Clinical Questions Flashcards
Typical Symptoms of PD
T - Tremor
R- Rigidity
A - Akinesia
P - Postural Instability
Others: Muffled speech, drooling, dysphagia, constipation
Drugs that worsen PD
Haloperidol, Droperidol
1st/2nd antipsychotics (Risperidone, Paliperidone)
Prochlorperazine (Compazine, DA blocker)
Metoclopramide (Reglan, DA blocker)
A PD patient starts to have dyskinesia from his treatment, what could be added on to help?
Amantadine
A PD patient has really bad tremors and his current treatment is not helping, what could be added on to help?
Benztropine
A PD patient is experiencing orthostatic hypotension, what could be added on to help?
Droxidopa
What drugs are contraindicated when taking Sinemet?
Non-selective MAO inhibitors
EX: tranylcypromine, isocarboxazid, phenelzine
A parkinson’s patient is also experiencing pychosis, what is the best antipsychotic treatment for his movement disorder?
Quetiapine (Seroquel)
What is the first line treatment for PD?
Sinemet (Carbidopa/Levodopa)
What drugs can be added onto Sinemet to decrease the peripheral conversion of levodopa?
COMT inhibitors
EX: entacapone, opicapone, topcapone
What are the typical side effects you may experience with treatment for PD?
Dyskinesia
Hallucinations
Psychosis
Orthostasis
Somnolence
Which PD treatment can cause brown/black discoloring of the urine, saliva, or sweat?
Sinemet (Carbidopa/Levodopa)
What dose of Carbidopa is required to block the metabolism of Levodopa?
70 - 100 mg/day
With diease progression, after the 1st line therapy, what should be added on to PD patient’s therapy?
COMT inhibitors (Entacapone, Opicapone, Tolcapone)
Dopamine Agonists (Pramipexole [Mirapex], Ropinirole [Requip], Rotigotine)
What PD drug is contraindicated with opioids and SNRIs?
Selective MAO-B inhibitors (Selegiline, Rasagiline, Safinamide)
Typical Symptoms of Alzeimers
Memory loss
Difficulty communications
inability to learn
Difficulty planning
Poor coordination/motor function
Personality changes
Inappropriate behavior
Paranoia, agitation
Hallucinations
What drugs can worsen dementia?
Antiemetics (promethazine)
Antihistamines (diphenhydramine, doxylamine)
Antipsychotics (chlorpromazine, aripiprazole)
Barbiturates (phenobartbital, butalbital)
Benzodiazepines
Central anticholinergics (benztropine)
Skeletal muscle relaxants (Baclofen)
CNS depressants (opioids, sedatives)
What is the 1st line treatment therapy for Alzheimers?
Acetylcholinesterase inhibitors
Ex:Donepezil (Aricept), Rivastigmine (Exelon)
What is used at adjunct therapy for Alzheimers?
Memantine (Namenda)
What drugs should cautiously be used with acetylchoninerstase inhibitors?
Diltiazem, BB, Verapamil, Digoxin —– decreased HR
Antipsychotics, alpha blockers, muscle relaxers, hypnotics, opioids —– dizziness
Which formulation of Donepezil (Aricept) has less GI side effects?
ODT formulation
How is Donepezil (Aricept) dosed to reduce nausea?
qHS
Which formulation of Rivastigmine (Exelon has less GI side effects?
Patch
Which drugs will reduce the effects of Donepezil (Aricept) and Rivastigmine (Exelon)?
Anticholinergic drugs
