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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
Q

What are the therapeutics for Ropinorole (Requip)

A

Mild Parkinson’s; restless leg syndrome

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26
Q

What are the important side effects for Ropinorole (Requip)

A

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

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27
Q

What are the miscellaneous for Ropinorole (Requip)

A

Less effective with motor symptoms of PD

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28
Q

What is the class for Rotigotine (Neupro)

A

Non-ergot DA receptor agonist

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29
Q

What is the mechanism for Rotigotine (Neupro)

A

Selective D2 agonist

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30
Q

What are the therapeutics for Rotigotine (Neupro)

A

Mild Parkinson’s; restless leg syndrome

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31
Q

What are the important side effects for Rotigotine (Neupro)

A

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

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32
Q

What is the class for Apomorphine (Apokyn)

A

Non-ergot DA receptor agonist

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33
Q

What are the therapeutics for Apomorphine (Apokyn)

A

Rescue therapy for ‘off’ periods (immobility)

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34
Q

What are the important side effects for Apomorphine (Apokyn)

A

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

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35
Q

What are the other side effects for Apomorphine (Apokyn)

A

Peripheral DA effects

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36
Q

What are the miscellaneous for Apomorphine (Apokyn)

A

Injectable only; serotonin receptor antagonists contraindicated (e.g., ondansetron)

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37
Q

What is the class for Entacapone (Comtan)

A

COMT inhibitor

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38
Q

What is the mechanism for Entacapone (Comtan)

A

Prevents breakdown of DA

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39
Q

What are the therapeutics for Entacapone (Comtan)

A

Prolong half-life of levodopa, reduce ‘off’ time; primarily works peripherally

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40
Q

What are the important side effects for Entacapone (Comtan)

A

Increase in dyskinesias, diarrhea, urine discoloration

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41
Q

What are the other side effects for Entacapone (Comtan)

A

DA side effects

42
Q

What are the miscellaneous for Entacapone (Comtan)

A

Short-acting (2 hours)

43
Q

What is the class for Tolcapone (Tasmar)

A

COMT inhibitor

44
Q

What is the mechanism for Tolcapone (Tasmar)

A

Prevents breakdown of DA

45
Q

What are the therapeutics for Tolcapone (Tasmar)

A

Prolong half-life of levodopa, reduce ‘off’ time; primarily works peripherally

46
Q

What are the important side effects for Tolcapone (Tasmar)

A

Fatal hepatotoxicity (use only if entacapone fails), increase in dyskinesias, diarrhea (worse than entacapone), urine discoloration

47
Q

What are the other side effects for Tolcapone (Tasmar)

A

DA side effects

48
Q

What are the miscellaneous for Tolcapone (Tasmar)

A

Short-acting (2 hours)

49
Q

What is the class for Selegiline (Eldepryl)

A

MAO-B inhibitor

50
Q

What is the mechanism for Selegiline (Eldepryl)

A

Prevents breakdown of DA

51
Q

What are the therapeutics for Selegiline (Eldepryl)

A

Mild early Parkinson’s (monotherapy); may delay onset of levodopa therapy

52
Q

What are the important side effects for Selegiline (Eldepryl)

A

Hypotension, GI distress, dyskinesia, psychosis

53
Q

What are the other side effects for Selegiline (Eldepryl)

A

Nausea, vomiting

54
Q

What are the miscellaneous for Selegiline (Eldepryl)

A

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
Q

What is the class for Rasagiline (Azilect)

A

MAO-B inhibitor

56
Q

What is the mechanism for Rasagiline (Azilect)

A

Prevents breakdown of DA

57
Q

What are the therapeutics for Rasagiline (Azilect)

A

Mild early Parkinson’s (monotherapy); may delay onset of levodopa therapy; also, as an adjunct with levodopa (reduces ‘off’ time)

58
Q

What are the important side effects for Rasagiline (Azilect)

A

Hypotension, GI distress, dyskinesia, psychosis

59
Q

What are the other side effects for Rasagiline (Azilect)

A

Nausea, vomiting

60
Q

What are the miscellaneous for Rasagiline (Azilect)

A

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
Q

What is the class for Benztropine (Cogentin)

A

Anticholinergics

62
Q

What is the mechanism for Benztropine (Cogentin)

A

Antagonizes the ACh muscarinic receptor

63
Q

What are the therapeutics for Benztropine (Cogentin)

A

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
Q

What are the important side effects for Benztropine (Cogentin)

A

Confusion, impaired memory, hallucinations

65
Q

What are the other side effects for Benztropine (Cogentin)

A

Typical anticholinergic (dry mouth, blurred vision, racing heart, constipation, urinary dysfunction, memory loss)

66
Q

What are the miscellaneous for Benztropine (Cogentin)

A

Contraindicated in demented Parkinson’s; abrupt discontinuation exacerbates symptoms

67
Q

What is the class for Biperiden (Akineton)

A

Anticholinergics

68
Q

What is the mechanism for Biperiden (Akineton)

A

Antagonizes the ACh muscarinic receptor

69
Q

What are the therapeutics for Biperiden (Akineton)

A

Tremor and drooling in Parkinson’s, and really only used if drooling is a major problem

70
Q

What are the important side effects for Biperiden (Akineton)

A

Confusion, impaired memory, hallucinations

71
Q

What are the other side effects for Biperiden (Akineton)

A

Typical anticholinergic (dry mouth, blurred vision, racing heart, urinary dysfunction,memory loss)

72
Q

What are the miscellaneous for Biperiden (Akineton)

A

Contraindicated in demented Parkinson’s; abrupt discontinuation exacerbates symptoms

73
Q

What is the class for Trihexyphenidyl (Artane)

A

Anticholinergics

74
Q

What is the mechanism for Trihexyphenidyl (Artane)

A

Antagonizes the ACh muscarinic receptor

75
Q

What are the therapeutics for Trihexyphenidyl (Artane)

A

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
Q

What are the important side effects for Trihexyphenidyl (Artane)

A

Confusion, impaired memory, hallucinations

77
Q

What are the other side effects for Trihexyphenidyl (Artane)

A

Typical anticholinergic (dry mouth, blurred vision, racing heart, urinary dysfunction, memory loss)

78
Q

What are the miscellaneous for Trihexyphenidyl (Artane)

A

Contraindicated in demented Parkinson’s; abrupt discontinuation exacerbates symptoms

79
Q

What is the class for Procyclidine (Kemadrin)

A

Anticholinergics

80
Q

What is the mechanism for Procyclidine (Kemadrin)

A

Antagonizes the ACh muscarinic receptor

81
Q

What are the therapeutics for Procyclidine (Kemadrin)

A

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
Q

What are the important side effects for Procyclidine (Kemadrin)

A

Confusion, impaired memory, hallucinations

83
Q

What are the other side effects for Procyclidine (Kemadrin)

A

Typical anticholinergic (dry mouth, etc)

84
Q

What are the miscellaneous for Procyclidine (Kemadrin)

A

Contraindicated in demented Parkinson’s; abrupt discontinuation exacerbates symptoms

85
Q

What is the class for Ethopropazine (Parsidol)

A

Anticholinergics

86
Q

What is the mechanism for Ethopropazine (Parsidol)

A

Antagonizes the ACh muscarinic receptor

87
Q

What are the therapeutics for Ethopropazine (Parsidol)

A

Tremor and drooling in Parkinson’s, and really only used if drooling is a major problem (otherwise, very bad mental symptoms)

88
Q

What are the important side effects for Ethopropazine (Parsidol)

A

Confusion, impaired memory, hallucinations

89
Q

What are the other side effects for Ethopropazine (Parsidol)

A

Typical anticholinergic (dry mouth, etc)

90
Q

What are the miscellaneous for Ethopropazine (Parsidol)

A

Contraindicated in demented Parkinson’s; abrupt discontinuation exacerbates symptoms

91
Q

What is the class for Amantadine (Symmetrel)

A

Anti-viral

92
Q

What is the mechanism for Amantadine (Symmetrel)

A

Dopaminergic, anticholinergic, anti-NMDA

93
Q

What are the therapeutics for Amantadine (Symmetrel)

A

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
Q

What are the important side effects for Amantadine (Symmetrel)

A

DA side effects, edema, psychosis

95
Q

What are the miscellaneous for Amantadine (Symmetrel)

A

Excreted unchanged in urine (renal dysfunction requires lower dose); contraindicated in elderly with dementia (anticholinergic effects)

96
Q

What is the class for Deep brain stimulation

A

Surgery

97
Q

What is the mechanism for Deep brain stimulation

A

Hits subthalamic nucleus

98
Q

What are the therapeutics for Deep brain stimulation

A

Treatment for motor fluctuations or dyskinesias refractory to other medications; reduces ‘off’ time, may reduce levodopa dosage

99
Q

What are the important side effects for Deep brain stimulation

A

Fatal intracerebral hemorrhage, cognitive impairment

100
Q

What are the miscellaneous for Deep brain stimulation

A

Patients must still be sensitive to levodopa therapy (or they aren’t a candidate)

Pharm U3 (13 decks)

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