Parkinson - Flashcards
What is a progressive DZ with the following cardinal sx: Bradykinesia, Postural instability, gait disturb, resting tremor, and rigidity?
Parkinson’s- MEN 1mil USA, >65yo. Genetics, Pesticides, Age
What location of brain is depleted of this chemical in PD?
Substania Nigra depleted of Dopamine. DEC movement issues. INC DOPAMINE- psychosis
Is Dopamine inhibitory or excretory on the ACH receptor to stimulate GABA?
Inhibits Cholinergic. Thus if depleted in PD, Cholinergic SNS will INC.
What is TRAP and SOAP in PD?
Tremor, Rigidity, Akinesia, Postural Instability
Sleep Disturbances, Other Autonomic, Psychological
What is req to DX PD?
Bradykinesia +1. R/o Antipsychotics, Anti-emetic
What antipsychotics cause extrapyramidal symptoms?
Methyldopa Valproate Reserpine Verapamil Risperidone
What are the Goals with PD meds?
- Restore Dopamine in CNS. 2. DEC ACH levels. MIN symptoms, medication SE. MAX QOL, safety and reduce fall
what are pitfalls of PD?
Currently no approach to alter Dz progression
This Drug is initiated 1st and will have less motor benefit w/ INC in hallucinations?
Levodopa or DA agonist
Which med is req with LEVODOPA to allow Dopamin not to be degraded in the periphery?
Carbidopa- inhibit LAAD enzyme, so LEVO can cross BBB to convert to Dopamine. INC DOPAMINE in brain
What affects Carbidopa-Levodopa PK?
NO PROTEIN
This eye condition is contraindicated in C-L?
Narrow angle glaucoma
Avoid these drugs w/ C-L
Antiemetics, Antipsychotics, MAOIs, Phenytoin, iron-DEC efficacy
What are the ADR of C-L
- GI,
- Postural HTN
- Dreams
What can MC occur with C-L and what is management of this ADR?
- Wearing off- loss of DA storage, depends on LEVO 2. INC Frequency, short to long acting…ADD DA agonist, MAO, COMT inhibitors
What is cause if Pt experience delayed or no response?
GI Absorption. Give on empty stomach, crush tablet
What meds selective activate dopamine receptors?
DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine
Which med is req. to take Trimethbenzamind 3 day prior for N/V ADE?
Apomorthoine- INJ
Rotigotine is DA that can be used for RLS, PD add on. How is it RX?
Transdermal Patch- slow and low.
Where do Tolcapone and Entacapone inhibit cateholometh transferase, which will INC Dopamine?
- Tol (2)-Peripheral and CNS- 2. Enta-( enter body) COMT is another enxyme that breaks done DOPA
Are COMT inhibitor ever given mono-therapy?
NO. OFten give with other DA, thus may need to lower other doses
What does Monoamine oxidase B inhibitory do?
Selegline, Rasagline, block MOA-B enzymes that break down DOPA in the CNS. 1. MIN on ff phenomena 2. Prolongs LEVO
What is drug that has rare ADR of A.fib, and should avoid, meperidine, methadone, tramadol, Dextrmethrphan, and MAOIs?
Selegline
What is drug that has rare ADR of GIBs, HTN, MDD and should be avoid, St. John wart, methadone and Dextromethorphan?
Rasalgiline
What is drug that has rare ADR of HTN, dreams, insomnia, falls ONLY?
Safinamide
What is life threatening risk with LEVO and other MOAB?
Hypertensive crisis
What are other caution with MAOB?
NO OTC RX. Risk of Serotonin Syndrome
What antiviral INC Dopamine by synthesis release of Dopamine?
Amantadine
What skin and LE edema reaction is R/T amantadine?
Livedo Reticularis- RENAL Dose Adjust
What RX for PD controls TREMORS only?
Anticholinergics- Benztrophine, Trihexyphenidyl (BENZ car tremor). DEC ACH excess
If PD pt present with confusion, dry mouth, red, urinary retention, what is management?
Titrate low and slowly or D/c Anitcholingeric response or Add artificial saliva add docusate stool softness
What RX is used for PD psychosis condition if pt has hallucination and delusions?
pimavanserin- ADR- prolong QT, Avoid CYP3A
Which PD RX had more improvement in motor symptoms?
LEVOdopa- use if motor sx affect QOL
Which PD RX had more improvement in ADLs?
LEVOdopa
Which PD RX has less motor complication for PD?
DA-Ropinirole, Apomorphine, Rotigotine, MOABI-Resilgine, Segeline- Use early stages where motor doesn’t impact QOL
Which have the most ADR for PD?
DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine
What should never be used for 1st line PD due to ADE?
DA- Bromocriptine-ergot
What are adds on for PD when the develop dyskinesia or motor fluctuations even if on LEVODOPA?
DA agonist, MAOBI-geline or COMT- capone
What is preferred PD initially?
**Rasalgiline
John is 66yo w/PD he is on Rasagiline, but needs conrol for tremors, what is considered?
Amantadine
John is 56yo w/PD he is on Rasagiline, but needs control for tremors, what is considered?
Benztrophine, Trihexyphenidyl (Anit ACH) or Amantadine
If further control is need for both for tremor, bradykinesia, rigidity, what is used?
Amantadine,
DA agonist,
Carb/ldopa
Mr. Hyde c/o slow movement often at beginning of dose?
Delayed on response fluctuations.
Mr. Jekyll c/o slow movement 4hrs later post taking meds? How is managed?
Wearing off. MAINTAIN Adjust interval of carbibdop/levo (*opa, met, ary)ADD MAOB, or COMT or DA. OR
What is profound unpredictable return of PD sx unrelated to dosing intervals?
ON-OFF phenomenon- random movement oscillations. keep extra dose while away or longer acting meds or schedule activities or space meds 2hr post meal or consider protein intake.
LAST ADD entacapone-COMT, rasalgilne-MOA, pramipexole-DA, ropinirole-DA or segline-MAOB
Which has the most ADE?
COMT-capones
Which PD has the most hallucinations and OFF time reduction?
DA-pramipexole, ropinirole
