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Nayla Pharm > 3- Parkinson's Disease > Flashcards

3- Parkinson's Disease Flashcards

1
Q

What is Parkinson’s disease

A

Autoimmune affecting CNS with Dopamine deficiency (of Ach excess)

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2
Q

Classing PD findings include

A

resting tremor
cog wheel rigidity
bradykinesia
postural instability

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3
Q

How id PD different from MS

A

MS includes visual compromise and weakness but no tremors!

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4
Q

What is Amyotropic Lateral Sclerosis (ALS)

A

Progressive neurodegenerative disease

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5
Q

What is an essential tremor

A

nerve disorder with uncontrollable shaking while moving

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6
Q

What is Guillain-Barre

A

Immune system attacks the nerves causing weakness and tingling in the LE and feet

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7
Q

What is Huntington’s disease

A

inherited adult onset near disease with dementia and bizarre involuntary movements

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8
Q

What is MG

A

chronic AI neuro disorder with fluctuating weakness

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9
Q

What is RLS

A

urge to move legs, associated with Iron deficiency

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10
Q

What is Tourettes

A

repetitive movements or unwanted sounds that are not easily controlled

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11
Q

What is Wilson’s disease

A

autosomal recessive disorder with copper accumulation in eyes, liver, brain, and kidneys

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12
Q

When should you initiate PD pharm therapy

A

When symptoms interfere with daily life

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13
Q

What are Dopamine precursors

A

Levodopa

Levodopa-Carbidopa

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14
Q

Why add carbidopa

A

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

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15
Q

When should you take L-Dopa

A

absorbed best on empty stomach, but take with food to avoid nausea

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16
Q

What does L-Dopa interact with

A

COMT and MAO inhibitors- They prolong the action causing excess dopamine

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17
Q

What are S/E of L-Dopa

A

Drowsiness
Nausea
Dyskinesia
Impulsive behavior

18
Q

What is Dupoa

A

enteral suspension (gel) form of carbidopa/levodopa that is pumped directly into your small intestines through a stoma

19
Q

What is Duopa used for

A

Treating motor symptoms of PD by improving absorption and reducing off-times

20
Q

What are Dopamine Agonists

A

Pramipexole

Bromocriptine

21
Q

How do Dopamine agonists work

A

They stimulate dopamine receptors in substantial nigra and stratium making the brain think there is more dopamine

22
Q

Side effects of Dopamine Agonists are

A 
Postural hypotension 
Confusion
hallucinations
Sedation
Psychosis (vivid dreams)
Impulsive behavior
23
Q

What are Monoamine oxidase inhibitors

A

Rasagiline (#1- early start maintains functionality)

Selegiline

24
Q

How do MAOI’s work

A

inhibit metabolism and destruction of dopamine

25
Q

What are Side Effects of Monoamine oxidase inhibitors

A 
Nausea
Orthostatic hypotension
insomnia
confusion
hallucinations
26
Q

What does Rasagiline interact with

A

Meperidine (demerol) and causes Serotonin Syndrome (n/v, tremor, agitation, BP change)

27
Q

What are Catechol-O-methyltransferase inhibitors

A

Entacapone

Tolcapone

28
Q

How do CMT inhibitors work

A

Block conversion of L-Dopa into inactive 3-O-Methyldopa (more L-dopa crosses BBB)
Prevents conversion of Dopamine to 3-Methoxytyramine

29
Q

Side effects of CMT inhibitors are

A 
related to high L-Dopa; Dyskinesia, confusion, nausea, diarrhea, orthostatic hypotension 
Liver toxicity (monitor LFT's!)
30
Q

What do CMT inhibitors react with

A

L-Dopa (reduce dose)

Anti-diarrheal’s

31
Q

What are Anti-cholinergics

A

Bentropine
Trihexyphenidyl
(balance cholinergic and dopaminergic activity)

32
Q

What are anticholinergics used for

A

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

33
Q

Side effects of anticholinergics

A 
Hot as a hare
dry as a bone
blind as a bat
red as a beat
mad as a hatter
34
Q

What is Deep Brain Stimulation

A

long probe stuck into brain to block muscular response causing tremor and involuntary movements

35
Q

How do you treat End-Of-Dose (wearing off)

A

Increase frequency of carbidopa/L-dopa dose

can add MAO or CMT inhibitor

36
Q

How do you treat “Delayed on” (no on) response

A

Carbidopa/L-dopa on empty stomach in ODT form

37
Q

How do you treat Start Hesitation (freezing) response

A

Increase carbidopa/L-dopa dose
add bromocriptine or pramipexole OR MAOI
PT and assistive walking

38
Q

How do you treat Peak-dose dyskinesia

A

Give smaller carbidopa/L-dopa dose

add Amantidine

39
Q

How does Amantidine work

A

enhances dopamine release, Blocks NDMA receptor

*same S/E as anticholinergics

40
Q

What is Amantidine used for

A

young patient with early/mild PD
Later in disease with problematic dyskinesia
Decreases tremor, rigidity, bradykinesia

Nayla Pharm (12 decks)

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