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Pharm U3 > 1) Parkinsons > Flashcards

1) Parkinsons Flashcards

1
Q

What is the class for Levodopa (L-DOPA) (Dopar)

A

Dopamine precursor

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2
Q

What is the mechanism for Levodopa (L-DOPA) (Dopar)

A

Oral, absorbed in small bowel

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3
Q

What are the therapeutics for Levodopa (L-DOPA) (Dopar)

A

Given with carbidopa (as Sinemet); first-line treatment for Parkinson’s unless patient is young (want to delay as long as possible)

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4
Q

What are the important side effects for Levodopa (L-DOPA) (Dopar)

A

Hallucinations, dyskinesias; on-off phenomenon, psychosis possible with high dose

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5
Q

What are the other side effects for Levodopa (L-DOPA) (Dopar)

A

Nausea/GI distress, hypotension, dizziness

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6
Q

What are the miscellaneous for Levodopa (L-DOPA) (Dopar)

A

MAO-A inhibitors are contraindicated (except MAO-B, which only hits DA)

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7
Q

What is the class for Carbidopa (Lodosyn)

A

Aromatic amino acid decarboxylase inhibitor

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8
Q

What is the mechanism for Carbidopa (Lodosyn)

A

Inhibits peripheral conversion of L-DOPA to dopamine; does not cross BBB

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9
Q

What are the therapeutics for Carbidopa (Lodosyn)

A

Parkinson’s (given with Levadopa to lower side effects)

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10
Q

What are the important side effects for Carbidopa (Lodosyn)

A

Dyskinesias, on-off phenomenon,

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11
Q

What are the miscellaneous for Carbidopa (Lodosyn)

A

MAO-A inhibitors are contraindicated (except MAO-B, which only hits DA)

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12
Q

What is the class for Bromocriptine (Parlodel)

A

Ergot derivative

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13
Q

What is the mechanism for Bromocriptine (Parlodel)

A

D2 agonist, D1 antagonist

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14
Q

What are the therapeutics for Bromocriptine (Parlodel)

A

Mild Parkinson’s; DA agonism in NMS; hyperprolactinemia

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15
Q

What are the important side effects for Bromocriptine (Parlodel)

A

Pleural effusions, cough, shortness of breath, pulmonary fibrosis

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16
Q

What are the other side effects for Bromocriptine (Parlodel)

A

Peripheral DA-like effects; sedation; dizziness

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17
Q

What are the miscellaneous for Bromocriptine (Parlodel)

A

Must be titrated slowly due to hypotension

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18
Q

What is the class for Pramipexole (Mirapex)

A

Non-ergot DA receptor agonist

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19
Q

What is the mechanism for Pramipexole (Mirapex)

A

Selective D2 agonist

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20
Q

What are the therapeutics for Pramipexole (Mirapex)

A

Mild Parkinson’s (first-line); to delay L-dopa treatment, usually in combination with ropinorole; can use in RLS

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21
Q

What are the important side effects for Pramipexole (Mirapex)

A

More acute: psychosis/mania, nausea, dizziness, sedation, edema, compulsive behavior

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22
Q

What are the miscellaneous for Pramipexole (Mirapex)

A

Less effective with motor symptoms of PD

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23
Q

What is the class for Ropinorole (Requip)

A

Non-ergot DA receptor agonist

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24
Q

What is the mechanism for Ropinorole (Requip)

A

Selective D2 agonist

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25
What are the therapeutics for Ropinorole (Requip)
Mild Parkinson's; restless leg syndrome
26
What are the important side effects for Ropinorole (Requip)
More acute: psychosis/mania, nausea, dizziness, sedation, edema, compulsive behavior
27
What are the miscellaneous for Ropinorole (Requip)
Less effective with motor symptoms of PD
28
What is the class for Rotigotine (Neupro)
Non-ergot DA receptor agonist
29
What is the mechanism for Rotigotine (Neupro)
Selective D2 agonist
30
What are the therapeutics for Rotigotine (Neupro)
Mild Parkinson's; restless leg syndrome
31
What are the important side effects for Rotigotine (Neupro)
More acute: psychosis/mania, nausea, dizziness, sedation, edema, compulsive behavior
32
What is the class for Apomorphine (Apokyn)
Non-ergot DA receptor agonist
33
What are the therapeutics for Apomorphine (Apokyn)
Rescue therapy for 'off' periods (immobility)
34
What are the important side effects for Apomorphine (Apokyn)
More acute: psychosis/mania, nausea, dizziness, sedation, edema, compulsive behavior
35
What are the other side effects for Apomorphine (Apokyn)
Peripheral DA effects
36
What are the miscellaneous for Apomorphine (Apokyn)
Injectable only; serotonin receptor antagonists contraindicated (e.g., ondansetron)
37
What is the class for Entacapone (Comtan)
COMT inhibitor
38
What is the mechanism for Entacapone (Comtan)
Prevents breakdown of DA
39
What are the therapeutics for Entacapone (Comtan)
Prolong half-life of levodopa, reduce 'off' time; primarily works peripherally
40
What are the important side effects for Entacapone (Comtan)
Increase in dyskinesias, diarrhea, urine discoloration
41
What are the other side effects for Entacapone (Comtan)
DA side effects
42
What are the miscellaneous for Entacapone (Comtan)
Short-acting (2 hours)
43
What is the class for Tolcapone (Tasmar)
COMT inhibitor
44
What is the mechanism for Tolcapone (Tasmar)
Prevents breakdown of DA
45
What are the therapeutics for Tolcapone (Tasmar)
Prolong half-life of levodopa, reduce 'off' time; primarily works peripherally
46
What are the important side effects for Tolcapone (Tasmar)
Fatal hepatotoxicity (use only if entacapone fails), increase in dyskinesias, diarrhea (worse than entacapone), urine discoloration
47
What are the other side effects for Tolcapone (Tasmar)
DA side effects
48
What are the miscellaneous for Tolcapone (Tasmar)
Short-acting (2 hours)
49
What is the class for Selegiline (Eldepryl)
MAO-B inhibitor
50
What is the mechanism for Selegiline (Eldepryl)
Prevents breakdown of DA
51
What are the therapeutics for Selegiline (Eldepryl)
Mild early Parkinson's (monotherapy); may delay onset of levodopa therapy
52
What are the important side effects for Selegiline (Eldepryl)
Hypotension, GI distress, dyskinesia, psychosis
53
What are the other side effects for Selegiline (Eldepryl)
Nausea, vomiting
54
What are the miscellaneous for Selegiline (Eldepryl)
Antidote to environmental toxins; at high doses is a MAO-A inhibitor and would have same diet and drug interactions, tyramine crisis, serotonin syndrome, etc. For depression it comes in a patch called EMSAM
55
What is the class for Rasagiline (Azilect)
MAO-B inhibitor
56
What is the mechanism for Rasagiline (Azilect)
Prevents breakdown of DA
57
What are the therapeutics for Rasagiline (Azilect)
Mild early Parkinson's (monotherapy); may delay onset of levodopa therapy; also, as an adjunct with levodopa (reduces 'off' time)
58
What are the important side effects for Rasagiline (Azilect)
Hypotension, GI distress, dyskinesia, psychosis
59
What are the other side effects for Rasagiline (Azilect)
Nausea, vomiting
60
What are the miscellaneous for Rasagiline (Azilect)
Antidote to environmental toxins; at high doses is a MAO-A inhibitor and would have same diet and drug interactions, tyramine crisis, serotonin syndrome, etc. For depression it comes in a patch called EMSAM
61
What is the class for Benztropine (Cogentin)
Anticholinergics
62
What is the mechanism for Benztropine (Cogentin)
Antagonizes the ACh muscarinic receptor
63
What are the therapeutics for Benztropine (Cogentin)
Tremor and drooling in Parkinson's, and really only used if drooling is a major problem, but is used for EPS parkinsonian side effects
64
What are the important side effects for Benztropine (Cogentin)
Confusion, impaired memory, hallucinations
65
What are the other side effects for Benztropine (Cogentin)
Typical anticholinergic (dry mouth, blurred vision, racing heart, constipation, urinary dysfunction, memory loss)
66
What are the miscellaneous for Benztropine (Cogentin)
Contraindicated in demented Parkinson's; abrupt discontinuation exacerbates symptoms
67
What is the class for Biperiden (Akineton)
Anticholinergics
68
What is the mechanism for Biperiden (Akineton)
Antagonizes the ACh muscarinic receptor
69
What are the therapeutics for Biperiden (Akineton)
Tremor and drooling in Parkinson's, and really only used if drooling is a major problem
70
What are the important side effects for Biperiden (Akineton)
Confusion, impaired memory, hallucinations
71
What are the other side effects for Biperiden (Akineton)
Typical anticholinergic (dry mouth, blurred vision, racing heart, urinary dysfunction,memory loss)
72
What are the miscellaneous for Biperiden (Akineton)
Contraindicated in demented Parkinson's; abrupt discontinuation exacerbates symptoms
73
What is the class for Trihexyphenidyl (Artane)
Anticholinergics
74
What is the mechanism for Trihexyphenidyl (Artane)
Antagonizes the ACh muscarinic receptor
75
What are the therapeutics for Trihexyphenidyl (Artane)
Tremor and drooling in Parkinson's, and really only used if drooling is a major problem, but is used for EPS parkinsonian side effects
76
What are the important side effects for Trihexyphenidyl (Artane)
Confusion, impaired memory, hallucinations
77
What are the other side effects for Trihexyphenidyl (Artane)
Typical anticholinergic (dry mouth, blurred vision, racing heart, urinary dysfunction, memory loss)
78
What are the miscellaneous for Trihexyphenidyl (Artane)
Contraindicated in demented Parkinson's; abrupt discontinuation exacerbates symptoms
79
What is the class for Procyclidine (Kemadrin)
Anticholinergics
80
What is the mechanism for Procyclidine (Kemadrin)
Antagonizes the ACh muscarinic receptor
81
What are the therapeutics for Procyclidine (Kemadrin)
Tremor and drooling in Parkinson's, and really only used if drooling is a major problem, but is used for EPS parkinsonian side effects
82
What are the important side effects for Procyclidine (Kemadrin)
Confusion, impaired memory, hallucinations
83
What are the other side effects for Procyclidine (Kemadrin)
Typical anticholinergic (dry mouth, etc)
84
What are the miscellaneous for Procyclidine (Kemadrin)
Contraindicated in demented Parkinson's; abrupt discontinuation exacerbates symptoms
85
What is the class for Ethopropazine (Parsidol)
Anticholinergics
86
What is the mechanism for Ethopropazine (Parsidol)
Antagonizes the ACh muscarinic receptor
87
What are the therapeutics for Ethopropazine (Parsidol)
Tremor and drooling in Parkinson's, and really only used if drooling is a major problem (otherwise, very bad mental symptoms)
88
What are the important side effects for Ethopropazine (Parsidol)
Confusion, impaired memory, hallucinations
89
What are the other side effects for Ethopropazine (Parsidol)
Typical anticholinergic (dry mouth, etc)
90
What are the miscellaneous for Ethopropazine (Parsidol)
Contraindicated in demented Parkinson's; abrupt discontinuation exacerbates symptoms
91
What is the class for Amantadine (Symmetrel)
Anti-viral
92
What is the mechanism for Amantadine (Symmetrel)
Dopaminergic, anticholinergic, anti-NMDA
93
What are the therapeutics for Amantadine (Symmetrel)
Mild early Parkinson's (2nd-line); best as an adjunct to levodopa/carbidopa for long-term treatment; movement disorders in Huntingtons; only adjunct that reduces dyskinesias
94
What are the important side effects for Amantadine (Symmetrel)
DA side effects, edema, psychosis
95
What are the miscellaneous for Amantadine (Symmetrel)
Excreted unchanged in urine (renal dysfunction requires lower dose); contraindicated in elderly with dementia (anticholinergic effects)
96
What is the class for Deep brain stimulation
Surgery
97
What is the mechanism for Deep brain stimulation
Hits subthalamic nucleus
98
What are the therapeutics for Deep brain stimulation
Treatment for motor fluctuations or dyskinesias refractory to other medications; reduces 'off' time, may reduce levodopa dosage
99
What are the important side effects for Deep brain stimulation
Fatal intracerebral hemorrhage, cognitive impairment
100
What are the miscellaneous for Deep brain stimulation
Patients must still be sensitive to levodopa therapy (or they aren't a candidate)

Pharm U3 (13 decks)

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