Deck 16: Geriatric Psychopharmacology

Question 1

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

Answer 1

D

Question 2

The amount of levodopa that crosses the blood-brain barrier is:

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

Answer 2

A

Question 3

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.

Answer 3

B

Question 4

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

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

Question 5

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 6

The mainstay of therapy for Parkinson's disease is:

A) implementation of dopamine neurons.
B) administration of dopamine.
C) administration of neuroleptics.
D) administration of dopamine precursors.

Question 7

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

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

Question 8

The precursor of levodopa (dihydroxyphenylalanine)is:

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

Question 9

In your answer above,carbidopa achieves this by virtue of two properties,namely it inhibits 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 10

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 11

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 12

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 13

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 14

______ cause significant cognitive impairment in elderly populations.

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

Question 15

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 16

The two main COMT-inhibitory drugs tolcapone (Tasmar)and entacapone:

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 nor CNS.

Question 17

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 18

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

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

Question 19

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 20

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 21

The most common neurodegenerative disease is _____ disease.

A) cardiovascular
B) Parkinson's
C) bipolar
D) Alzheimer's

Question 22

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 23

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 24

Depression with comorbid anxiety has been shown to improve the overall treatment prognosis in the elderly.

Question 25

_____ 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 26

Long-acting benzodiazepines are appropriate for treatment in the elderly.

Question 27

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 28

Loss of motor function in Parkinson's disease can be restored by antipsychotic drugs.

Question 29

Widely used prior to levodopa,______ are now considered to be 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 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

The core symptoms of dementia are markedly reduced through the use of atypical antipsychotics.

Question 32

Parkinson's disease is characterized by a blockade of dopamine receptors.

Question 33

Depression in the elderly is generally diagnosed quickly and treated adequately.

Question 34

Antipsychotics have been shown to be neuroprotective for the development of Parkinson's disease in elderly populations.

Question 35

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 36

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 37

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

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

Question 38

Voluntary tremor is a cardinal symptom of parkinsonism.

Question 39

Transplantation of DA cells into the brains of patients with Parkinson's disease has been remarkably successful.

Question 40

The elimination half-life for medications is similar in both adult and elderly populations.

Question 41

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

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

Question 42

Levadopa is a mainstay of therapy for Parkinson's disease.

Question 43

Carbidopa,in combination with levodopa,inhibits the synthesis of dopamine in the systemic,but not central,circulation.

Question 44

Alzheimer's disease is correlated with the irreversible loss of cholinergic neurons.

Question 45

Inhibitors of dopamine breakdown can restore function in Parkinson's disease.

Question 46

Thus far,drugs that block formation of amyloid plaques have demonstrated significant efficacy in treating Alzheimer's disease.

Question 47

About 95 percent of levadopa administered orally crosses the blood-brain barrier.

Question 48

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 49

When considering neurodegenerative diseases,Alzheimer's disease (AD)is the most common.

Question 50

In the brain,dopamine is converted into levodopa by decarboxylation.

Question 51

Currently,no treatment can alter the course of Alzheimer's disease.

Question 52

Reducing levels of dopamine in the systemic circulation is a major component of the current approach in treating Parkinson's disease.

Question 53

Carbidopa,delivered with levodopa,increases the dose of levodopa necessary for a therapeutic effect by 75%.

Question 54

Marked tolerance develops to levadopa.

Question 55

Levodopa produces undesirable side effects in the peripheral circulation.

Question 56

Dopamine readily crosses the blood-brain barrier.

Question 57

At high doses,the new anti-Alzheimer's drug memantine impairs memory.

Question 58

Insufficient levels of the neurotransmitter glutamate can lead to neuronal damage via the phenomenon of excitotoxicity.

Question 59

Current treatments for mild to moderate Alzheimer's disease involve primarily inhibitors of acetylcholine.

Question 60

Based on the actions of memantine,noncompetitive NMDA receptor antagonists may reduce clinical deterioration in patients with moderate to severe AD.

Question 61

_______ 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 62

The second most common neurodegenerative disease is:

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

Question 63

______ 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 64

Research is supportive of the following therapy for cognitive symptoms associated with Alzheimer's disease:

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

Question 65

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 66

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 67

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

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

Question 68

______ 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 69

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 70

The most common neurodegenerative disease is:

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

Question 71

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 72

Dopa is converted into dopamine by the enzyme:

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

Question 73

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

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

Question 74

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

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

Question 75

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.

Question 76

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 77

Tyrosine is converted into dopa (dihydroxyphenylalanine)via the enzyme:

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

Question 78

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