UC NURS 8024 Module 8 Neuro Test
Questions With Guaranteed Pass
Solutions.
drugs used in Parkinsonism - Answer dopamine precursor (levodopa), dopamine agonists
(bromocriptine, pramipexole), MAOI (selegiline), COMT inhibitors (entacopone), muscarinic antagonists
(benztropine)
amantadine - Answer glutamate antagonist (antiviral), enhances dopaminergic neurotransmission.
Used for minor Parkinson's sx, improves bradykinesia, rigidity, tremor. ADE - dry mouth, restlessness,
agitation, urinary retention, post. hypotension, pedal edema. Caution in seizure disorders and CHF!
Anticholinergic agents - Answer antimuscarinic, decreases the excitatory actions of cholinergic neurons
by blocking muscarinic repectors. Improves tremor and rigidity but not bradykinesia. ex: benztropine
(Cogentin). Caution in elderly, BPH, urinary retention, liver, renal or GI or GU disease. Can precipitate
narrow angle glaucoma. Limited use d/t ADEs
dopamine receptor agonists - Answer effective mild parkinsonism, used in combo with levodopa. also
for restless leg syndrome. ex: pramipexole (Mirapex). ADE - N/V, anorexia, dyskinesias, CNS - confusion,
delusions, hallucinations (more common with levodopa). Monitor - renal function
pramipexole (Mirapex) - Answer dopamine receptor agonist, often combined with levodopa. ADE - N/V,
anorexia, dyskinesias, CNS - confusion, delusions, hallucinations (more common with levodopa). Monitor
- renal function
ropinirole hydrocholoride (Requip) - Answer dopamine receptor agonist. effective for mild
parkinsonism, also used in combo with levodopa, and in restless leg syndrome.
ADE - N/V, anorexia, dyskinesias, CNS - confusion, delusions, hallucinations (more common with
levodopa). Monitor - renal function
monamine oxidase B inhibitors - Answer MOA not fully understood. ex: selegiline (Eldepryl), rasagiline
(Azilect). used in early Parkinson's disease, mild sx, usually given with levodopa. No tyramine foods! ADE
- insomnia, mood changes, dyskinesias, GI sx, hypotension. Do not combine with fluoxetine or
meperidine - additive effect!
, Dopamine precursors - Answer enhances synthesis of dopamine. levodopa and carbidopa (Sinemet).
works best in new patients. over time, number of neurons decreases. relief lasts only while drug is
present in body. Give levodopa in combination with carbidopa to increase levadopa availability
Levadopa - Answer dopamine precursor. attempts to replace dopamine. Can cross BBB. rapid GI
absorption, short half life. On-off phenomenon - sudden loss of normal mobility, tremors. Take levodopa
on empty stomach to increase CNS availability - meals (esp high protein) interferes with levodopa
transport in CNS
carbidopa - Answer dopamine precursor. enhances effect of levadopa by diminishing metabolism of
levadopa in GI tract and peripheral tissues. Increases availability of levadopa to cross into CNS.
levodopa/carbidopa combination - Answer potent and effective in treatment. carbidopa increases
bioavailability of levodopa - more CNS availability. levodopa decreases rigidity and tremors. typical
decline in response in 3rd to 5th year of tx.
levodopa ADEs - Answer GI sx, tachycardia, PVCs, postural hypotension, mydriasis (can precipitate
glaucoma). CNS effects: hallucinations, dyskinesias, mood changes, depression, psychosis, anxiety. CI in
hx of psychosis
COMT inhibitors - Answer Catechol-O-Methyltransferase (COMT) inhibitor. Adjunctive therapy with
levodopa-carbidopa. increases concentration of dopamine in CNS. ex: Entacapone (Comtan). ADE
(secondary to inc. levadopa): dyskinesias, GI distress, postural hypotension. Tolcapone - increased liver
enzymes, acute hepatic failure. **Do not use MAOI and COMT together
distinguishing features of Alzheimer's - Answer accumulation of senile plaques (beta-amyloid),
formation of neurofibrillary tangles, loss of cortical neurons -particularly cholinergic neurons
cholinesterase inhibitors - Answer management of mild to moderate Alzheimer's. MOA - block enzyme
that degrades ACh, enhances cholinergic transmission. ADE - GI sx, insomnia, fatigue, cramps, anorexia.
ex: donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)
NMDA receptor antagonists - Answer Decreases activity of glutamate in synapse, neuroprotective.
mod-severe Alzheimer's. often given in addition to cholinesterase inhibitors. ex: memantine (Namenda).
