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PR3153 > IC16 - Parkinson's Disease > Flashcards

IC16 - Parkinson's Disease Flashcards

1
Q

What are the 4 characteristic features of Parksion disease?

A
  1. Tremor at rest
  2. Rigidity
  3. Akinesia
  4. Postural instability
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2
Q

How is diagnosis made for Parkinson’s disease?

A

Tremor, Rigidity, Akinesia/ bradykinesia

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3
Q

What are the features of the idiopathic PD at initial presentation?

A
  1. Asymmetric
  2. No postural instability
  3. No autonomic dysfunction
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4
Q

List 2 drugs that patients with idiopathic PD response to at initial presentation.

A
  1. Levodopa
  2. Apomorphine
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5
Q

What are the two neuroimaging techniques that can be used for differential diagnosis?

A
  1. MRI
  2. SPECT, DaT (differentiate essential tremors and other non-dopamine deficiency etiologies)
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6
Q

What are symptoms associated with disease progression of idiopathic PD?

A
  1. Unable to perform basic ADLs
  2. Choking
  3. Pneumonia
  4. Falls
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7
Q

What is the pathophysiology behind PD?

A
  1. Loss of dopaminergic neurons in substantia nigra
  2. Misfolded alpha-synuclein formation of Lewy body –> long term expression of alpha-synuclein decrease DA neurotransmission and mediates mitochondrial failure –> neuroinflammation –> activation of microglia
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8
Q

What are the non-motor symptoms of Parkinson disease?

A
  1. Cognitive impairments
  2. Psychiatric symptoms
  3. Sleep disorders
  4. Autonomic dysfunction
  5. Others: fatigue
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9
Q

What are the features of early/ young onset PD?

A
  1. < cognitive decline
  2. earlier motor complications
  3. Dystonia
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10
Q

What is the preferred agent early/ young onset PD?

A

Dopamine agonists

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11
Q

What are the two purpose of pharmacological treatments for PD?

A
  1. Increase central dopamine, dopaminergic transmission
  2. Correct imbalance in other pathways
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12
Q

What symptoms is levodopa most effective in treating?

A

bradykinesia and rigidity

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13
Q

Why is dopamine not recommended in treatment of PD?

A

It does not cross BBB

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14
Q

What are the side effects of levodopa?

A

N/V
Hypotension (orhtostatic)
Dorwsiness, sudden sleep onset
Hallucinations, psychosis
Dyskinesias

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15
Q

What is one important counselling point for patients on levodopa?

A

Eat on empty stomach or with light snacks if cannot tolerate drug S/E.

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16
Q

Absorption of levodopa ________ with high fat or high protein meals.

A

decreases

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17
Q

What drug is levodopa often give with?

A
  1. DOPA decarboxylase inhibitors (benserazide, carbidopa)
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18
Q

DCI ____ cross BBB.

A

does not

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19
Q

What is the dose of DCI needed to be administered with Levodopa?

A

75 to 100mg (to saturate dopa)

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20
Q

What is the on-off phenomenon?

A

Unpredictable response to levodopa and is not related to dose or dosing interval

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21
Q

What is the wearing off phenomenon?

A

Effects wanes off before end of doing interval

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22
Q

What can be done to manage the wearing off effects?

A
  1. Modify times of administration
  2. Replace with modified release preparations at appropriate time
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23
Q

_____ is an motor complication of levodopa.

A

Dyskinesia

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24
Q

How can dyskinesia for PD be managed?

A
  1. Amantadine
  2. Replace with specific doses with modified-release levodopa
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25
Q

How can motor complications of levodopa be managed?

A
  1. Adjust levodopa dose
  2. Offer dopamine agonist, MAOB-i, or catechol-O-methyl transferase inhibitors as adjunct
26
Q

Sustained release form levodopa has ___ bioavailability.

A

Lower

27
Q

How can dose adjustment be made when switching between IR and CR levodopa?

A

IR to CR: increase dose
CR to IR: decrease dose

28
Q

What is the sustained release forms useful for?

A

Decrease stiffness

29
Q

What are some counselling points pertaining to sustained released levodopa?

A

Do not crush or open capsule

30
Q

List four DDI with Levodopa.

A
  1. Pyridoxine
  2. Iron
  3. Protein
  4. Dopamine antagonists
31
Q

What is the antiemetic of choice in PD?

A

Domperidone

32
Q

What are some ergot derivatives dopamine agonists?

A

Bromocriptine
Cabergoline
Pergolide

33
Q

What are some non-ergot derivatives dopamine agonists?

A
  1. Ropinirole
  2. Pramipexole
  3. Rotigotine
  4. Apomorphine
34
Q

Ropinirole is ______ by liver.

A

metabolised

35
Q

Dose adjustment is needed for ____ impaired patients for Pramipexole.

A

Renal (excreted unchanged in urine)

36
Q

Dopamine agonists have ____ t1/2 and duration of action than levodopa.

A

longer

37
Q

What are the peripheral dopaminergic A/E of dopamine agonists?

A
  1. N/V
  2. Orthostatic hypotension
  3. Leg Oedema
38
Q

What are the central dopaminergic A/E of dopamine agonists?

A
  1. Hallucination
  2. Somnolence, day-time sleepiness
  3. Compulsive behaviors
39
Q

What are the non-dopaminergic A/E of dopamine agonists?

A
  1. Fibrosis
  2. Valvular heart disease

Pertains more for ergot derivatives

40
Q

What is the MAOi type that have central effects and is used for PD?

A

MAO-B

41
Q

List two MAOi medications used for PD.

A

Selegiline
Rasagiline

42
Q

Why does selegiline and rasagiline have long duration of action?

A

Irreversible enzymes inhibitors

43
Q

MAOB inhibitors are useful in _____ stages of PD as monotherapy.

A

Early

44
Q

Which of the MAOB inhibitors is metabolized to amphetamines that are stimulating?

A

Selegiline

45
Q

List 7 DDI associated with MAOB-inhibitors?

A
  1. SSRIs, SNRIs, TCAs
  2. Pethidine, tramadol
  3. Linezolid
  4. Dextromethorphan
  5. Dopamine
  6. Sympathomimetics
  7. MAOi
46
Q

What is the most important DFI associated with MAOi?

A

Food containing tyramine . e.g. cheese or fermented products

47
Q

What are two examples of COMT?

A
  1. Entacapone
  2. Tolcapone
48
Q

COMT must be given with ______.

A

Levodopa

49
Q

What are the DDI associated with Entacapone?

A
  1. Iron. Ca2+
  2. Concurrent nonselective MAOi (but safe with MAO- Bi, caution with selective MAO-Ai)
  3. Catecholamine drug
  4. Enhance anticoagulant effect of warfarin
50
Q

List 2 side effects of entacapone.

A

Diarrhoea, urine discolouration (orange)

51
Q

Which special population should use entacapone with caution?

A

Hepatic impairment

52
Q

______ may occur when entacapone is initiated.

A

Dyskinesia

53
Q

What is the main purpose of anticholinergic in PD?

A

Tremor control

54
Q

What is the use of amantadine?

A

NMDA anatagonist –> prevent glutamate from binding to NMDA receptor and subsequent cell death

55
Q

What drug should not be given with amanadine?

A

Memantine

56
Q

Which group should use amatadine with caution?

A

Renal impaired

57
Q

NMDA antagonists can be _____.

A

stimulating

58
Q

What are the six adverse effects of NMDA antagonists?

A

Nausea, light-headedness, insomnia, confusion, hallucinations, livedo reticularis

59
Q

Describe drug-induced parkinsonism.

A
  1. Bilateral and reversible symptoms
  2. Acute/ subacute onset
  3. Uncommon to have rest tremors
  4. Will have normal uptake of presynaptic markers and reduced uptake of dopamine receptor ligands
60
Q

List 5 drugs that can cause drug induced parkisonism.

A

Dopamine D2 receptor blockers
Dopamine depletes
Calcium channel antagonists
Atypical antipsychotics
Antiepileptic

61
Q

What is the management of drug-induced parkinsonism?

A
  1. Anticholinergics
  2. Amantadine

PR3153 (16 decks)

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