Central Nervous System - Parkinsons Flashcards
what is parkinsons?
alleviated high levels of dopamine
if patient has parkinsons and their motor symptoms reduce QoL what is the tx?
levodopa + carbidopa/berserazide
if patient has parkinsons and their symptoms do not reduce their QoL what is the tx?
- levodopa
- non-ergot derived dopamine receptor
- monoamine-oxidase B inhibitors
what is added to levodopa in order to prevent breakdown of levodopa before it crosses into the brain
carbidopa or benserazide
what is the s/e of levodopa?
- impulsive disorders; pathological gambling, binge eating and hypersexuality
- sudden onset of sleep
- red urine
what is the tx of sudden onset of sleep?
modafinil
give examples of non-ergot derived dopamine receptors
- pramipexole
- ropinirole
- rotigotine
what are the side effects of non-ergot derived dopamine receptors?
- impulse disorders (higher than levodopa)
- sudden onset of sleep
- hypotension
give examples of monoamine-oxidase B inhibitors
rasagiline or selegiline
which drug interacts with rasagiline or selegiline and what does it cause?
- phenylephrine
- causes hypertensive crisis
mature cheese, salami, marmite, yeast, tofu
Which MAO interacts with tyramine rich foods?
MOA-A inhibitors
If pt develops dyskinesia or motor fluctuations despite optimal levodopa therapy what is added?
added to levodopa:
- non-ergot dopamine receptor agonists
- monoamine oxidase B inhibitors
- COMT inhibitors
give two examples of COMT inhibitors
- entacapone
- tolcapone
what is the s/e of entacapone
red-brown urine
what is s/e of tolcapone
hepatotxicity
in CVD events does parasympathetic s/e increase or decrease with entacapone and tolcapone?
increase
when is ergot dervied dopamine receptor agonist added to levodopa
if symptoms x adequately controlled with non-ergot derived dopamine receptors
give two examples of ergot dervied receptor agonists
- bromocriptine
- cabergoline
what are the s/e of
bromocriptine, cabergoline
- pulmonary reactions; SoB, chest pain and cough
- pericardial reactions; chest pain
should you withdraw medications abruptly in parkinsons?
NO
If patient is experiencing “off-periods” due to end of deterioration what do you give?
MR preparation
what is 1st line tx of noctural akinesia?
levodopa or oral dopamine receptor agonists
What is 2nd line tx of noctural akinesia?
rotigotine
What is the tx of hypotension in parkinsons?
midodrine
