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PHRM 845 > L43 PD pharmacotherapy > Flashcards

L43 PD pharmacotherapy Flashcards

1
Q

clinical presentation of PD (4 things)

A

tremor
bradykinesia
rigidity
parkinson gait

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2
Q

non-motor sxs of PD (7 but idk how important they are)

A

anxiety/depression
constipation
dementia
insomnia
orthostatic htn
psychosis/delirium
sexual dysfxn

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3
Q

what does a high UPDRS score mean?

A

worse PD sxs

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4
Q

Non-pharm therapy and when is it important?

A

exercise/PT
Nutritional counseling
Occupational therapy
psycotherapy/support groups
speech therapy

its important early after diagnosis

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5
Q

what is recommended before pharmacologic options?

A

physical therapy

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6
Q

1st line pharm therapy- initial tx

A

rule out drug induced PD *
dopamine precursor
dopamine agonist
MAO-B i

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7
Q

2nd line pharm therapy-initial tx

A

COMT i
Amantadine

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8
Q

what drug class has a risk of potentiating PD?

A

dopamine precursors (L-DOPA)

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9
Q

meds that can induce PD

A

antipsychotics/antiemetics and promethazine (which is an antiemetic)

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10
Q

what is the typical first medication

A

L-DOPA, a dopamine precursor

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11
Q

if someone is younger than 60 what could you consider giving first?

A

dopamine agonist

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12
Q

when should you avoid dopamine agonists as initial tx? (6 things)

A

age >70
history of ICD
cognitive impairment
excessive daytime sleepiness
Hallucinations

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13
Q

T or F: in general you start with CR opposed to IR

A

False, start immediate release

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14
Q

order of efficacy for motor symptoms between drug classes **

A

levodopa/carbidopa > DA> MAOB-i

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15
Q

what is the starting dose for CD/LD?

A

25/100 mg po bid-tid with meals

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16
Q

side effects of LD/CD

A

LD motor fluctuations/dyskinesias **

N/V

hallucinations

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17
Q

LD motor fluctuations:
wearing off, what it means and what do you do

A

sxs come back because meds are wearing off, shorten intervals or give a higher dose *

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18
Q

LD motor fluctuations:
Freezing

A

inability to move bc fluctuating or inefficient dopamine levels

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19
Q

LD motor fluctuations: delayed onset, what is it and what do you do?

A

therapeutic benefits are delayed, typically a morning problem, controlled release if pt doesnt have an IR

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20
Q

LD motor fluctuations:
Peak dose dyskinesias, what is it and how is it caused

A

involuntary body movement. caused by high DA levels (duh)

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21
Q

non-ergot Dopamine Agonists (4)

A

Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neuropro)
Apomorphine (Apokyn)

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22
Q

ergot dopamine agonists (2)

A

Bromocriptine (Parlodel)
Cabergoline (Dostinex)

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23
Q

T or F: You typically use non-ergot

A

True

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24
Q

T or F: DA are first line for initial PD therapy

A

true

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25
Q

why are ergots rarely used?

A

toxicity

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26
Q

advantages of dopamine agonists (2) **

A
  • fewer motor fluctuations.
  • long-acting formulations
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27
Q

3 MAO-B inhibitors

A

Rasagiline (Azilect)
Selegiline (Eldepryl)
Safinamide (Xadago)

28
Q

T or F: MAO-Bi’s are more effective than DA at controlling motor sxs

A

false

29
Q

starting dose rasagiline

A

0.5mg po qd

30
Q

starting dose selegiline

A

5 mg po bid

31
Q

starting dose safinamide

A

50 mg po qd

32
Q

MAO-Bi’s have a dietary restriction, what is it?

A

tyramine-rich foods

33
Q

Which of the following MAO-B’s has insomnia as a side effect?
A. Rasagiline (Azilect)
B. Selegiline (Eldepryl)
C. Safinamide (Xadago)

A

B. Selegiline (Eldepryl)

34
Q

MAO-Bi’s are first line for what and second line for what

A

first line-> mild sxs
second line-> adjunct therapy

35
Q

T or F: MAO-Bi’s have a risk of serotonin syndrome

A

True

36
Q

what drug class minimizes the breakdown of dopamine?

A

COMT inhibitors

37
Q

what drug causes orange/brown urine discoloration? what class is it in?

A

Entacapone, COMT-i

38
Q

3 COMT inhibitors

A

Entacapone (Comtan)
Opicapone (Ongentys)
Tolcapone (Tasmar)

39
Q

starting dose entacapone

A

200 mg po with each CD/LD dose

40
Q

starting dose tolcapone

A

100 mg po tid

41
Q

starting dose opicapone

A

50 mg po qhs

42
Q

amantadine (symmertrel) place in therapy

A

management of LD motor fluctuations

43
Q

side effects of amantadine (symmetrel) (3 things)

A

insomnia
confusion/hallucinations
livedo reticularis ?

44
Q

starting dose amantadine (symmetrel)

A

100 mg po bid

45
Q

T or F: Amantadine (symmetrel) is hepatically excreted

A

False, renally

46
Q

2 anticholinergics

A

benztropine (cogentin)
Trihexyphenidyl (artane)

47
Q

place in therapy of anticholinergics

A

management of tremor-dominant symptom pts that are UNDER 65 yo *

48
Q

starting dose of benztropine (cogentin)

A

0.5 mg po qhs

48
Q

Starting dose trihexyphenidyl

A

1 mg po qd

48
Q

why is use of anticholinergics limited?

A

confusion and antimuscarinic effects

49
Q

when should you avoid anticholinergics

A

> 65 yo

50
Q

5 side effects of anticholinergics

A

confusion/dementia
blurry vision
urinary retention
dry mouth
constipation

51
Q

monitoring for drug tx of PD (3 things)

A

evaluate motor sxs
assess for side effects related to drugs
identify meds that can worsen PD

52
Q

what meds can worsen PD?

A

DA, antipsychotics, metoclopramide

53
Q

effect of taking dopamine precursor without food

A

increased absorption

54
Q

effect of taking dopamine precursor with food

A

decrease in nausea

55
Q

Management of LD Motor Fluctuations:
wearing off (3 things)

A
  • increase CD/LD dose or frequency
  • add DA agonist, MAOi, or COMTi
  • XR CD/LD
56
Q

Management of LD Motor Fluctuations:
Freezing (3 things)

A
  • increase CD/LD dose or frequency
  • add DA agonist, (apomorphine)
  • Add ODT CD/LD
57
Q

Management of LD Motor Fluctuations:
Delayed onset (3 things)

A
  • take CD/LD on empty stomach (increases absorption)
  • ODT CD/LD
  • Avoid CR/XR CD/LD *
58
Q

Management of LD Motor Fluctuations:
Peak-dose dyskinesias (2 things)

A
  • add amantadine *
  • decrease dose of DA or CD/LD
59
Q

what is deep brain stimulation?

A

elective surgical procedure offered after maximizing drug tx

60
Q

risks of deep brain stimulation

A
  • infections
  • device malfunction
  • headache
  • tingling of face or limbs
  • cost
61
Q

what drug class do you want to avoid with insomnia

A

benzos (diazepam, lorazepam, oxazepam) **

62
Q

what drug class do you avoid with anxiety?

A

benzos (diazepam, lorazepam, oxazepam) **
and caution with tricyclic antidepressants

63
Q

what drug classes do you avoid in dementia (4)

A

anticholinergics, benzos, antihistamines, sedatives *

64
Q

what drugs do you avoid in psychosis/delirium? (4)

A

haloperidol
olanzapine
paliperidone
risperidone

65
Q
A

PHRM 845 (34 decks)

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