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SUMPHARM > Parkinson - > Flashcards

Parkinson - Flashcards

1
Q

What is a progressive DZ with the following cardinal sx: Bradykinesia, Postural instability, gait disturb, resting tremor, and rigidity?

A

Parkinson’s- MEN 1mil USA, >65yo. Genetics, Pesticides, Age

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2
Q

What location of brain is depleted of this chemical in PD?

A

Substania Nigra depleted of Dopamine. DEC movement issues. INC DOPAMINE- psychosis

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3
Q

Is Dopamine inhibitory or excretory on the ACH receptor to stimulate GABA?

A

Inhibits Cholinergic. Thus if depleted in PD, Cholinergic SNS will INC.

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4
Q

What is TRAP and SOAP in PD?

A

Tremor, Rigidity, Akinesia, Postural Instability

Sleep Disturbances, Other Autonomic, Psychological

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5
Q

What is req to DX PD?

A

Bradykinesia +1. R/o Antipsychotics, Anti-emetic

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6
Q

What antipsychotics cause extrapyramidal symptoms?

A 
Methyldopa 
Valproate 
Reserpine 
Verapamil 
Risperidone
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7
Q

What are the Goals with PD meds?

A
  1. Restore Dopamine in CNS. 2. DEC ACH levels. MIN symptoms, medication SE. MAX QOL, safety and reduce fall
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8
Q

what are pitfalls of PD?

A

Currently no approach to alter Dz progression

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9
Q

This Drug is initiated 1st and will have less motor benefit w/ INC in hallucinations?

A

Levodopa or DA agonist

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10
Q

Which med is req with LEVODOPA to allow Dopamin not to be degraded in the periphery?

A

Carbidopa- inhibit LAAD enzyme, so LEVO can cross BBB to convert to Dopamine. INC DOPAMINE in brain

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11
Q

What affects Carbidopa-Levodopa PK?

A

NO PROTEIN

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12
Q

This eye condition is contraindicated in C-L?

A

Narrow angle glaucoma

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13
Q

Avoid these drugs w/ C-L

A

Antiemetics, Antipsychotics, MAOIs, Phenytoin, iron-DEC efficacy

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14
Q

What are the ADR of C-L

A
  1. GI,
  2. Postural HTN
  3. Dreams
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15
Q

What can MC occur with C-L and what is management of this ADR?

A
  1. Wearing off- loss of DA storage, depends on LEVO 2. INC Frequency, short to long acting…ADD DA agonist, MAO, COMT inhibitors
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16
Q

What is cause if Pt experience delayed or no response?

A

GI Absorption. Give on empty stomach, crush tablet

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17
Q

What meds selective activate dopamine receptors?

A

DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine

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18
Q

Which med is req. to take Trimethbenzamind 3 day prior for N/V ADE?

A

Apomorthoine- INJ

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19
Q

Rotigotine is DA that can be used for RLS, PD add on. How is it RX?

A

Transdermal Patch- slow and low.

20
Q

Where do Tolcapone and Entacapone inhibit cateholometh transferase, which will INC Dopamine?

A
  1. Tol (2)-Peripheral and CNS- 2. Enta-( enter body) COMT is another enxyme that breaks done DOPA
21
Q

Are COMT inhibitor ever given mono-therapy?

A

NO. OFten give with other DA, thus may need to lower other doses

22
Q

What does Monoamine oxidase B inhibitory do?

A

Selegline, Rasagline, block MOA-B enzymes that break down DOPA in the CNS. 1. MIN on ff phenomena 2. Prolongs LEVO

23
Q

What is drug that has rare ADR of A.fib, and should avoid, meperidine, methadone, tramadol, Dextrmethrphan, and MAOIs?

A

Selegline

24
Q

What is drug that has rare ADR of GIBs, HTN, MDD and should be avoid, St. John wart, methadone and Dextromethorphan?

A

Rasalgiline

25
Q

What is drug that has rare ADR of HTN, dreams, insomnia, falls ONLY?

A

Safinamide

26
Q

What is life threatening risk with LEVO and other MOAB?

A

Hypertensive crisis

27
Q

What are other caution with MAOB?

A

NO OTC RX. Risk of Serotonin Syndrome

28
Q

What antiviral INC Dopamine by synthesis release of Dopamine?

A

Amantadine

29
Q

What skin and LE edema reaction is R/T amantadine?

A

Livedo Reticularis- RENAL Dose Adjust

30
Q

What RX for PD controls TREMORS only?

A

Anticholinergics- Benztrophine, Trihexyphenidyl (BENZ car tremor). DEC ACH excess

31
Q

If PD pt present with confusion, dry mouth, red, urinary retention, what is management?

A

Titrate low and slowly or D/c Anitcholingeric response or Add artificial saliva add docusate stool softness

32
Q

What RX is used for PD psychosis condition if pt has hallucination and delusions?

A

pimavanserin- ADR- prolong QT, Avoid CYP3A

33
Q

Which PD RX had more improvement in motor symptoms?

A

LEVOdopa- use if motor sx affect QOL

34
Q

Which PD RX had more improvement in ADLs?

A

LEVOdopa

35
Q

Which PD RX has less motor complication for PD?

A

DA-Ropinirole, Apomorphine, Rotigotine, MOABI-Resilgine, Segeline- Use early stages where motor doesn’t impact QOL

36
Q

Which have the most ADR for PD?

A

DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine

37
Q

What should never be used for 1st line PD due to ADE?

A

DA- Bromocriptine-ergot

38
Q

What are adds on for PD when the develop dyskinesia or motor fluctuations even if on LEVODOPA?

A

DA agonist, MAOBI-geline or COMT- capone

39
Q

What is preferred PD initially?

A

**Rasalgiline

40
Q

John is 66yo w/PD he is on Rasagiline, but needs conrol for tremors, what is considered?

A

Amantadine

41
Q

John is 56yo w/PD he is on Rasagiline, but needs control for tremors, what is considered?

A

Benztrophine, Trihexyphenidyl (Anit ACH) or Amantadine

42
Q

If further control is need for both for tremor, bradykinesia, rigidity, what is used?

A

Amantadine,
DA agonist,
Carb/ldopa

43
Q

Mr. Hyde c/o slow movement often at beginning of dose?

A

Delayed on response fluctuations.

44
Q

Mr. Jekyll c/o slow movement 4hrs later post taking meds? How is managed?

A

Wearing off. MAINTAIN Adjust interval of carbibdop/levo (*opa, met, ary)ADD MAOB, or COMT or DA. OR

45
Q

What is profound unpredictable return of PD sx unrelated to dosing intervals?

A

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

46
Q

Which has the most ADE?

A

COMT-capones

47
Q

Which PD has the most hallucinations and OFF time reduction?

A

DA-pramipexole, ropinirole

SUMPHARM (26 decks)

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