AntiPARKINSONISM

Question 1

a chronic, progressive degenerative disorder affecting the dopamine – producing neurons in the basal ganglia

Answer 1

Parkinson’s Disease

Question 2

What is the pathophysiology of parkinson’s dse?

Answer 2

reduction: of dopamine in the basal ganglia of the brain à normal

     **    balance of cholinergic** and **dopaminergic neurons is lost**

Question 3

What age is Parkinson’s dse common?

Answer 3

common among people between 45 and 65 years old

Question 4

What gender is greatly affected in Parkinson’s dse?

Answer 4

men and women are equally affected

Question 5

What are the early signs and symptoms of Parkinson’s DSe?

Answer 5

1. muscle rigidity (cogwheel rigidity)
   
   2. tremor at rest (pill – rolling tremor)
   3. loss of voluntary muscle movement (akinesia)
   4. abnormal slowness of movements (bradykinesia)
   5. difficulty of movement (dyskinesia)
   6. expressionless face (masked facie)

Question 6

What are the late signs and symptoms of Parkinson’s DSe?

Answer 6

1. depression and emotional changes
   
   2. sleep problems
   3. memory loss and slow thinking

Question 7

What is the Goal of thex for Parkinson’s dse?

Answer 7

restore the balance between dopamine and acetylcholine:

 1. increasing activity of dopamine **(dopaminergics)**
 2. blocking the action of acetylcholine **(anticholinergics)**

Question 8

What are the 3 sub categories for anti-parkinsonism agents?

Answer 8

• Dopaminergic Agents
• Anticholinergic Agents
• Neuroprotective Agents

Question 9

What are Dopaminergic Agents?

Answer 9

• • amantadine,
• bromocriptine,
• levodopa,
• levodopa – carbidopa,
• pergolide,
• pramipexole,
• ropinirole

Question 10

Anticholinergic Agents

Answer 10

• benztropine,
• biperiden,
• diphenhydramine,
• ethopropazine,
• procyclidine,
• trihexyphenidyl

Question 11

Neuroprotective Agents

Answer 11

• selegiline

Question 12

Geriatric Considerations: Anticholinergics

Answer 12

• Elderly patients are at risk for the development of the side effects of anticholinergics (dry mouth, constipation, impaired thought processes and urinary retention).
• Anticholinergics are contraindicated in patients with narrow – angle glaucoma or with a history of urinary retention.
• Elderly patients taking anticholinergic agents may experience paradoxical reactions (excitement, confusion, irritability
• Overheating may occur in patients taking anticholinergics.

Question 13

Geriatric Considerations: Levodopa

Answer 13

• Levodopa should be used cautiously in elderly patients with history of cardiac, renal, hepatic, endocrine, pulmonary, ulcers or psychiatric disease.
• Elderly patients taking levodopa are at risk for confusion.

Question 14

Why is Levodopa – carbidopa often started at low dose?

Answer 14

because of the** increased sensitivity of the aged patient to these medications.**

Question 15

Dopaminergic Agents MOA acts by 3 ways:

Answer 15

1. stimulation of dopamine release (indirect acting)
2. increasing brain levels of dopamine (replacement)
3. direct stimulation of dopaminergic centers (direct acting)

Question 16

stimulation of dopamine release **(indirect acting): **

Answer 16

** a**mantadine,

entacapone

” Alber Einstein School INDIRECT science highschool”

Question 17

increasing brain levels of dopamine (replacement):

Answer 17

levodopa,

         levodopa – carbidopa

Question 18

direct stimulation of dopaminergic centers (direct acting):

Answer 18

** bromocriptine, pergolide, ropinirole **

” Bro per Role ang direct acting dapat”

Question 19

precursor of dopamine;

crosses the blood brain barrier

Answer 19

Levodopa

Question 20

What are the contraindications of Levodopa?

Answer 20

1. hypersensitivity
   2. narrow – angle glaucoma
   3. history of melanoma
   4. psychotic patients

Question 21

What are the route of administration of Levodopa?

Answer 21

only available in oral form

Question 22

What is the plasma half-life of levodopa?

Answer 22

Plasma half life is 1 – 3 hours

Question 23

Levodopa is usually in combination with

Answer 23

Usually given in combination with carbidopa

Question 24

Levodopa’s best results are obtained when?

Answer 24

Best results are obtained in the in the first few months of treatment due to the need of reducing the dose

Question 25

Levodopa is contraindicated to:

Answer 25

• psychotic patients
• angle-closure glaucoma

Question 26

Levodopa has special precaution to:

Answer 26

• PUD
• malignant melanoma

Question 27

What are the adverse effects of levodopa?

Answer 27

GI – anorexia, nausea and vomiting

          CV – tachycardia, postural hypotension

          Musculo-skeletal – Dyskinesia

          Behavioral effects – depression, anxiety, agitation

         Others –mydriasis, blood dyscrasias, hot flushes

Question 28

– may alleviate some of the neurologic and** behavioral adverse** effects of levodopa

Answer 28

Drug holidays

; 3-21 days

Question 29

Levodopa has drug interactions to?

Answer 29

Drug interactions:

1. Pyridoxine (Vitamin B6) – enhance extracerebral metabolism of levodopa à decreased levels à decreased therapeutic effect
2. Should not be given with MAOI or **within 2 weeks of discontinuance à hypertensive crisis **