Neurologic Conditions: Parkinson Disease

Question 1

Parkinsons TRAP major symptoms

Answer 1

T = Tremor
R = rigidity in legs, arms, trunk and face
A = Akinesia/bradykinesia = lack of/slow start in movement
P = postural instability = imbalance, falls

Question 2

“off time”

Answer 2

when symptoms worsen before next dose of medication is due

Question 3

Carbidopa-Levodopa

Answer 3

Sinment

Levodopa = prodrug of dopamine
Carbidopa prevents metabolism in peripheral CNS

Question 4

Carbidopa-Levodopa (Sinmet) dosing

Answer 4

titrate slowly

IR: start TID
ER: start BID

ER tab can be cut in 1/2

dont stop abruptly, have to taper

Question 5

Carbidopa-Levodopa (Sinmet) contraindications

Answer 5

Non-selective MAOi within 14 days

Question 6

Carbidopa-Levodopa (Sinmet) side effects

Answer 6

nausea
dizziness
Orthostasis
dyskinesias
hallucinations
psychosis
can cause brown/black/dark discoloring of urine/saliva/sweat
unusual sexual urges
priapism

Question 7

COMT inhibitors

Answer 7

Entacapone = Comtan
Entacapone + carbo/levo = Stalevo
Opicapone = Ongentys
Tolcapone = Tasmar = rarely used due to hepatotoxicity

Question 8

COMT inhibits side effects & notes

Answer 8

SE = similar to Levodopa

when giving COMTi, dec levodopa dose by 10-30%

Question 9

Dopamine agonists

Answer 9

Pramipexole = Mirapex
Ropinirole = Requip
Rotigotine = Neupro = patch

Question 10

Dopamine agonist warnings

Answer 10

Somnolence = sudden daytime sleep attacks, orthostasis, hallucinations, dyskinesias

postural deformity/rhambdo w/ Pramipexole

Question 11

Dopamine agonist side effects

Answer 11

Dizziness
nausea
vomiting
dry mouth
peripheral edema
constipation

Question 12

Rotigotine (Neupro) patch notes

Answer 12

replace same time each day.
rotate sites, dont use same site for atleast 14 days
remove before MRI

Question 13

Dopamine agonist used as “rescue” for “off” moments

Answer 13

Apomorphine

Question 14

Apomorphine contraindications

Answer 14

dont use with 5-HT3 antagonist (ondansetron) due to severe hypertension and loss of consciousness

Question 15

Apomorphine side effects

Answer 15

Severe nausea
vomiting
hypotension
QT prolong

Question 16

Apomorphine emesis prevention

Answer 16

give trimethobenzamide (Tigan) 300mg TID started 3 days prior to dose

Question 17

Amantadine MOA

Answer 17

blocks dopamine reuptake into presynaptic neurons and increases dopamine release from presynaptic fibers

primarily used to treat dyskinesias associated with peak-dose of carbo/levo

Question 18

Amantadine warnings

Answer 18

Somnolence, psychosis

Question 19

Amantadine side effects

Answer 19

dizziness
orthostatic hypotension
syncope
insomnia
abnormal dreams
dry mouth
livedo reticularis

Question 20

Selective MAO-B inhibitor MOA

Answer 20

MAO-b inhibitors

block breakdown of dopamine which increases dopaminergic activity
primarily used as adjunctive txm to carbidopa/levodopa

Question 21

Selective MAO-B inhibitors

Answer 21

Selegiline
Rasagiline
Safinamide

Question 22

MAO-B inhibitor Contraindications

Answer 22

use in combo w/ other MAOi, opioids, SNRIs, TCAs

Question 23

MAO-B inhibitor warnings

Answer 23

serotonin syndrome
hypertension
nausea
CNS depression

Question 24

Centrally acting anticholinergics

Answer 24

Benztropine = Cogentin
Trihexyphenidyl

Primarily used for tremor

Question 25

Benztropine (Congetin) side effects

Answer 25

high incidence of peripheral/central antichlingeric effects = dry mouth, constipation, urinary retention, blurred vision, mydriasis, somnolence, confusion, tachycardia

Question 26

Med used for neurogenic orthostatic hypotension

Answer 26

Droxidopa (Northerna)

Question 27

Droxidopa (Northera) side effects

Answer 27

syncope
falls
headache