Parkinson 1- SG Flashcards
4 features of Parkinson’s
- Resting Tremor - pill rolling
- Rigidity - cogwheel
- Bradykinesia - slow shuffling gate
- Postural Instability - no contralateral gait
Pathology of Parkinson
Dopamine deficiency
or
Acetylcholine excess
3 features of MS
- Visual compromise
- Stiffness
- Weakness (unilateral)
Pathology of MS
Autoimmune disease (affects CNS)
- Does Parkinson develop rapidly or slowly?
- It develops after age ___.
- Rarely occurs in what population?
- Gradually/slowly
- 50
- Blacks
A sporadic or familial progressive neurodegenerative disease which affects nerve cells in brain & spinal cord, results in loss of voluntary movement & muscle control
Amyotrophic Lateral Sclerosis (ALS)
Nerve disorder characterized by uncontrollable shaking or “tremors” seen in especially when you do simple tasks (drinking from glass/tying shoelaces)
Essential Tremor
- 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
Guillain-Barre
- Inherited adult-onset neurologic disease characterized by dementia and bizarre involuntary movements
Huntington’s Disease
Chronic autoimmune neuromuscular disorder characterized by fluctuating weakness of voluntary muscle groups
Myasthenia Gravis
- A disorder of the part of the nervous system which causes urge to move legs
- Associated w/ iron deficiency
Restless Leg Syndrome (RLS)
- 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
Tourette’s Syndrome
- An inherited (autosomal recessive) disorder of copper accumulation in liver, brain, kidneys, eyes
Wilson’s Disease
- Education
- Exercise
- Nutrition
- Psychosocial support
Non-pharm tx for Parkinson Disease
- Levodopa
- Levodopa-carbidopa
Dopamine precursor
(for PD)
- Bromocriptine
- Pramipexole
- Ropinirole
Dopamine Agonists
(for PD)
- Selegiline
- Rasagiline
MAOI inhibitors
(for PD)
- Entacapone
- Tolcapone
COMT inhibitors
(for PD)
- Benztropine
- Trihexyphenidyl
Muscarinic antagonists
- Initial drug for the flu, helps PD
Amantadine
- Neurosynaptic cleft
- Enhances dopamine release
- Blocks glutamatergic N methyl D
Amantadine
- ___ can cross BBB
- _____ cannot cross BBB
- Levodopa can cross BBB
- Dopamine cannot
(when levo crosses BBB it becomes dopamine)
- Treatment should be initiated for PD when?
- When the disease begins to interfere w/ activities of daily living, employment, or quality of life
Monotherapy for PD?
MAO-B inhibitors (Rasagiline/Selegiline)
(interferes w/ degredation of dopamine & results in prolonged dopamergic activity)
- 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 ____ _____.
-
Catechol-O-methyltransferase (COMT) inhibitor
- Entacapone
- Tolcapone
-
Dopamine agonist
- Bromocriptine
- Pramipexole
*
For management of L-dopa induced peak dose dyskinesias, consider addition of _______.
Amantadine (initial drug for flu)
MOA: Selective irreversible inhibition of MAO-B in the brain interferes w/ degredation of dopamine and results in prolonged dopamingergic activity
MOA-B inhibitors (Rasagiline/Selegiline)
Adverse affects of what drug?
- Nausea
- Orthostatic hypotension
- Confusion
- Insomnia
- Hallucinations
MAO-B inhibitor
(Rasagiline / Selegiline)
What does a drug interaction of MAO-B inhibitor (Rasagiline/Selegiline) w/ Meperidine and opioid analgesics result in?
Serotonin Syndrome
Sxs of what?
- Change in BP
- Rapid HR
- N/V
- Tremor
- Agitation / Restlessness
Serotonin Syndrome
T/F
- Concomitant use of serotonergic antidepressants w/ MAO-B inhibitors is NOT contraindicated
- (These drugs can be used concomitantly when clinically warranted)
True
What is the administration route of Selegiline?
- Oral
- ODT formulation (oral dissolving tablet)
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
Selegiline
Metabolism:
Which drug undergoes “first pass hepatic metabolism predominantly via cytochrome P450 (CYP450 2B6 and 2C19) to end products of methamphetamine and I-amphetamine?
Selegiline (MAO-B inhibitor)
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)
Selegiline (MAO-B inhibitor)
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
Safinamide (MAO-B inhibitor)
Which drug?
Most common adverse events:
- Dyskinesia
- Falls
- HTN
- Hallucinations
- Impulse control disorder
- Serotonin Syndrome
- *Very high tyramine containing foods*
- $30/ tablet
Safinamide (MAO-B inhibitor)
- Is found in aged cheese, meats, and beer
- If not metabolized, will lead to HTN crisis and HA
Tyramine
What is the tx of Parkinson if the main PE finding is a tremor?
Anticholinergic medication
(Increased Cholinergic activity is believed to contribute to tremor of PD)
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
Anticholinergic med for PD
(Benztropine & Trihexyphenidyl)
What meds are these?
- Benztropine
- Trihexyphenidyl
Anticholinergic meds for PD
What are the 5 adverse effects of anticholinergics?
- Hot as a hare
- Dry as a bone
- Blind as a bat
- Red as a beet
- Mad as hatter
Instead of anticholinergic, what would you give pt who is 65 or older?
Dopamine
