Antiparkinson Agents Flashcards
5 questions
what are the 4 big symptoms of Parkinson’s disease?
bradykinesia
rigidity
resting tremor
impaired balance
most Parkinson Syndromes are associated with ______ ______ ______
idiopathic Parkinson’s Disease
how is idiopathic Parkinson’s disease described? (2)
chronic
slowly progressive
what is a definite risk factor for Parkinson’s disease?
old age
what are 2 possible protective effects of Parkinson’s disease?
drinking alcohol
smoking
besides old age, what are 2 other risk factors for Parkinson’s disease?
MZ twin with early PD
family history
what are 4 pesticides known to have neurotoxic effects on dopamine neurons, leading to PD?
rotenone
maneb
dieldren
paraquate
what increases the life expectancy in PD patients? (2)
non-demented PD cases
L-dopa use
what are the 4 most common causes of death associated with PD?
pulm infection/aspiration
UTI
pulm embolism
fall/fracture complications
what symptom does the severity of dopamine loss best correlate with?
bradykinesia
what are the 2 dopaminergic agents for PD?
levodopa
carbidopa
what is the most effective drug for parkinsonian symptoms?
Levodopa
which drug is a dopamine precursor that crosses the BB and is converted into dopamine by dopa decarboxylase?
levodopa
what are the 4 ADR of Levodopa?
nausea
postural hypotension
motor fluctuations
dyskinesias
peripheral decarboxylase inhibitor used with levodopa
carbidopa
why is carbidopa combined with levodopa? (2)
decrease ADR from peripheral formation of catecholamines
increase levodopa into brain
drug class that inhibits an enzyme which degrades dopamine; given with levodopa to inhibit its degradation and prolong its effects
COMT inhibitors
-capone
COMT inhibitors
COMT inhibitor that does not cross the BBB, but blocks levodopa metabolism in the periphery
entacapone
COMT inhibitor that cross the BBB and has a long half-life
tolcapone
combination drug of levodopa, carbidopa, and entacapone
stalevo
what is an ADR of tolcapone?
liver toxicity
levodopa treats _____, rather than _____
symptoms
disease
levodopa therapy for 1 year can cause:
dyskinesia
levodopa therapy for 3 years can cause:
on-off effects; mobility + immobility
levodopa therapy past 5 years has:
poor prognosis
what are 3 reversible, acute ADR of levodopa?
N/V
orthostatic hypotension
arrhythmias
what are 2 reversible, chronic ADR of levodopa?
dyskinesia
psych disturbance
patients experiencing psychosis with levodopa treatment can be treated with that?
clozapine
what are 2 irreversible ADR of levodopa therapy?
akinesia
on-off effect
what can treat the on-off effect of levodopa therapy? (5)
smaller doses/more frequent intervals
drug holidays
dopamine agonists
MAO-B inhibitors
SR formulations
what 2 drugs does levodopa interact with?
phenothiazines
epi in local anesthetic
what can occur if levodopa is used with local anesthetic Epi?
heart arrhythmias
what are the 3 dopamine receptor agonists?
pergolide
bromocriptine
pramipexole
what are 2 features of dopamine agonists?
longer half-life than levodopa
no absorption delay d/t amino acids
what drug class can delay or reduce motor fluctuations and dyskinesias associated with levodopa?
dopamine agonists
what are the 5 ADR of dopamine agonists?
N/V/dizziness
postural hypotension
headache
dyskinesia
hallucination/paranoia/confusion
(same as levodopa, but add CNS symptoms)
what are the 2 dopaminergic agents?
selegiline
amantadine
irreversible MAO-B (mitochondrial enzyme that metabolizes dopamine) inhibitor that works in the brain
selegiline
what is the use of selegiline?
adjunct therapy to levodopa to diminish on-off effect
what are the 3 ADR of selegiline?
insomnia
hallucinations
nausea (rare)
what drugs can selegiline interact with?
tricyclics
SSRIs
an antiviral agent that promotes the release and delays uptake of dopamine
amantadine
what are the 4 uses of amantadine?
tremor
bradykinesia
rigidity
dyskinesia
what are the 2 ADR of amantadine?
autonomic
psych
why are anticholinergics used for PD?
dopamine depletion lead to overactive acetylcholine; used to treat cholinergic symptoms
what are the 3 anticholinergics?
“Ben(ztropine) Tri(hexyphenidyl) to treat cholinergic symptoms in Ethan (Ethopropazine)”
benztropine
trihexyphenidyl
ethopropazine
what are the uses of anticholinergics?
initial stages
adjunctive
what 2 symptoms do anticholinergics treat?
tremor
rigidity
what are 5 ADR of anticholinergics?
dry mouth
sedation
delirium
constipation
urinary retention
