3- Parkinson's Disease Flashcards
What is Parkinson’s disease
Autoimmune affecting CNS with Dopamine deficiency (of Ach excess)
Classing PD findings include
resting tremor
cog wheel rigidity
bradykinesia
postural instability
How id PD different from MS
MS includes visual compromise and weakness but no tremors!
What is Amyotropic Lateral Sclerosis (ALS)
Progressive neurodegenerative disease
What is an essential tremor
nerve disorder with uncontrollable shaking while moving
What is Guillain-Barre
Immune system attacks the nerves causing weakness and tingling in the LE and feet
What is Huntington’s disease
inherited adult onset near disease with dementia and bizarre involuntary movements
What is MG
chronic AI neuro disorder with fluctuating weakness
What is RLS
urge to move legs, associated with Iron deficiency
What is Tourettes
repetitive movements or unwanted sounds that are not easily controlled
What is Wilson’s disease
autosomal recessive disorder with copper accumulation in eyes, liver, brain, and kidneys
When should you initiate PD pharm therapy
When symptoms interfere with daily life
What are Dopamine precursors
Levodopa
Levodopa-Carbidopa
Why add carbidopa
Enzymes outside the brain (dopa decarboxylase) turn Levodopa into dopamine and epinephrine (causing arrhythmia) so not a lot gets in.
Carbidopa blocks these enzymes so more Levodopa can cross the BBB and convert into Dopamine
When should you take L-Dopa
absorbed best on empty stomach, but take with food to avoid nausea
What does L-Dopa interact with
COMT and MAO inhibitors- They prolong the action causing excess dopamine
What are S/E of L-Dopa
Drowsiness
Nausea
Dyskinesia
Impulsive behavior
What is Dupoa
enteral suspension (gel) form of carbidopa/levodopa that is pumped directly into your small intestines through a stoma
What is Duopa used for
Treating motor symptoms of PD by improving absorption and reducing off-times
What are Dopamine Agonists
Pramipexole
Bromocriptine
How do Dopamine agonists work
They stimulate dopamine receptors in substantial nigra and stratium making the brain think there is more dopamine
Side effects of Dopamine Agonists are
Postural hypotension Confusion hallucinations Sedation Psychosis (vivid dreams) Impulsive behavior
What are Monoamine oxidase inhibitors
Rasagiline (#1- early start maintains functionality)
Selegiline
How do MAOI’s work
inhibit metabolism and destruction of dopamine
What are Side Effects of Monoamine oxidase inhibitors
Nausea Orthostatic hypotension insomnia confusion hallucinations
What does Rasagiline interact with
Meperidine (demerol) and causes Serotonin Syndrome (n/v, tremor, agitation, BP change)
What are Catechol-O-methyltransferase inhibitors
Entacapone
Tolcapone
How do CMT inhibitors work
Block conversion of L-Dopa into inactive 3-O-Methyldopa (more L-dopa crosses BBB)
Prevents conversion of Dopamine to 3-Methoxytyramine
Side effects of CMT inhibitors are
related to high L-Dopa; Dyskinesia, confusion, nausea, diarrhea, orthostatic hypotension Liver toxicity (monitor LFT's!)
What do CMT inhibitors react with
L-Dopa (reduce dose)
Anti-diarrheal’s
What are Anti-cholinergics
Bentropine
Trihexyphenidyl
(balance cholinergic and dopaminergic activity)
What are anticholinergics used for
Mild Tremor predominant PD
<70 w/ disturbing tremor and no bradykinesia or gait change
Advanced disease with refractory persistent tremor
**Caution in elderly with cognitive difficulties
Side effects of anticholinergics
Hot as a hare dry as a bone blind as a bat red as a beat mad as a hatter
What is Deep Brain Stimulation
long probe stuck into brain to block muscular response causing tremor and involuntary movements
How do you treat End-Of-Dose (wearing off)
Increase frequency of carbidopa/L-dopa dose
can add MAO or CMT inhibitor
How do you treat “Delayed on” (no on) response
Carbidopa/L-dopa on empty stomach in ODT form
How do you treat Start Hesitation (freezing) response
Increase carbidopa/L-dopa dose
add bromocriptine or pramipexole OR MAOI
PT and assistive walking
How do you treat Peak-dose dyskinesia
Give smaller carbidopa/L-dopa dose
add Amantidine
How does Amantidine work
enhances dopamine release, Blocks NDMA receptor
*same S/E as anticholinergics
What is Amantidine used for
young patient with early/mild PD
Later in disease with problematic dyskinesia
Decreases tremor, rigidity, bradykinesia
