Deck 16: Geriatric Psychopharmacology

Question 1

All of the following are features associated with Parkinson's disease EXCEPT:

A)resting tremor.
B)bradykinesia.
C)thrashing movements.
D)muscle rigidity.

Answer 1

C

Question 2

Among the psychoactive medicines,_____ are most commonly and inappropriately prescribed among the elderly.

A)antidepressants
B)antihistamines
C)benzodiazepines
D)opioids

Answer 2

C

Question 3

______ cause significant cognitive impairment in elderly populations.

A)SSRI antidepressants
B)Atypical antipsychotics
C)Ritalin
D)Benzodiazepines

Answer 3

D

Question 4

__________ is the second most common neurodegenerative disease.

A)Alzheimer's disease.
B)Parkinson's disease.
C)depression.
D)bipolar disorder.

Question 5

To treat agitation and aggression in the elderly,risperidone and olanzapine were used most frequently but _____ has rapidly gained favor.

A)haloperidol
B)quetiapine
C)clozapine
D)aripiprazole

Question 6

Based on your knowledge of the cellular basis of parkinsonism and psychotropic drugs,you would expect drugs used to treat _______ to worsen Parkinson's symptoms.

A)schizophrenia
B)anxiety
C)mania
D)depression

Question 7

Symptoms of Parkinson's disease are frequently a side effect of:

A)antidepressants.
B)antipsychotic agents.
C)mood stabilizers.
D)anti-anxiety agents.

Question 8

Comorbid ______ with depression generally suggests a poorer outcome for treatment in the elderly.

A)psychosis
B)bipolar disorder
C)panic disorder
D)anxiety

Question 9

Symptoms of Parkinson's disease reveal themselves when levels of dopamine ______ by _____ percent.

A)increase; 20
B)decrease; 20
C)increase; 80
D)decrease; 80

Question 10

In the elderly,______ doses of medications are often effective with a ______ half-life.

A)higher; shorter
B)lower; longer
C)higher; longer
D)lower; shorter

Question 11

At the cellular level,the biological basis for Parkinsonism is best described as a _____ state.

A)hypernoradrenergic
B)hyponoradrenergic
C)hyperdopaminergic
D)hypodopaminergic

Question 12

While the precise cause of Parkinson's disease remains to be determined,symptoms are correlated with changes in the number and function of the ______ system.

A)serotonergic
B)cholinergic
C)glutamatergic
D)dopaminergic

Question 13

All of the following are drugs of concern in elderly populations EXCEPT:

A)tricyclic antidepressants.
B)dopamine agonists.
C)antihistamines.
D)benzodiazepines.

Question 14

In elderly populations,______ are the most inappropriately prescribed medications.

A)long-acting benzodiazepines
B)tricyclic antidepressants
C)muscle relaxants
D)antihistamines

Question 15

It has been suggested that a _____ approach to treating depression in the elderly can be quite successful.

A)team
B)psychosocial
C)cognitive behavioral
D)polypharmaceutical

Question 16

Of the drugs that are used for control of agitation and aggression in the elderly,______ is most often prescribed.

A)atypical antipsychotics
B)risperidone (Risperdal)
C)quetiapine (Seroquel)
D)olanzapine (Zyprexa)

Question 17

When considering the pharmacological treatments of geriatric populations,all of the following are true EXCEPT:

A)elderly populations do not metabolize medication as efficiently,thus half-lives of medications may be quite long.
B)sedative-hypnotics are dementing the in the elderly.
C)substance abuse in the elderly is a rare occurrence.
D)elderly populations often exhibit depression and comorbid anxiety.

Question 18

The Partnership to Improve Dementia Care initiative was primarily implemented to:

A)increase public awareness of dementia.
B)evaluate nursing practices.
C)reduce antipsychotic medication use.
D)improve patient care.

Question 19

According to 2014 statistics from the CDC,the highest rate of suicide deaths for males and females combined is in the _____ age group.

A)25 to 34
B)45 to 54
C)65 to 74
D)85+

Question 20

The clinical syndrome of parkinsonism includes all of the following EXCEPT:

A)slowness/poverty of movement.
B)muscle rigidity.
C)tremor during voluntary movement.
D)impaired postural balance.

Question 21

_______ is used to inhibit peripheral catechol-o-methyltransferase (COMT)thereby increasing dopamine availability in the brain with no apparent adverse effects on the liver.

A)Levodopa
B)Tolcapone (Tasmar)
C)Entacapone (Comtan)
D)Stalevo

Question 22

The most undesirable side effects of treatment with levodopa are caused by the buildup of high levels of ______ in the ______.

A)levodopa; brain
B)levodopa; systemic circulation
C)dopamine; brain
D)dopamine; systemic circulation

Question 23

The new dopamine receptor agonists are ______ in the treatment of Parkinson's disease.

A)highly effective
B)about as effective as levodopa
C)totally ineffective
D)marginally effective

Question 24

Inhibition of _______ in the liver and the blood supply of the gastrointestinal tract suppresses degradation of levodopa in the periphery.

A)tyrosine hydroxlase
B)dopa decarboxylase
C)dopamine $\beta$ -hydroxylase
D)catechol-o-methyltransferase

Question 25

The enzyme dopa decarboxylase:

A)inhibits the conversion of dopamine to levodopa.
B)inhibits the conversion of levodopa to dopamine.
C)converts dopamine to levodopa.
D)converts levodopa to dopamine.

Question 26

__________ is the mainstay of therapy for Parkinson's disease.

A)Implementation of dopamine neurons
B)Administration of dopamine
C)Administration of neuroleptics
D)Administration of dopamine precursors

Question 27

Undesirable side effects are minimized by combining levodopa with carbidopa,a drug which acts to:

A)inhibit the breakdown of dopamine.
B)increase the amount of dopamine in the peripheral circulation and the brain.
C)decrease the amount of dopamine in both the peripheral circulation and the brain.
D)decrease the amount of dopamine in the peripheral circulation,but not the brain.

Question 28

Traditional drug treatments for parkinsonism target the ______; newer drugs target the ______.

A)postsynaptic receptor; cell body
B)cell body; postsynaptic receptor
C)presynaptic terminal; postsynaptic receptor
D)postsynaptic receptor; presynaptic terminal

Question 29

The enzyme __________ converts dopa into dopamine.

A)tyrosine hydroxlase
B)dopa decarboxylase
C)dopamine $\beta$ -hydroxylase
D)dopa synthase

Question 30

Selegiline ameliorates symptoms of parkinsonism through a unique mechanism,namely inhibiting:

A)the conversion of levodopa to dopamine.
B)COMT,an enzyme involved in the degradation of dopamine.
C)the reuptake of dopamine into the presynaptic terminal.
D)the breakdown of dopamine by MAO-B.

Question 31

Carbidopa works by inhibiting the breakdown of ______ the blood-brain barrier.

A)dopamine and readily crosses
B)dopamine and does not cross
C)levodopa and readily crosses
D)levodopa and does not cross

Question 32

Tolcapone and entacapone,the two main COMT-inhibitory drugs:

A)inhibit peripheral COMT but not in the CNS.
B)enhance central COMT but not in the PNS.
C)enhance COMT in both the PNS and CNS.
D)have no effect on COMT in either the PNS or CNS.

Question 33

A major limitation of present-day,long-term drug therapy for parkinsonism is:

A)a high incidence of serious liver toxicity associated with levodopa.
B)a rebound or withdrawal effect following discontinuation of treatment.
C)a sensitization phenomenon wherein less and less drug is needed even as dyskinesia and other side effects develop.
D)decreased effectiveness of levodopa.

Question 34

MAO-A is associated with ______ neurons; MAO-B is associated with ______neurons.

A)norepinephrine; serotonin
B)serotonin; dopamine
C)dopamine; norepinephrine
D)norepinephrine; dopamine

Question 35

The amount of levodopa that crosses the blood-brain barrier is __________ percent.

A)1 to 5
B)20 to 30
C)50 to 60
D)80 to 90

Question 36

The precursor of levodopa is:

A)dopamine.
B)dopa decarboxylase.
C)tyramine.
D)tyrosine.

Question 37

All of the following treatments ameliorate parkinsonism symptomatology EXCEPT:

A)replacement of dopamine.
B)administration of antipsychotics.
C)administration of dopamine agonists.
D)administration of dopamine-breakdown inhibitors.

Question 38

Levodopa therapy will typically be effective in Parkinson's patients for about ______ years.

A)3
B)5
C)10
D)20

Question 39

All of the following are standard treatment approaches for Parkinson's disease EXCEPT:

A)dopamine breakdown inhibitors.
B)dopaminergic antagonists.
C)dopaminergic agonists.
D)dopamine replacement therapy.

Question 40

The enzyme ___________ converts tyrosine into dopa by the enzyme.

A)tyrosine synthase
B)tyrosine beta-hydroxlase
C)tyrosine hydroxylase
D)dopa decarboxylase

Question 41

The most common neurodegenerative disease is _____ disease.

A)Alzheimer's disease
B)Parkinson's disease
C)Depression
D)Bipolar disorder

Question 42

______ is a nontoxic compound derived from tobacco that has been reported to block plaque formation in animal models of Alzheimer's disease.

A)Epicatechin
B)Orcein
C)Cotinine
D)Cinnamaldehyde

Question 43

Acetyl-cholinesterase inhibitors (AChE-Is)work by:

A)decreasing acetylcholine levels.
B)blocking acetylcholine receptors.
C)preventing the breakdown of acetylcholine.
D)blocking reuptake of acetylcholine.

Question 44

Of the AChE-I medications,_____ was the first to be approved,but is now rarely prescribed.

A)tacrine (Cognex)
B)rivastigmine (Exelon)
C)donepezil (Aricept)
D)galantamine (Razadyne)

Question 45

_____ is more selective for AChE in the brain,possesses a longer half-life and induces few gastrointestinal side effects.

A)tacrine (Cognex)
B)rivastigmine (Exelon)
C)donepezil (Aricept)
D)galantamine (Razadyne)

Question 46

The Alzheimer's population is expected to __________ by the year 2050.

A)double
B)triple
C)quadruple
D)quintuple

Question 47

Time between onset of Alzheimer's disease and death may span _____ years.

A)1 to 3
B)4 to 8
C)9 to 15
D)16 to 24

Question 48

Currently,approximately _____ million people in the United States have Alzheimer's disease.

A)3
B)5
C)7
D)9

Question 49

Widely used prior to levodopa,______ are now considered to be second-tier agents for the treatment of Parkinson's disease.

A)dopamine receptor agonists
B)sulfa drugs
C)muscarinic receptor antagonists
D)selective monoamine oxidase-B inhibitors

Question 50

The typical onset of Alzheimer's disease is after _____ years of age.

A)50
B)60
C)70
D)80

Question 51

Dietary supplements of ______ may provide protection from Alzheimer's disease.

A)ginkgo biloba
B)omega-3 fatty acids
C)vitamin E
D)vitamin C

Question 52

______ are now viewed as second-tier agents in the treatment of Parkinson's disease.

A)COMT inhibitors
B)Dopamine receptor agonists
C)Selective monoamine oxidase-B inhibitors
D)Muscarinic receptor antagonists

Question 53

Drugs to treat Alzheimer's disease work by _____ in the brain.

A)increasing acetylcholine levels
B)mimicking the effects of acetylcholine
C)inhibiting the breakdown of acetylcholine
D)blocking acetylcholine receptors

Question 54

Patients with severe Alzheimer's disease show acetylcholine levels _____ percent below normal.

A)5 to 10
B)15 to 25
C)40 to 50
D)60 to 85

Question 55

Acetyl-cholinesterase inhibitors (AChE-Is)are used to treat _____ in an attempt to address its _____ symptoms.

A)Alzheimer's disease; cognitive
B)Alzheimer's disease; motor
C)Parkinson's disease; cognitive
D)Parkinson's disease; motor

Question 56

The primary treatment for delaying the onset of Alzheimer's disease is:

A)blockade of acetylcholine receptors.
B)stimulation of acetylcholine receptors.
C)inhibition of acetylcholine breakdown.
D)potentiation of acetylcholine breakdown.

Question 57

Research is supportive of __________ therapy to alleviate the cognitive symptoms associated with Alzheimer's disease.

A)acetylcholinesterase inhibiting drug
B)ginkgo biloba
C)ketamine
D)vitamin E

Question 58

Memantine's mechanism of action is:

A)blockade of acetylcholine receptors.
B)inhibition of acetylcholine breakdown.
C)blockade of NMDA receptors.
D)inhibition of glutamate breakdown.

Question 59

Alzheimer's disease is marked by damage in all of the following EXCEPT:

A)cholinergic neurons.
B)dopaminergic neurons.
C)hippocampus.
D)cortex.

Question 60

The antioxidant _______,also found in blueberries,has been reported to provide protection from oxidative stress that may be involved in the development of Alzheimer's disease.

A)epicatechin
B)orcein
C)cotinine
D)cinnamaldehyde

Question 61

All of the following are important principles of therapy in the context of Alzheimer's disease EXCEPT:

A)a focus on the potential pathophysiology of the disease.
B)supportive care for patients.
C)supportive resources for physicians.
D)treatments targeted at improving cognitive symptoms.