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Pharm 3 Shea > Parkinson 1 > Flashcards

Parkinson 1 Flashcards

1
Q

4 features of Parkinson’s

A
  • Resting Tremor - pill rolling
  • Rigidity - cogwheel
  • Bradykinesia - slow shuffling gate
  • Postural Instability - no contralateral gait
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2
Q

Pathology of Parkinson

A

Dopamine deficiency

or

Acetylcholine excess

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3
Q

3 features of MS

A
  • Visual compromise
  • Stiffness
  • Weakness (unilateral)
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4
Q

Pathology of MS

A

Autoimmune disease (affects CNS)

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5
Q
  • Does Parkinson develop rapidly or slowly?
  • It develops after age ___.
  • Rarely occurs in what population?
A
  • Gradually/slowly
  • 50
  • Blacks
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6
Q

A sporadic or familial progressive neurodegenerative disease which affects nerve cells in brain & spinal cord, results in loss of voluntary movement & muscle control

A

Amyotrophic Lateral Sclerosis (ALS)

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7
Q

Nerve disorder characterized by uncontrollable shaking or “tremors” seen in especially when you do simple tasks (drinking from glass/tying shoelaces)

A

Essential Tremor

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8
Q
  • Flu vaccine
  • A condition where the immune system attacks the nerves w/ sxs of weakness & tingling in the fet and legs ascending to upper body.
  • Paralysis can occur
A

Guillain-Barre

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9
Q
  • Inherited adult-onset neurologic disease characterized by dementia and bizarre involuntary movements
A

Huntington’s Disease

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10
Q

Chronic autoimmune neuromuscular disorder characterized by fluctuating weakness of voluntary muscle groups

A

Myasthenia Gravis

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11
Q
  • A disorder of the part of the nervous system which causes urge to move legs
  • Associated w/ iron deficiency
A

Restless Leg Syndrome (RLS)

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12
Q
  • Disorder w/ repetitive movements or unwanted sounds (tics) that can’t be easily controlled
  • Etiology is unknown, but likely combo of inherited/genetic & environmental factors
A

Tourette’s Syndrome

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13
Q
  • An inherited (autosomal recessive) disorder of copper accumulation in liver, brain, kidneys, eyes
A

Wilson’s Disease

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14
Q
  • Education
  • Exercise
  • Nutrition
  • Psychosocial support
A

Non-pharm tx for Parkinson Disease

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15
Q
  • Levodopa
  • Levodopa-carbidopa
A

Dopamine precursor

(for PD)

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16
Q
  • Bromocriptine
  • Pramipexole
  • Ropinirole
A

Dopamine Agonists

(for PD)

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17
Q
  • Selegiline
  • Rasagiline
A

MAOI inhibitors

(for PD)

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18
Q
  • Entacapone
  • Tolcapone
A

COMT inhibitors

(for PD)

19
Q
  • Benztropine
  • Trihexyphenidyl
A

Muscarinic antagonists

20
Q
  • Initial drug for the flu, helps PD
A

Amantadine

21
Q
  • Neurosynaptic cleft
  • Enhances dopamine release
  • Blocks glutamatergic N methyl D
A

Amantadine

22
Q
  • ___ can cross BBB
  • _____ cannot cross BBB
A
  • Levodopa can cross BBB
  • Dopamine cannot

(when levo crosses BBB it becomes dopamine)

23
Q
  • Treatment should be initiated for PD when?
A
  • When the disease begins to interfere w/ activities of daily living, employment, or quality of life
24
Q

Monotherapy for PD?

A

MAO-B inhibitors (Rasagiline/Selegiline)

(interferes w/ degredation of dopamine & results in prolonged dopamergic activity)

25
Q
  • W/ tx of PD, MAO-B inhibitor along w/ addition of ______ should be considered if motor fluctuations develop to extend duration of activity of L-dopa (levodopa)
  • Alternatively consider addition of an MAO-B inhibitor or ____ _____.
A
  • Catechol-O-methyltransferase (COMT) inhibitor
    • Entacapone
    • Tolcapone
  • Dopamine agonist
    • Bromocriptine
    • Pramipexole
      *
26
Q

For management of L-dopa induced peak dose dyskinesias, consider addition of _______.

A

Amantadine (initial drug for flu)

27
Q

MOA: Selective irreversible inhibition of MAO-B in the brain interferes w/ degredation of dopamine and results in prolonged dopamingergic activity

A

MOA-B inhibitors (Rasagiline/Selegiline)

28
Q

Adverse affects of what drug?

  • Nausea
  • Orthostatic hypotension
  • Confusion
  • Insomnia
  • Hallucinations
A

MAO-B inhibitor

(Rasagiline / Selegiline)

29
Q

What does a drug interaction of MAO-B inhibitor (Rasagiline/Selegiline) w/ Meperidine and opioid analgesics result in?

A

Serotonin Syndrome

30
Q

Sxs of what?

  • Change in BP
  • Rapid HR
  • N/V
  • Tremor
  • Agitation / Restlessness
A

Serotonin Syndrome

31
Q

T/F

  • Concomitant use of serotonergic antidepressants w/ MAO-B inhibitors is NOT contraindicated
  • (These drugs can be used concomitantly when clinically warranted)
A

True

32
Q

What is the administration route of Selegiline?

A
  • Oral
  • ODT formulation (oral dissolving tablet)
33
Q

Which drug?

  • Provides “modest” improvement in motor function
  • In advanced PD, adjunctive use of selegiline can provide 1 hour of extra “on time” for pts w/ wearing off
  • (off time = can’t move)
  • Inconsistent results bc of erratic bioavailability
A

Selegiline

34
Q

Metabolism:

Which drug undergoes “first pass hepatic metabolism predominantly via cytochrome P450 (CYP450 2B6 and 2C19) to end products of methamphetamine and I-amphetamine?

A

Selegiline (MAO-B inhibitor)

35
Q

Which drug?

  • Agitation
  • Insomnia (esp if admin at bedtime)
  • Hallucinations
  • Orthostatic hypotension
  • Increases the peak effects of l-dopa and can worsen pre-existing dyskinesia or psych sxs (delusions)
A

Selegiline (MAO-B inhibitor)

36
Q

Which drug?

  • Indicated for Parkinson “off” episodes
  • MOA: selective, reversible monoamine oxidase type B (MAO-B) inhibitor approved as adjunctive tx w/ levodopa/carbidopa (w or w/o agents)
  • Modestly increases mean daily “on” time w/o troublesome dyskinesia
A

Safinamide (MAO-B inhibitor)

37
Q

Which drug?

Most common adverse events:

  • Dyskinesia
  • Falls
  • HTN
  • Hallucinations
  • Impulse control disorder
  • Serotonin Syndrome
  • *Very high tyramine containing foods*
  • $30/ tablet
A

Safinamide (MAO-B inhibitor)

38
Q
  • Is found in aged cheese, meats, and beer
  • If not metabolized, will lead to HTN crisis and HA
A

Tyramine

39
Q

What is the tx of Parkinson if the main PE finding is a tremor?

A

Anticholinergic medication

(Increased Cholinergic activity is believed to contribute to tremor of PD)

40
Q

Which med?

  • Useful for mild tremor-predominant PD
  • Most useful as monotherapy in pts <65yrs
  • DO NOT have significant bradykinesia or gait disturbance
  • “add on” in more advanced PD
  • Caution in elderly / pre-existing cognitive difficulties
A

Anticholinergic med for PD

(Benztropine & Trihexyphenidyl)

41
Q

What meds are these?

  • Benztropine
  • Trihexyphenidyl
A

Anticholinergic meds for PD

42
Q

What are the 5 adverse effects of anticholinergics?

A
  • Hot as a hare
  • Dry as a bone
  • Blind as a bat
  • Red as a beet
  • Mad as hatter
43
Q

Instead of anticholinergic, what would you give pt who is 65 or older?

A

Dopamine

Pharm 3 Shea (17 decks)

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