Alzheimer's Disease Medications Quiz

Study Notes

Alzheimer's Disease Medications

Rivastigmine slows the progression of Alzheimer's disease (AD) and has side effects including nausea, diarrhea, vomiting, anorexia, tremors, bradycardia, and muscle cramps.
Memantine (Namenda®) is an N-methyl-D-aspartic acid (NMDA) - glutamate receptor antagonist that works by attenuating the excitotoxic effects of glutamate in AD.
Normal stimulation of glutamate receptors is crucial for memory formation, but excessive stimulation can cause neuronal damage and apoptosis.
Overstimulation of glutamate receptors is linked to excitotoxic effects on neurons.
Memantine is excreted largely unchanged as the parent molecule.
Namzaric® is a combination of memantine extended-release with donepezil.
Caprylidene (Axona®) is a medical food that is metabolized into ketone bodies, providing energy for the brain when glucose processing is impaired.
MRI scans show decreased glucose uptake in the brains of the elderly and those with AD.

Multiple Sclerosis Medications

MS is an autoimmune inflammatory demyelinating disease of the CNS.
Demyelination leads to disrupted nerve transmission, inflammation, and the formation of plaques in the brain and spinal cord.
MS can be acute or chronic and cause pain, spasticity, weakness, ataxia, fatigue, and problems with speech, vision, gait, and bladder function.
Acute exacerbations of MS are treated with prednisone.
Disease-Modifying Therapies (DMTs) are designed to decrease relapse rates and prevent disability.
Interferon β-1b (Betaseron®) was the first drug to demonstrate an ability to halt and reverse the progression of MS in some cases.
Interferon β-1b increases the cytotoxicity of natural killer cells, increases macrophage phagocytic activity, and reduces interferon-γ secretion.
Interferon β-1a works as an immunomodulator and is synthesized by recombinant protein pathways.
Peginterferon β-1a is a PEGylated derivative of interferon β-1a with a longer duration of action.
Glatiramer (Copaxone®) is a synthetic polypeptide that mimics myelin basic protein and may act as a decoy to T-cell attack.
Fingolimod (Gilenya®) is an oral drug that alters lymphocyte migration, reducing lymphocyte counts in the CNS.
Fingolimod is a sphingosine-1-phosphate receptor modulator that blocks lymphocyte egress from lymph nodes.
Teriflunomide (Aubagio®) is an oral pyrimidine synthesis inhibitor that reduces the proliferation of immune cells and lowers lymphocyte concentration in the CNS.
Dimethyl fumarate (Tecfidera®) is an oral agent that may alter the cellular response to oxidative stress.
Dimethyl fumarate activates the Nrf2 pathway, which regulates the cellular response to oxidative stress.
Dalfampridine (Ampyra®) improves walking in patients with MS by blocking potassium channels and enhancing conduction in damaged nerves.
Mitoxantrone (Novantrone®) is an anti-neoplastic agent that suppresses T cells, B cells, and macrophages.
Ocrelizumab is the first agent approved for primary progressive forms of MS.
Natalizumab (Tysabr®) is a monoclonal antibody that blocks the molecular pathway involving cell adhesion that draws lymphocytes into the CNS.
Daclizumab is a monoclonal antibody preparation that blocks interleukin-2 (IL-2) receptor-mediated activation of lymphocytes.
Alemtuzumab is a CD52-directed cytolytic monoclonal antibody approved for relapsing forms of MS.

Amyotrophic Lateral Sclerosis Medications

ALS is a progressive degeneration disease of motor neurons resulting in muscle weakness and respiratory failure.
ALS causes muscle wasting and leads to death in 2 to 5 years.
ALS has an unknown cause, but evidence suggests a defect in superoxide dismutase.
Riluzole (Rilutek®) is the first drug specifically approved for the treatment of ALS and is an NMDA receptor antagonist.
Riluzole may improve survival time in ALS patients.
Edaravone (Radicava®) is a neuroprotective agent and an intravenous free radical scavenger that may slow the progression of ALS.
Baclofen (Lioresal®) is a GABAB receptor agonist that reduces motor neuron excitability and is useful for reducing MS-related spasticity.

Anti-Spastic Agents

Anti-spastic agents are used to treat skeletal muscle spasms that may occur from injury or neurologic disease.
Spasticity is frequently treated with physical therapy, but anti-spastic drugs may be useful in severe cases.
Gabapentin (Neurontin®) is used to slow the decline in muscle strength.