levodopa for parkinson's/seizure stuff - Flashcards
What is the most effective drug for Parkinson’s disease (PD)?
Levodopa/Carbidopa
What is the “wearing-off” effect in PD treatment?
A gradual loss of medication effectiveness before the next dose is due.
What should be questioned if a patient receives dopamine but shows no response?
Whether the patient truly has Parkinson’s disease.
What are the adverse effects of Levodopa/Carbidopa?
Nausea, vomiting, drowsiness (dose-dependent).
How does Pyridoxine (Vitamin B6) affect Levodopa?
It converts levodopa to dopamine.
Should patients change their Vitamin B6 intake while taking Levodopa?
No, they should maintain a consistent intake.
Why should protein intake be spaced out with Levodopa?
Protein can block the absorption of Carbidopa.
What is Carbidopa’s role in Levodopa therapy?
It prevents the breakdown of dopamine so it remains in the system longer.
What are signs of dyskinesias caused by Levodopa?
Head bobbing, tics, grimacing, tremors.
What cardiovascular effects can Levodopa cause?
Beta-1 stimulation leading to tachycardia, palpitations, and irregular heart rate.
What psychiatric effects can Levodopa cause?
Visual hallucinations, nightmares, paranoid ideation (psychosis).
What is a unique discoloration side effect of Levodopa?
Darkening of sweat and urine.
What skin condition must be assessed before prescribing Levodopa?
Malignant melanoma history.
What impulse control issues can Levodopa cause?
Gambling, binge eating, hypersexuality, alcohol abuse.
How can nausea/vomiting from Levodopa be managed?
Take with a small, non-protein snack.
Why should Levodopa not be discontinued abruptly?
Risk of severe withdrawal effects and worsening symptoms.
What serious sleep-related adverse effect can dopamine agonists cause?
Sudden sleep attacks.
What are other adverse effects of dopamine agonists?
Daytime drowsiness, orthostatic hypotension, psychosis, impulse control issues, dyskinesias, nausea.
What adverse effect is unique to Selegiline?
Insomnia.
What foods should be avoided with MAO-B inhibitors?
Tyramine-rich foods: avocados, soybeans, figs, smoked meats, dried/cured fish, cheese, yeast products, beer, red wine, chocolate, caffeine.
What are anticholinergic (atropine-like) effects?
Blurred vision, mydriasis, urinary retention, dry mouth, constipation.
What antihistamine effects do anticholinergics have?
Sedation, drowsiness.
What skin discoloration is caused by Amantadine?
Livedo reticularis (mottled skin discoloration, cosmetic only).
What GI effects do COMT inhibitors cause?
Vomiting, diarrhea, constipation.
What is a notable discoloration side effect of COMT inhibitors?
Yellow-orange urine.
What serious adverse effect can COMT inhibitors cause?
Rhabdomyolysis (muscle pain, tendon weakness) and liver failure.
What is Alzheimer’s disease?
A chronic, progressive neurodegenerative disorder characterized by irreversible cerebral impairment.
What is the life expectancy of Alzheimer’s disease?
4-8 years (can last up to 10 years).
What neurotransmitter is decreased in Alzheimer’s?
Acetylcholine (ACh).
What are the hallmark features of Alzheimer’s pathology?
Neurofibrillary tangles, senile plaques, neuronal loss, brain atrophy.
How effective are cholinesterase inhibitors?
Marginally effective (similar to losing only ½ pound on a weight loss pill in 6 months).
What are adverse effects of cholinesterase inhibitors?
Increased GI motility & secretions, diaphoresis, bradycardia, urinary urgency (cholinergic effects).
What is a cholinergic crisis?
DUMBBBELS: Diarrhea/Diaphoresis, Urination, Miosis, Bradycardia, Bronchospasm, Bronchorrhea, Emesis, Lacrimation, Salivation.
How is a cholinergic crisis managed?
Mechanical ventilation, oxygen, atropine.
What are contraindications for cholinesterase inhibitors?
Neuromuscular blockers (i.e. succinylcholine), renal/GI obstruction, seizures, PUD, asthma, bradycardia, hypotension.
What are the adverse effects of Memantine?
Dizziness, headache, confusion, constipation (better tolerated than cholinesterase inhibitors).
What is epilepsy?
A neurological disorder involving repeated seizures due to abnormal neuronal discharges.
Why should antiepileptics never be stopped abruptly?
Can cause withdrawal seizures.
What are the primary treatment goals for epilepsy?
Suppress neuron discharges and prevent abnormal focus from forming or spreading.
What therapeutic considerations are important for epilepsy?
Monitor drug levels, promote adherence, manage withdrawal, assess suicide risk.
What are other treatments for epilepsy besides medication?
Neurosurgery, vagal nerve stimulation, deep brain stimulation.
