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1. Neuro/Substance Abuse > E2 > Flashcards

E2 Flashcards

1
Q

Parkinson’s disease is _____ Dominant

A

Male

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2
Q

Average age of onset of PD

A

62

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3
Q

Things that can impact rate of PD

A

Rural life increases risk, theory is the neurotoxins

INVERSE correlation between smoking and caffeine consumption, more smoking and more caffeine the less PD

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4
Q

pathophysiology of PD

A

State of dopamine deficiency

Functional imbalance of inhibitory dopamine and excitatory acetylcholine, two main characteristics are loss of dopaminergic cells and formation of levy bodies

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5
Q

___% of Ingram cell death is needed before disease manifests clinically

A

30 - 80%

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6
Q

PD Diagnosis

A

Bradykinesia AND
Limb muscle rigidity OR resting tremor OR postural instability

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7
Q

Tremors in PD occur____ in the ___limb

A

Unilaterally, distal

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8
Q

Anticholinergics in PD is used to

A

Decrease cholinergic activity because dopamine normally inhibits Ach in the striatum

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9
Q

Anticholinergic medications for PD

A

Benztropine (cogentin)
Trihexyphenidyl (Artane)

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10
Q

anticholinergic meds ADE

A

Anti - sludge

Dry as a bone
Blind as a bat
Hot as a hare
Mad as a hatter
Red as a beet

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11
Q

Levodopa MOA and place in therapy

A

Precursor to dopamine
Gold standard in therapy

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12
Q

Carbidopa MOA

A

Inhibit L-dopa peripheral metabolism by acting as a noncompetitive dopa decarboxylase inhibitor

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13
Q

When dosing Sinemet, what is the ratio

A

Sinemet is carbidopa/levodopa

Need to maintain carbidopa doses of 70- 100mg/day

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14
Q

Sinemet CR

Bioavailability, onset, dosing pearl

A

Has lower bioavailability compared to IR
There is delayed onset of effect

When switching to Cr, increase IR dose by 25% because of less bioavailability
Taking in AM can help with morning rigidity

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15
Q

Duopa

A

Carbidopa/levodopa intestinal gel

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16
Q

Duopa dose

A

Max is 2000mg of levodopa per day (1 cassette)

Administer over 16hrs

Change therapy to oral Ir Sinemet to prepare for gel

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17
Q

Levodopa ADE

A

Dyskinesia
On off phenomena
Psychiatric disturbances and vivid dreams
GI issues
Orthostatic hypotension
Saliva. Sweat, urine discoloration
NMS with abrupt d/c

18
Q

Duopa ADE

A

Because given via PEG J tube
Risk of infection, bleeding, tube clogging or dislodging

ADE of carbidopa/levodopa as well

19
Q

Inbrija

A

Levodopa powder for inhalation, adjunctive to Sinemet PO

Is NOT a replacement therapy for PO Sinemet

20
Q

Inbrija Dose

A

2x 42mg capsules inhaled as needed for OFF symptoms, up to 5 times daily

21
Q

Inbrija ADE

A

Somnolence
Hallucinations
Dyskinesia
Cough (60%)
N
URTI (upper respiratory tract infection)
discolored suptum

22
Q

Inbrija Contraindications

A

MAOI (nonselective) use within 2 weeks

23
Q

Inbrija is NOT recommended in patients with

A

Asthma, COPD, chronic underlying lung disease

24
Q

Entacapone MOA

A

Inhibit catachol-O-methyltransferase (COMT)

Inhibition of COMT prevents the breakdown of L-dopa

25
Q

Tolcapone MOA

A

Inhibit catachol-O-methyltransferase (COMT)

Inhibition of COMT prevents the breakdown of L-dopa

26
Q

Opicapone MOA

A

Inhibit catachol-O-methyltransferase (COMT)

Inhibition of COMT prevents the breakdown of L-dopa

27
Q

All of the COMT inhibitors are _____

A

Tolcapone
Entacapone
Opicapone

28
Q

All of the COMT inhibitors do not work in the _____

A

absence of L-DOPA

29
Q

COMT inhibitors DDI

A

non-seletive MAOIs

30
Q

Entacapone Dose

A

200mg WITH EACH DOSE OF LEVODOPA/CARBIDOPA UP TO 8 TIMES DAILY

31
Q

Entacapone ADE

A

may produce brown/orange urine

32
Q

Stalevo is ______

A

carbidopa/levodopa/entacapone

1:4, 200mg

33
Q

Tolcapone Contraindications

A

Hepatic Disease because of tolcapone-induced hepatocellular injury

34
Q

Tolcapone ADE

A

increased LFTs because of tolcapone-induced hepatocellular injury. So a consistent monitoring plan is needed.

35
Q

Opicapone PKPD

A

TAKE ON EMPTY STOMACH

Absorption significantly decreased with moderate-fat/calorie meal. Cmax decreases. Tmax is delayed

36
Q

Opicapone Dosing

A

BEDTIME 50mg

DO NOT EAT FOR 1 hr before and after dose

37
Q

Seletive MAOIs

A

Selegiline, Rasaflin, Safinamide

38
Q

DA agonist

A

Amantadine

39
Q

Amantadine MAO

A

increases dopamine release and inhibit reuptake

40
Q

MAO of Selective MAOI

A

Inhibit central & peripheral metabolism by MAOB

1. Neuro/Substance Abuse (3 decks)

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