CNS Parkinsons Flashcards

1
Q

Parkinsons alleviated by what?

A

Increasing amounts of dopamine

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2
Q

what are the 2 types of pts in parkinsons

A
  1. whose motor symptoms decrease QoL
  2. whose motor symptoms dont affect QoL
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3
Q

PARKINSONS DISEASE- FIRST-LINE TREATMENT

Motor symptoms decrease quality of life?

A

Levodopa + Carbidopa/Benserazide

eg co-careldopa / co-beneldopa

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4
Q

PARKINSONS DISEASE- FIRST-LINE TREATMENT

Motor symptoms do NOT decrease quality of life?

A
  • Levodopa
  • Non-ergot-derived dopamine-receptor (pramipexole, rotigotine)
  • Monoamine-oxidase-B-inhibitors (rasagilin/selegiline)
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5
Q

examples of Non-ergot-derived dopamine-receptor agonists PR^2

A

pramipexole, rotigotine, ropinirole

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6
Q

examples of Monoamine-oxidase-B-inhibitors

A

rasagiline/selegiline

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7
Q

adverse reactions from antiparkinsonian drugs include what

A

psychotic symptoms, excessive sleepiness and sudden onset of sleep with dopamine-receptor agonists, and impulse control disorders with all dopaminergic therapy (especially dopamine-receptor agonists)

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8
Q

LEVODOPA

Whys is carbidopa/benserazide added?

A

Prevents breakdown of levodopa before it crosses into the brain

if levo given on its own, only 1% is used by body!

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9
Q

LEVODOPA- SIDE-EFFECTS?

A

Impulse disorders:
- gambling
- binge eating
- hypersexuality

Sudden onset of sleep (treat w/ modafinil)

Red urine

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10
Q

NON-ERGOT-DERIVED DOPAMINE RECEPTORS- PR^2

SIDE-EFFECTS?

A

Impulse disorders
Sudden onset of sleep
( same as levodopa but GREATER impulse control disorders)
Hypotension (postural-
treat w/ Midodrine->Fludrocortisone)

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11
Q

MONOAMINE-OXIDASE-B INHIBITORS

SIDE-EFFECTS?

A

Hypertensive crisis if given w/ phenylephrine/pseudoephedrine OTC

do not give these OTC with MAO-i. can cause hypertnesive crisis

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12
Q

MAO-i interact with which type of foods?

A

Tyramine-rich foods:
Mature cheese
Salami
Marmite
Yeast
Tofu
/Meat
Yeast Extract
Some beers/wines

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13
Q

mao-i interact with tyramine rich foods to cause a hypertensive crisis! why?

A

tyramine naturally increases BP and is broken down by the enzyme MAO.
so inhibitors will cause htn crisis

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14
Q

If patient develops dyskinesia (involuntary erratic writhing movements of face arms legs trunk) /motor fluctuations w/ optimal levodopa, WHAT DO YOU DO?

A

Add an adjuvant:

  • Non-ergotic dopamine receptor agonist (NEDR-A)
  • monoamine oxidase B inhibitor
  • COMT inhibitor
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15
Q

name 2 COMT INHIBITORS
ET

A

ENTACAPONE/TOLCAPONE

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16
Q

SEs of COMT inhibitors

A

Entacapone- red-brown urine
Tolcapone- hepatotoxic

Increases sympathetic SE- increase in CVD events
(tachycardia, fast breathing..)

17
Q

COMT inhibitors should be avoided in which pts

A

w CVD due to increased sympathetic SEs

18
Q

What do you do if symptoms are not controlled with a NEDR-A as adjunct to levodopa?

A

Add EDR-A instead, w/ levodopa
ergot derived dopamine receptor agonist

19
Q

ERGOT-DERIVED DOPAMINE RECEPTOR AGONISTS- 2 EXAMPLES?

BC

A

BROMOCRIPTINE/CABERGOLINE

20
Q

ERGOT-DERIVED DOPAMINE RECEPTOR AGONISTS SEs

A

FIBROTIC REACTIONS!!!
Pulmonary reactions: SOB, chest pain, cough
Pericardial reactions: Chest pain

21
Q

ANTI-PARKINSONS MEDS

Withdrawal associated?

A

yes, Do not withdraw medications abruptly

22
Q

what are ‘off periods’ associated w anti-parkinsons meds and how to handle

A

Person has ‘off periods’ (med wearing off, no longer optimal) due to end of dose deterioration -> use MR prep. more consistent conc of drug in blood

23
Q

ANTI-PARKINSONS MEDS

Nocturnal Akinesia-
1st line?
2nd line?

A

Nocturnal akinesia- treat with
1st line: levodopa/oral dopamine receptor agonist, i.e bromocriptine, cabergoline
2nd line: rotigotine

24
Q

ANTI-PARKINSONS MEDS
How is hypotension treated? and how why does it work

A

Midodrine
sympathomimetic causes vasoconstriction, increasing arterial resistance thus increasing BP

25
Q

ANTI-PARKINSONS MEDS
How is sudden onset of sleep treated?

26
Q

more on bnf…