E2 Flashcards
Parkinson’s disease is _____ Dominant
Male
Average age of onset of PD
62
Things that can impact rate of PD
Rural life increases risk, theory is the neurotoxins
INVERSE correlation between smoking and caffeine consumption, more smoking and more caffeine the less PD
pathophysiology of PD
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
___% of Ingram cell death is needed before disease manifests clinically
30 - 80%
PD Diagnosis
Bradykinesia AND
Limb muscle rigidity OR resting tremor OR postural instability
Tremors in PD occur____ in the ___limb
Unilaterally, distal
Anticholinergics in PD is used to
Decrease cholinergic activity because dopamine normally inhibits Ach in the striatum
Anticholinergic medications for PD
Benztropine (cogentin)
Trihexyphenidyl (Artane)
anticholinergic meds ADE
Anti - sludge
Dry as a bone
Blind as a bat
Hot as a hare
Mad as a hatter
Red as a beet
Levodopa MOA and place in therapy
Precursor to dopamine
Gold standard in therapy
Carbidopa MOA
Inhibit L-dopa peripheral metabolism by acting as a noncompetitive dopa decarboxylase inhibitor
When dosing Sinemet, what is the ratio
Sinemet is carbidopa/levodopa
Need to maintain carbidopa doses of 70- 100mg/day
Sinemet CR
Bioavailability, onset, dosing pearl
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
Duopa
Carbidopa/levodopa intestinal gel
Duopa dose
Max is 2000mg of levodopa per day (1 cassette)
Administer over 16hrs
Change therapy to oral Ir Sinemet to prepare for gel
Levodopa ADE
Dyskinesia
On off phenomena
Psychiatric disturbances and vivid dreams
GI issues
Orthostatic hypotension
Saliva. Sweat, urine discoloration
NMS with abrupt d/c
Duopa ADE
Because given via PEG J tube
Risk of infection, bleeding, tube clogging or dislodging
ADE of carbidopa/levodopa as well
Inbrija
Levodopa powder for inhalation, adjunctive to Sinemet PO
Is NOT a replacement therapy for PO Sinemet
Inbrija Dose
2x 42mg capsules inhaled as needed for OFF symptoms, up to 5 times daily
Inbrija ADE
Somnolence
Hallucinations
Dyskinesia
Cough (60%)
N
URTI (upper respiratory tract infection)
discolored suptum
Inbrija Contraindications
MAOI (nonselective) use within 2 weeks
Inbrija is NOT recommended in patients with
Asthma, COPD, chronic underlying lung disease
Entacapone MOA
Inhibit catachol-O-methyltransferase (COMT)
Inhibition of COMT prevents the breakdown of L-dopa
Tolcapone MOA
Inhibit catachol-O-methyltransferase (COMT)
Inhibition of COMT prevents the breakdown of L-dopa
Opicapone MOA
Inhibit catachol-O-methyltransferase (COMT)
Inhibition of COMT prevents the breakdown of L-dopa
All of the COMT inhibitors are _____
Tolcapone
Entacapone
Opicapone
All of the COMT inhibitors do not work in the _____
absence of L-DOPA
COMT inhibitors DDI
non-seletive MAOIs
Entacapone Dose
200mg WITH EACH DOSE OF LEVODOPA/CARBIDOPA UP TO 8 TIMES DAILY
Entacapone ADE
may produce brown/orange urine
Stalevo is ______
carbidopa/levodopa/entacapone
1:4, 200mg
Tolcapone Contraindications
Hepatic Disease because of tolcapone-induced hepatocellular injury
Tolcapone ADE
increased LFTs because of tolcapone-induced hepatocellular injury. So a consistent monitoring plan is needed.
Opicapone PKPD
TAKE ON EMPTY STOMACH
Absorption significantly decreased with moderate-fat/calorie meal. Cmax decreases. Tmax is delayed
Opicapone Dosing
BEDTIME 50mg
DO NOT EAT FOR 1 hr before and after dose
Seletive MAOIs
Selegiline, Rasaflin, Safinamide
DA agonist
Amantadine
Amantadine MAO
increases dopamine release and inhibit reuptake
MAO of Selective MAOI
Inhibit central & peripheral metabolism by MAOB
