Medical Management - Parkinson's

Question 1

medical management

Answer 1

primary importance in PD

Question 2

PD is

Answer 2

dynamic dz

not a static presentation

Question 3

what must we do w/ medical management

Answer 3

must constantly re-evaluate and change dosing and timing of meds

as the sxs change and the dx progresses

Question 4

what does the pt experience w/ meds

Answer 4

changing response to meds and dz’s progression

Question 5

medical management strategies

Answer 5

block acetylcholine

replace dopamine

Question 6

block acetylcholine

Answer 6

anticholinergics

effective for tremor only

Question 7

block acetylcholine –> S/E

Answer 7

confusion

decrease memory

hallucinations

dry mouth

constipation

urinary retention

orthostasis

Question 8

replace dopamine

Answer 8

sinemet

amantadine

dopamine agonists

enzyme inhibitors

Question 9

sinemet –> replace dopamine

Answer 9

L-dopa carbidopa

Question 10

what are some sxs caused by

Answer 10

decreased dopamine

Question 11

dopamine replacement therapy aimed at

Answer 11

replacing the deficient NT

Question 12

does dopamine cross the BBB

Answer 12

no

but L-Dopa (its precursor) does

Question 13

what is L-dopa delivered w/

Answer 13

carbidopa = sinemet

Question 14

what does sinemet inhibit

Answer 14

the release of L-dopa in the peripheral tissue

Question 15

what does sinemet do

Answer 15

increases its release into the brain

decreases the amount of L-dopa needed (cutting down the side effects)

Question 16

sinemet (levadopa/carbidopa)limits

Answer 16

limits bradykinesia, rigidity and tremor

Question 17

what doesnt levadopa/carbidopa treat

Answer 17

motor planning deficits

postural instability

non-motor sxs

Question 18

what happens overtime –> levadopa/carbidopa

Answer 18

therapeutic windown gets smaller and toxic window gets bigger

Question 19

S/E levadopa/carbidopa

Answer 19

dyskinesia

dystonia

on/off motor fluctuations

Question 20

50-60% of pts on L-dopa

Answer 20

will have motor complications w/in 5 yrs

Question 21

dopamine agonists

Answer 21

bromocriptine (parlodel)

pergolide (permax)

Question 22

what happens when dopamine agonists and added to sinemet

Answer 22

decrease clinical fluctuations

Question 23

what do dopamine agonists do

Answer 23

boosts output of remaining substantia nigra cells

Question 24

neuroprotective drugs

Answer 24

MAOs

Question 25

MAOs

Answer 25

monoamine oxidase inhibitors (MAOs)

Question 26

what do MAOs control

Answer 26

neuronal degradation can be controlled w/ anti-oxidase

which controls the synthesis and elimination of free radicals

Question 27

hypothesis –> MAOs

Answer 27

in PD –> there is increased production or decrease defense against free radicals in the SN

accelerating cell death

Question 28

type of MAO

Answer 28

selegiline

Question 29

selegiline

Answer 29

inhibits the enzyme that breaks down dopamine

Question 30

what does selegiline limit

Answer 30

free radical production during dopamine metabolism

Question 31

what must selegiline rescue

Answer 31

damaged but viable dopaminergic neurons

Question 32

what may early use of selegiline do

Answer 32

decrease the need for sinemet

early in the course of the dz

Question 33

what do anticholinergic drugs do

Answer 33

restore the balance of acetylcholine and dopamine

Question 34

anticholinergic drugs

Answer 34

parsidol

cogentin

akinetin

artane

Question 35

when are anticholinergic drugs used

Answer 35

less frequently than others

Question 36

when is the use of anticholinergic drugs more useful

Answer 36

early in the dz

when tremor is the most prominent problem

Question 37

amantadine has

Answer 37

dopaminergic and anticholinergic properties

Question 38

what dos amantadine do

Answer 38

stimulates the release of dopamine

from surviving presynaptic terminals in the striatum

Question 39

what does amantine affect

Answer 39

rigidity and bradykinesia

but not tremor