Chapter 61: Parkinson Disease Flashcards
Parkinson disease involves destruction of neurons in the substantia nigra in the brain resulting in a deficiency in neuronal BLANK?
Dopamine
Which of the following symptoms can be seen in Parkinson disease patients: (Select all that apply)
A. Tremor B. Orthostasis C. Trunk stiffness D. Frequent UTIs E. Depression
A, B, C, and E are correct
Which class of agents are most effective in treating depression in Parkinson disease patients?
TCAs. Preferably the secondary amines such as desipramine (Norpramin®) and nortriptyline (Pamelor®)
Although SSRIs are commonly used b/c physicians are comfortable with them. SSRIs can contribute to or make worse tremor and risk of serotonin syndrome if patients taking MAO-B inhibitors.
Which antipsychotic is the preferred agent in treating psychosis in Parkinson disease patients?
Quetiapine (Seroquel®) due to a low risk of movement disorders. Will still require monitoring for metabolic complications like increased blood glucose and cholesterol
Which of the following is NOT a brand name of carbidopa/levodopa? (Select all that apply)
A. Stalevo B. Sinemet C. Duopa D. Rytary E. Jadenu
A and E, Stalevo and Jadenu, are not brand names of carbidopa/levodopa. Stalevo® is the brand name of a combination Parkinson disease agent carbidopa/levodopa + entacapone, a COMT-inhibitor. Jadenu® is an iron chelation agent indicated in sickle cell patients for the treatment of chronically elevated levels of iron in the blood caused by repeated blood transfusions. The generic for Jadenu® is deferasirox.
Why must 70-100mg/day of carbidopa be combined with levodopa when treating Parkinson disease?
The combination is essential to both inhibit peripheral conversion of levodopa (before it has a chance to cross the BBB) and to decrease nausea, a common SE of levodopa.
All of the following are DA-agonists, EXCEPT:
A. Comtan® B. Mirapex ER C. Amantadine D. Ropinirole E. Apokyn
A and C: Comtan® (COMT-inhibitor) and amantadine (DA reuptake inhibitor) are NOT DA-agonists
DA-agonists
B. Pramipexole (Mirapex®)
D. Ropinirole (Requip®)
E. Apomorphine (Apokyn®) DA-agonist injection used for “rescue” during “off” periods - when Sx worsen before the next dose of medication is due
And Rotigotine (Neupro®) patch are all DA-agonists
What is the most important SE to be aware of in order to properly manage patients starting apomorphine injection for “off” periods of Parkinson disease?
Severe nausea and vomiting
Trimethobenzamide (Tigan®) 300mg po TID should be started 3 days prior to the initial dose of Apokyn® and continued at least during the first two months of therapy to manage the severe N/V due to apomorphine use.
Do NOT use apomorphine with 5HT-3 antagonists (ondansetron, etc) due to SEVERE hypotension and loss of consciousness
Which of the following statements regarding agents used to treat Parkinson disease is INCORRECT?
A. Sinemet can make the urine turn black
B. Apply the rotigotine patch twice daily making sure to rotate application sites
C. Carbidopa/levodopa administration must be separated from iron
D. Carbidopa/levodopa, COMT-inhibitors, and the non-injectable DA-agonists can ALL cause orthostasis
E. Northera® has a boxed warning for supine hypertension
B. Rotigotine (Neupro®) patch is applied ONCE daily at the same time each day. The patch contains aluminum and must be removed prior to MRI to avoid burn. Do NOT cut the patch.
E. Droxidopa (Northera®) is a newer agent used for orthostatic hypotension, which is commonly present in Parkinson disease patients. It is an alpha/beta agonists
Which of the following Parkinson disease agents can cause a rare cutaneous reaction called lived reticular (reddish skin mottling) that requires the drug to be discontinued?
A. Azilect® B. Entacapone C. Duopa® D. Pramipexole E. Symmetrel®
E. Symmetrel® (amantadine) blocks DA reuptake, increases DA release from presynaptic fibers.
This drug can also cause toxic delirium. Symmetrel dose must be decreased in renal impairment.
