect exerted in the striatum
Definition
Anticholinergics agents
Term
oDopamine inhibits acetylcholine neurons in striatum through ___receptors
Definition
D2 
Term
oDegeneration of _____dopamine neurons results in increase of striatal cholinergic interneuron activity
Definition
nigrostriatal 
Term
Effective mainly for tremor in PD 
Definition
anticholinergics
Term
Name 2 muscarinic receptor antagonists used for parkinsons
Definition
vBenztropine (Cogentin®)

 

vTrihexyphenidyl (Artane
Term
Antiviral drug used for the prophylaxis and treatment of influenza A
Enhances DA release, inhibits its reuptake, possesses anticholinergic properties, blocks NMDA receptors
Modest symptom relief
Used for mild PD as dopaminergic neurons are required for dopamine
Can suppress L-dopa-induced dyskinesias
Eliminated renally
Definition
Amantadine (Symmetrel)
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