Exam 2 - Parkinson's Disease Flashcards
Characteristics of Parkinson’s Disease epidemiology? (4)
male predominant, average age of onset 62, rural life increases risk, cigarette smoking inversely correlated
Characteristics of Parkinson’s Disease pathophysiology? (4)
dopamine deficiency, loss of dopaminergic cells, formation of Lewy Bodies, nigral cell death (30-80%) before clinical manifestation
Diagnosis criteria for Parkinson’s Disease? (3)
bradykinesia and rigidity/resting tremor/postural instability
“On” vs “Off” meaning?
“On” = good movements, “Off” = poor movements
What class of medications for PD are on the Beer’s list?
anticholinergics
What is the MOA for anticholinergics?
antimuscarinic
What are examples of anticholinergics available for PD? (2)
benztropine (Cogentin) and trihexyphenidyl (Artane)
What are AEs of anticholinergics? (2)
dementia/cognitive decline risk, anti-SLUDGE
What is the MOA for levodopa?
precursor to dopamine
What are contraindications for levodopa? (3)
breastfeeding, closed-angle glaucoma, melanoma(?)
What are AEs of levodopa? (3)
dyskinesias, psychiatric, GI
What are important counseling points for levodopa? (2)
effectiveness may decrease over time, take without food (or with food consistently)
What is the dosing for levodopa?
200-300 mg/d in divided doses, no max
What is the MOA for carbidopa?
noncompetitive dopa decarboxylase inhibitor
Does carbidopa or levodopa cross the BBB?
levodopa only
What are contraindications for carbidopa? (2)
pregnancy, breastfeeding
What is the dosing for carbidopa/levodopa (Sinemet) to avoid N/V?
carbidopa amount of at least 70-100 mg/d
What are important counseling points for carbidopa/levodopa CR (Sinemet CR)? (2)
bioavailability is decreased by 25%, delayed onset of effect
What is the dosing for carbidopa/levodopa intestinal gel (Duopa)?
max 2000 mg of levodopa
What are AEs for carbidopa/levodopa intestinal gel (Duopa)? (2)
same as levodopa, PEG-J tube infection
What is the indication for levodopa powder for inhalation (Inbrija)?
two 42 mg capsules inhaled, max five times daily
What are contraindications for levodopa powder for inhalation (Inbrija)? (2)
nonselective MAOI use within 2 weeks, respiratory disorders (asthma, COPD)
What is the MOA for COMT inhibitors?
prevent the breakdown of L-dopa
What is the dosing of entacapone (Comtan)?
200 mg with each dose of levodopa/carbidopa, max eight times daily
What are contraindications for entacapone (Comtan)?
none
What are AEs for entacapone? (2)
same as levodopa, discolored urine
What is the dosing for the combination entacapone/carbidopa/levodopa (Stalevo)?
1:4 200 mg
What is the dosing for tolcapone (Tasmar)?
100 mg tid
What are contraindications for tolcapone (Tasmar)?
hepatic disease
What are AEs for tolcapone (Tasmar)?
hepatocellular disease/liver problems/increase in LFTs
What is the dosing for opicapone (Ongentys)?
50 mg qhs
What is an important counseling point for opicapone (Ongentys)?
do not eat for 1 hr before and after dose
What are contraindications for opicapone (Ongentys)? (2)
nonselective MAOI use, catecholamine-secreting neoplasms
What are AEs for opicapone (Ongentys)?
same as levodopa
What is the MOA for MAOIs?
noncompetitive, selective antagonists of monoamine oxidase type B (prevent dopamine breakdown)
What is important regarding the PKPD of selegiline (Eldepryl, Zelapar)?
many active metabolites with long half-lives
What is the dosing for selegiline (Eldepryl)? For transbuccal selegiline (Zelapar)?
5 mg qd-bid, 1.25 mg qd
What are contraindications for selegiline (Eldepryl, Zelapar)?
none
What are AEs for selegiline (Eldepryl, Zelapar)? (3)
insomnia, jitteriness, serotonin syndrome
What is the dosing for rasagiline (Azilect)?
0.5 mg qd with levodopa, 1 mg as monotherapy
What are contraindications for rasagiline (Azilect)? (2)
many meds, vasoconstrictors
What are AEs for rasagiline (Azilect)? (2)
orthostasis, arthralgia
What is the MOA for safinamide (Xadago)?
Na and K channel blocker (decreases glutamate release)
What is the dosing for safinamide (Xadago)?
50 mg qd
What are contraindications for safinamide (Xadago)?
renal impairment (Child-Pugh Class C)
What are AEs for safinamide (Xadago)? (3)
dopaminergic (dyskinesias, psychosis), hypersomnolence, retinal pathology
What is the MOA of amantadine (Symmetrel, Gocovri, Osmolex)?
unknown
Which version of amantadine is immediate release?
Symmetrel
What is important regarding the PKPD of amantadine (Symmetrel, Gocovri, Osmolex)?
adjust dose with renal impairment
What are contraindications for amantadine (Symmetrel, Gocovri, Osmolex)? (3)
CHF, orthostatic HTN, peripheral edema
What are AEs for amantadine (Symmetrel, Gocovri, Osmolex)?
livedo reticularis
Which class of medications has a reduced risk of developing motor complications?
dopamine agonists
What are the four dopamine agonists?
apomorphine, pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro)
What is the dosing for pramipexole IR (Mirapex)? For pramipexole ER (Mirapex)?
0.125 mg tid, 0.375 mg qd
What is the dosing for ropinirole IR (Requip)? For ropinirole ER (Requip)?
0.25 mg tid, 2 mg qd
What are contraindications for ropinirole (Requip)? (2)
hepatic disease, abrupt discontinuation
What are drug interactions with ropinirole (Requip)?
inhibitors of CYP1A2
What is the dosing for rotigotine (Neupro)?
2 mg qd
What are contraindications for rotigotine (Neupro)?
sulfite sensitivity
What are AEs for rotigotine? (4)
application site reaction, CNS, GI, peripheral edema
What is the indication for apomorphine (Apokyn)?
off episodes
What is the dosing for apomorphine (Apokyn)?
2 mg SQ
What is important regarding the PKPD of apomorphine (Apokyn)?
t1/2 = 40 min
What are contraindications for apomorphine (Apokyn)?
5HT3 antagonists
What is the MOA of istradefylline (Nourianz)?
adenosine A2A receptor antagonist
What is the dosing for istradefylline (Nourianz)?
20 mg qam
What conditions require dose adjustment for istradefylline (Nourianz)? (2)
tobacco smoking, hepatic impairment
What are AEs for istradefylline (Nourianz)? (2)
dyskinesias, psychiatric
What are non-pharm treatments for PD? (4)
surgery, PT/exercise, nutrition, OT and fall precautions
What has been proven useful for depression in PD? (2)
pramipexole, venlafaxine
What has been proven useful for dementia/cognitive impairment in PD?
rivastigmine
What has been FDA-approved for orthostatic HTN in PD?
droxidopa
What has been proven useful for sexual dysfunction in PD?
sildenafil
What has been proven useful for constipation in PD? (2)
probiotics and fiber
What has been proven useful for drooling in PD?
Botox
What is the first step in managing psychosis in PD?
evaluate hypoxemia, infection, and electrolyte disturbances
What is the second step in managing psychosis in PD?
simplify regimen
What is the third step in managing psychosis in PD?
consider atypical antipsychotic drugs
What is the MOA of pimavanserin (Nuplazid)?
atypical antipsychotic, 5HT inverse agonist
What is a BBW for pimavanserin (Nuplazid)?
death in elderly with dementia being treated with APDs
What are AEs for pimavanserin (Nuplazid)? (2)
QTc prolongation, peripheral edema