C4 Flashcards
what is parkinsons’ disease
chronic degenerative disorder that primarily affects the neurons of basal ganglia
PD: hallmark motor symptoms
tremor (occurs when resting)
rigidity (increased muscle tone)
akinesia (bradykinesia - slowness of movement)
postural instability (impaired postural reflexes)
PD: RF
exposure to pesticide
fam hx
type 2 diabetes
male, age > 60yo
head injury
PD: pharm tx
increase supply of dopamine
- combination formulation
PD: combinations
levodopa + benserazide
levodopa + carbidopa
PD: pharm class of levodopa & carbidopa/benserazide
dopamine precursor
peripheral decarboxylase inhibitors
PD: contraindication of combi
< 25 yo
pregnant women / women of childbearing potential in the absence of adequate contraception
PD: SE of combi
dz
n/v
orthostatic hypotension
PD: CP of levodopa
- empty stomach
- taken w low-protein food (if stomach becomes irritated to reduce food-drug interaction on absorption)
- for HBS (sustained release for less symptoms) formulation, swallow whole
- important to follow regular dosing times & intervals -> maintain effects
- cannot take with metoclopramide (med used for v or digestion)
summary: drugs
levodopa + carbidopa / benserazide
ropinirole
bromocriptine
entacapone
selegiline
benzhexol (trihexyohenidyl)
PD: pharm class of ropinirole
non-ergot dopaminergic agonists
PD: indi of ropinirole
monotherapy or adjunct to combi
PD: SE of ropinirole
confusion
dz, dw / sudden onset of sleep
nervousness
PD: CP of ropinirole
- taken w meals (reduce occurrence of n)
- sudden onset of sleep / excessive daytime dw
- risk of impulse-control disorders (including pathological gambling, binge eating, overspending -> see dr immediately)
PD: pharm class of bromocriptine
ergot dopaminergic agonists
PD: indi of bromocriptine
monotherapy or adjunct to combi (less preferred due to more SE)
PD: SE of bromocriptine
hd, dw, sudden sleep onset, orthostatic hypotension
PD: pharm class of entacapone
COMT inhibitor
PD: indi of entacapone
adjunct only to combi
PD: SE of entacapone
confusion, dm, n/v
PD: pharm class of selegiline
MAO-B inhibitors
PD: indi of selegiline
monotherapy or adjunct to combi
PD: SE of selegiline
arthralgia, confusion, HTN, orthostatic hypotension, dyskinesia
PD: drug interaction of selegiline
depression MAOi
PD: pharm class of trihexyphenidyl (benzhexol)
central anticholinergics
PD: indi of trihexyphenidyl (benzhexol)
PD (target tremors & muscle stiffness)
-> not recommended in elderly
PD: SE of trihexyphenidyl (benzhexol)
bv, conf, c, dz, dm, urinary retention
PD: rationale of d choice
dopamine precursors (levodopa) is recommended as monotherapy, especially for those whose motor symptoms in early stage of PD which decrease their QoL
- keep dose min to achieve good motor fx
PD: considerations for choosing alternative first-line monotherapy
non-ergot dopamine agonists (ropinirole) are generally preferred in younger patients (<50 yo) w high risk for dyskinesia
MAO-B inhibitor (selegiline) -> reasonable for patients who prefers lesser dosing frequency & only require modest benefit in motor improvement
dementia: RF
diabetes, HBP, HCL
age, fam hx, stroke, PD
