Exam 3 lecture 5 Flashcards
disease progression of PD
Develops over 5-10 years with an increase in motor symptoms.
Cognitive symptoms may be present after several years of PD
Life expectancy after diagnosis is 15 years
clinical presentation of PD (motor)
Tremor
bradykinesia
rigidity
parkinsonian gait (walking style)
Clinical presentation of PD (non motor)
Anxiety and depression
constipation
dementia
insomnia
Psychosis
non pcol tx of PD
Exercise/physical therapy
nutritional counseling
occupational therapy
psychotherapy
speech therapy
Pcol tx of pd
1st line- rule out drug induced PD
Dopamine precursor
dopamine agonist
MAO-B inhibitor
Rank drug efficacy with motor symptoms
Levodopa/carbidopa>DA>MAOB-I
for most PD pts we initiate
Levodopa
When to use dopamine agonist? WHen to avoid dopamine agonist?
Dopamine agonist may be used as initial tx if age<60 yrs and higher risk for dyskinesia
Avoid dopamine agonist as initial tx if
age>70
history of ICD
cognitive impairement
excessive daytime sleepiness
hallucinations
What is the dopamine precursor used in PD
CD/LD (carbidopa/levidopa)
place in therapy for PD for LD/CD
1st line for initial PD therapy
most effective monotherapy “gold standard”
side effects of LD/CD (!)
N/V
LD motor fluctuations/dyskinesia
hallucinations
starting dose of LD/CD (!)
25/100 mg CD/LD PO BID-TID with meals
What are LD motor fluctuations (!)
wearing off
Freezing
Delayed onset
peak dose dyskinesia
Define the LD motor fluctuations (!!)
wearing off- before next dosing interval, signs of motor symptoms
freezing- inability to move due to insufficient or fluctuating DA levels
Delayed onset- Therapeutic benefits delayed
Peak-dose dyskinesias- Involuntary body movement caused by high DA levels
What are the types of dopamine agonists used to treat PD
ergots and non ergots
Name none ergot dopamine agonists
pramiprexole
ropinirole
rotigotine
apomorphine
strating doses for non ergot dopamine agonists
pramipexole IR 0.125 mg PO TID; ER 0.375 mg PO daily
- ropinirole IR 0.25 mg PO TID; ER 2 mg PO daily
- rotigotine 2 mg patch applied to the skin Q24H
- apomorphine 2 mg SC injection prn up to 5 x daily or
10 mg SL Film up to 5 x daily
place in therapy for non ergot DA agonists? What is used more, ergots or non ergots? Why?
1st line for initial PD therapy
non ergots used more because they are less likely to cause LD motor fluctuations.
What are MAO-B i drugs? When are they used?
Rasagiline
Selegiline
Safinimide
less effective at controlling motor symotoms
place in therapy for MAO-B I drugs
1st line for mild symptoms of PD
2nd line for adjunct
starting doses of MAO-B I drugs
Rasagiline- 0.5 mg po
Selegiline- 5 mg PO BID
Safinamide- 50 mg PO QD
What drug drug i/a should we be aware of with MAO B i
serotonergic antidepressants
dextromethorphan
serotonergic opioids
COMT i MOA
Minimize breakdown of dopamine
COMT i drugs and place in therapt
entacapone
opicapone
tolcapone
in combo with levodopa/carbidopa. PRevents wearing offS
S/E of COMT i drugs
N/V
brown/orange urine discoloration for entacapone (!!!!!)