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PHM701 > Exam 2 - Parkinson's Disease > Flashcards

Exam 2 - Parkinson's Disease Flashcards

1
Q

Characteristics of Parkinson’s Disease epidemiology? (4)

A

male predominant, average age of onset 62, rural life increases risk, cigarette smoking inversely correlated

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2
Q

Characteristics of Parkinson’s Disease pathophysiology? (4)

A

dopamine deficiency, loss of dopaminergic cells, formation of Lewy Bodies, nigral cell death (30-80%) before clinical manifestation

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3
Q

Diagnosis criteria for Parkinson’s Disease? (3)

A

bradykinesia and rigidity/resting tremor/postural instability

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4
Q

“On” vs “Off” meaning?

A

“On” = good movements, “Off” = poor movements

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5
Q

What class of medications for PD are on the Beer’s list?

A

anticholinergics

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6
Q

What is the MOA for anticholinergics?

A

antimuscarinic

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7
Q

What are examples of anticholinergics available for PD? (2)

A

benztropine (Cogentin) and trihexyphenidyl (Artane)

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8
Q

What are AEs of anticholinergics? (2)

A

dementia/cognitive decline risk, anti-SLUDGE

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9
Q

What is the MOA for levodopa?

A

precursor to dopamine

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10
Q

What are contraindications for levodopa? (3)

A

breastfeeding, closed-angle glaucoma, melanoma(?)

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11
Q

What are AEs of levodopa? (3)

A

dyskinesias, psychiatric, GI

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12
Q

What are important counseling points for levodopa? (2)

A

effectiveness may decrease over time, take without food (or with food consistently)

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13
Q

What is the dosing for levodopa?

A

200-300 mg/d in divided doses, no max

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14
Q

What is the MOA for carbidopa?

A

noncompetitive dopa decarboxylase inhibitor

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15
Q

Does carbidopa or levodopa cross the BBB?

A

levodopa only

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16
Q

What are contraindications for carbidopa? (2)

A

pregnancy, breastfeeding

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17
Q

What is the dosing for carbidopa/levodopa (Sinemet) to avoid N/V?

A

carbidopa amount of at least 70-100 mg/d

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18
Q

What are important counseling points for carbidopa/levodopa CR (Sinemet CR)? (2)

A

bioavailability is decreased by 25%, delayed onset of effect

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19
Q

What is the dosing for carbidopa/levodopa intestinal gel (Duopa)?

A

max 2000 mg of levodopa

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20
Q

What are AEs for carbidopa/levodopa intestinal gel (Duopa)? (2)

A

same as levodopa, PEG-J tube infection

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21
Q

What is the indication for levodopa powder for inhalation (Inbrija)?

A

two 42 mg capsules inhaled, max five times daily

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22
Q

What are contraindications for levodopa powder for inhalation (Inbrija)? (2)

A

nonselective MAOI use within 2 weeks, respiratory disorders (asthma, COPD)

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23
Q

What is the MOA for COMT inhibitors?

A

prevent the breakdown of L-dopa

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24
Q

What is the dosing of entacapone (Comtan)?

A

200 mg with each dose of levodopa/carbidopa, max eight times daily

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25
Q

What are contraindications for entacapone (Comtan)?

A

none

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26
Q

What are AEs for entacapone? (2)

A

same as levodopa, discolored urine

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27
Q

What is the dosing for the combination entacapone/carbidopa/levodopa (Stalevo)?

A

1:4 200 mg

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28
Q

What is the dosing for tolcapone (Tasmar)?

A

100 mg tid

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29
Q

What are contraindications for tolcapone (Tasmar)?

A

hepatic disease

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30
Q

What are AEs for tolcapone (Tasmar)?

A

hepatocellular disease/liver problems/increase in LFTs

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31
Q

What is the dosing for opicapone (Ongentys)?

A

50 mg qhs

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32
Q

What is an important counseling point for opicapone (Ongentys)?

A

do not eat for 1 hr before and after dose

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33
Q

What are contraindications for opicapone (Ongentys)? (2)

A

nonselective MAOI use, catecholamine-secreting neoplasms

34
Q

What are AEs for opicapone (Ongentys)?

A

same as levodopa

35
Q

What is the MOA for MAOIs?

A

noncompetitive, selective antagonists of monoamine oxidase type B (prevent dopamine breakdown)

36
Q

What is important regarding the PKPD of selegiline (Eldepryl, Zelapar)?

A

many active metabolites with long half-lives

37
Q

What is the dosing for selegiline (Eldepryl)? For transbuccal selegiline (Zelapar)?

A

5 mg qd-bid, 1.25 mg qd

38
Q

What are contraindications for selegiline (Eldepryl, Zelapar)?

A

none

39
Q

What are AEs for selegiline (Eldepryl, Zelapar)? (3)

A

insomnia, jitteriness, serotonin syndrome

40
Q

What is the dosing for rasagiline (Azilect)?

A

0.5 mg qd with levodopa, 1 mg as monotherapy

41
Q

What are contraindications for rasagiline (Azilect)? (2)

A

many meds, vasoconstrictors

42
Q

What are AEs for rasagiline (Azilect)? (2)

A

orthostasis, arthralgia

43
Q

What is the MOA for safinamide (Xadago)?

A

Na and K channel blocker (decreases glutamate release)

44
Q

What is the dosing for safinamide (Xadago)?

A

50 mg qd

45
Q

What are contraindications for safinamide (Xadago)?

A

renal impairment (Child-Pugh Class C)

46
Q

What are AEs for safinamide (Xadago)? (3)

A

dopaminergic (dyskinesias, psychosis), hypersomnolence, retinal pathology

47
Q

What is the MOA of amantadine (Symmetrel, Gocovri, Osmolex)?

A

unknown

48
Q

Which version of amantadine is immediate release?

A

Symmetrel

49
Q

What is important regarding the PKPD of amantadine (Symmetrel, Gocovri, Osmolex)?

A

adjust dose with renal impairment

50
Q

What are contraindications for amantadine (Symmetrel, Gocovri, Osmolex)? (3)

A

CHF, orthostatic HTN, peripheral edema

51
Q

What are AEs for amantadine (Symmetrel, Gocovri, Osmolex)?

A

livedo reticularis

52
Q

Which class of medications has a reduced risk of developing motor complications?

A

dopamine agonists

53
Q

What are the four dopamine agonists?

A

apomorphine, pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro)

54
Q

What is the dosing for pramipexole IR (Mirapex)? For pramipexole ER (Mirapex)?

A

0.125 mg tid, 0.375 mg qd

55
Q

What is the dosing for ropinirole IR (Requip)? For ropinirole ER (Requip)?

A

0.25 mg tid, 2 mg qd

56
Q

What are contraindications for ropinirole (Requip)? (2)

A

hepatic disease, abrupt discontinuation

57
Q

What are drug interactions with ropinirole (Requip)?

A

inhibitors of CYP1A2

58
Q

What is the dosing for rotigotine (Neupro)?

A

2 mg qd

59
Q

What are contraindications for rotigotine (Neupro)?

A

sulfite sensitivity

60
Q

What are AEs for rotigotine? (4)

A

application site reaction, CNS, GI, peripheral edema

61
Q

What is the indication for apomorphine (Apokyn)?

A

off episodes

62
Q

What is the dosing for apomorphine (Apokyn)?

A

2 mg SQ

63
Q

What is important regarding the PKPD of apomorphine (Apokyn)?

A

t1/2 = 40 min

64
Q

What are contraindications for apomorphine (Apokyn)?

A

5HT3 antagonists

65
Q

What is the MOA of istradefylline (Nourianz)?

A

adenosine A2A receptor antagonist

66
Q

What is the dosing for istradefylline (Nourianz)?

A

20 mg qam

67
Q

What conditions require dose adjustment for istradefylline (Nourianz)? (2)

A

tobacco smoking, hepatic impairment

68
Q

What are AEs for istradefylline (Nourianz)? (2)

A

dyskinesias, psychiatric

69
Q

What are non-pharm treatments for PD? (4)

A

surgery, PT/exercise, nutrition, OT and fall precautions

70
Q

What has been proven useful for depression in PD? (2)

A

pramipexole, venlafaxine

71
Q

What has been proven useful for dementia/cognitive impairment in PD?

A

rivastigmine

72
Q

What has been FDA-approved for orthostatic HTN in PD?

A

droxidopa

73
Q

What has been proven useful for sexual dysfunction in PD?

A

sildenafil

74
Q

What has been proven useful for constipation in PD? (2)

A

probiotics and fiber

75
Q

What has been proven useful for drooling in PD?

A

Botox

76
Q

What is the first step in managing psychosis in PD?

A

evaluate hypoxemia, infection, and electrolyte disturbances

77
Q

What is the second step in managing psychosis in PD?

A

simplify regimen

78
Q

What is the third step in managing psychosis in PD?

A

consider atypical antipsychotic drugs

79
Q

What is the MOA of pimavanserin (Nuplazid)?

A

atypical antipsychotic, 5HT inverse agonist

80
Q

What is a BBW for pimavanserin (Nuplazid)?

A

death in elderly with dementia being treated with APDs

81
Q

What are AEs for pimavanserin (Nuplazid)? (2)

A

QTc prolongation, peripheral edema

PHM701 (14 decks)

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