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Pharm 3 Shea > Parkinson 2 > Flashcards

Parkinson 2 Flashcards

1
Q

What is the precursor of Dopamine?

A

Levodopa/Carbidopa/L-dopa

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2
Q
  • What is the best tx of a pt who is 65 yrs or older?
  • Is useful if tremor is not controlled by an anticholinergic
  • Most effective drug for symptomatic tx of PD
A

Levodopa / Carbidopa

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3
Q

Ultimately all pts w/ PD will require what med?

A

Levodopa / Carbidopa / l-dopa

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4
Q

Why is Carbidopa added to Levodopa?

A

It prevents the breakdown of Levodopa

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5
Q

Carbidopa inhibits peripheral metabolism of Levodopa via ___ ______.

A

Dopa decarboxylase

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6
Q

Ultimately leads to an increase in the fraction of the dose that reaches the brain.

A

Role of adding Carbidopa to Levodopa (prevents breakdown of Levodopa)

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7
Q

What 2 drugs interact w/ Levodopa/Carbidopa resulting in:

  • diminished doses
  • prolonged action

What would pt experience w/ this interaction?

A

COMT (peripheral & brain, prevent dopamine degredation)

MAO B inhibitors

Excess dopamine (hallucinations/schizophrenia) and EPS - extra priamital ability

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8
Q

Adverse effects of what drug?

  • Drowsiness
  • Dyskinesias
  • **Motor Complications**
A

Levodopa / Carbidopa

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9
Q

MOA of what drug?

  • Blocks the conversion of L-dopa into the inactive form of 3-O-Methyldopa (3-OMD)
  • Prevents conversion of Dopamine to 3-methoxtyramine (3-MT)
  • Provides greater % of l-dopa to cross BBB & Dopamine in brain
A

COMT inhibitor

(Entacapone & Tolcapone)

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10
Q

Which drug?

  • Attenuate motor fluctuations in carbidopa/l-dopa treated pts
  • Modest symptomatic benefit as monotherapy
  • Benefit may be from neuroprotective effect
  • NO benefit as a monotherapy as it may not get more levodopa into the brain
A

COMT inhibitors (catechol-O-methyl-transferase)

(Entacapone & Tolcapone)

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11
Q

Adverse effects of which drug?

  • Relates to increased levels of L-dopa
  • Dyskinesias
  • Confusion
  • Liver toxicity *
  • Orthostatic hypotension
A

COMT inhibitors

(Entacapone & Tolcapone)

Tolcapone specifically toxic to liver**

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12
Q

Which drug has these drug interactions?

  • L-dopa reduces dose
  • Antidiarrheals reduce dose
A

COMT inhibitors

(Entacapone & Tolcapone)

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13
Q

What should you monitor in a patient taking COMT inhibitors (Entacapone & Tolcapone)?

A

LFTs

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14
Q

Which drug?

  • MOA: stimulates dopamine activity on the nerves in the subtantia nigra and striatum
  • Pramipexole is the “prototype”
  • Causes doing things in excess like spending money / gambling
A

Dopamine Agonists

(Amantadine)

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15
Q

Adverse Effects of which drug?

  • **Postural hypotension**
  • Pulmonary fibrosis
  • Confusion
  • Hallucinations
  • Sedation
  • Vivid dreaming
  • **Impulsive Behaviors**

(Underlined = Psychosis)

A

Dopamine Agonists

(Amantadine)

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16
Q

When should you consider giving pt Amantadine?

A

If pt is older and doesn’t want to go on l-dopa

17
Q

Which drug?

  • Enhances dopamine release
  • Blocks glutamatergic N-methyl-D-aspartate (NMDA) receptors
A

Amantadine (Dopamine Agonist)

18
Q

What 3 things does Amantadine (Dopamine Agonist) improve in PD pts?

A
  • Tremors
  • Rigidity
  • Bradykinesia
19
Q

Adverse effects of which drug?

  • Dizziness
  • Dry mouth
  • Hallucinations
  • Livedo reticularis
A

Amantadine (dopamine agonist)

20
Q
  • Which drug has adverse reactions similar to anticholinergics?
  • What are the 5 effects?
A

Amantadine (dopamine agonist)

  • Mad as a hatter
  • Blind as a bat
  • Dry as a bone
  • Red as a beet
  • Hot as a hair
21
Q
  • What drug provides “symptomatic benefit,”
  • but less than that of dopamine agonists or carbidopa/l-dopa
  • Useful add-on agent to attenuate dyskinesias
A

Amantadine

22
Q
  • An aporphine alkaloid originally derived from morphine, but lacks narcotic properties
  • Bc of poor oral bioavailability due to extensive hepatic 1st pass metabolism
  • Is administered subcutaneously
  • Indicated for pts w/ advanced PD who are experiencing intermittent off episodes despite optimized therapy
A

Apomorphine

23
Q
  • Upon subcutaneous administration, apomorphine produces an “on” response within ___ minutes.
  • Sites of injection (abd, UE, upper thigh) should be rotated to avoid development of ____ ____.
  • Apomorphine elimination half life is approximately ___ minutes and duration of benefit can be up to ____ minutes.
A
  • 20 mins
  • Subcutaneous nodules
  • 40 minutes
  • 100 minutes
24
Q

What should patients be “premedicated” w/ before receiving Apomorphine?

A

Trimethobenzamide

(antiemetic)

25
Q

If drug overdose, give what med? Which causes nausea and vomiting.

A

Apomorphine

26
Q

Tx of what effect?

  • Increase frequency of carbidopa/L-dopa doses
  • Add either COMT inhibitor or MAO-B inhibitor or dopamine agonist
A

End-of-dose “wearing off”

(motor fluctuation)

27
Q

Tx of what effect?

  • Give carbidopa / L-dopa on empty stomach
  • Use carbidopa/L-dopa ODT
  • Avoid carbidopa/L-dopa CR (long acting)
  • Use apomorphine subcutaneous
A

“Delayed on”

“no on” response

28
Q

Tx of what effect?

  • Increase carbidopa/L-dopa dose
  • Add a dopamine agonist or MAO-B inhibitor
  • Utilize physical therapy along w/ assistive walking devices or sensory cues
  • (rhythmic commands, stepping over objects)
A

Start hesistation (freezing)

29
Q

Tx of what effect?

  • Provide smaller doses of carbidopa/L-dopa
  • Add amantadine
A

Peak-dose dyskinesia

30
Q

A form of carbidopa / levodopa delivered in gel form, called enteral suspension

A

Duopa

31
Q
  • Used to treat the motor sxs of PD
  • Surgical placement of enteral tube in stomach wall to place a tube in your intestine
  • Pump then delivers ____ directly to the intestine
A

Duopa

32
Q

Duopa uses the same active ingredients as orally administered ____ _____, but is designed to improve absorption and reduce off times by delivering the drug directly to the small intestine.

A

Carbidopa / Levodopa

33
Q

What drug do you give on empty stomach?

A

L-lopa/Carbidopa

34
Q

Surgery should be considered an adjunct to pharmacotherapy when pts are experiencing _____ or ______ or ______ despite an optimized medical regimen.

A
  • frequent motor fluctuations
  • disabling dyskinesia
  • tremor
35
Q

____ DBS (Deep Brain Stimulation) is very effective for suppressing tremor specifically ___ tremor, but it does not significantly improve the other parkinsonian features (bradykinesia, rigidity, motor functions, or dyskinesias)

A
  • Thalamic
  • arm
36
Q

Both ____ and ____ are associated w/ improvements in tremor, rigidity, bradykinesia, motor fluctuations, dyskinesia, and activities of daily living, however, _____ allows for greater reduction in medications.

A
  • STN and GPi DBS
  • STN DBS
37
Q

As with pharmacotherapy, DBS uncommonly improves ____ or _____.

A

Gait or postural instability

38
Q
  • Excess dopamine results in ______ sxs
  • When we tx _____, it looks like Parkinsons
A
  • schizophrenia

Pharm 3 Shea (17 decks)

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