Parkinson Disease Flashcards
The pharmacist is counseling a pt with Parkinson disease on the use of the rotigotine patch. Which of the following statements are appropriate to include?
a. Apply the patch every 72 hours
b. Don’t use the patch if you have RLS
c. Don’t use the same site for at least 14 days
d. Don’t use the patch if you have an allergy to sulfites
e. Remove the patch before an MRI
c, d, e
The rotigotine patch is applied once daily. It’s also approved to treat RLS.
Side effects of amantadine include:
a. Dizziness
b. Hepatic impairment
c. Severe nausea and vomiting
d. Livedo reticularis
e. Psychosis
a, d, e
Livedo reticularis - mottled purplish discoloration of the lower extremities (d/c if this occurs)
MH is a 74 y/o female with Parkinson disease. She takes Sinemet and Mirapex to help control her symptoms. Recently, MH has started experiencing visual hallucinations, and her Dr would like to start an antipsychotic. Which of the following meds would carry the lowest risk of worsening her Parkinson symptoms?
a. Risperidone
b. Haloperidol
c. Quetiapine
d. Paliperidone
e. Fluphenazine
c
-Clozapine has a low risk of movement disorders but requires frequent lab monitoring for agranulocytosis and has a risk of seizures.
-Pimavanserin (Nuplazid) is FDA-approved to treat psychosis in Parkinson disease and doesn’t worsen motor symptoms.
A pt is prescribed selegiline 5 mg PO BID for Parkinson disease tremor. All of the following statements are correct EXCEPT:
a. Selegiline is activating and shouldn’t be taken at bedtime
b. Selegiline is a selective MAO-B inhibitor
c. BP should be monitored during tx d/t the risk of HTN
d. Opioids and linezolid are contraindicated d/t the risk of serotonin syndrome
e. Selegiline works by breaking down dopamine and decreasing dopaminergic activity
e
Selegiline is a selective MAO-B inhibitor that blocks the breakdown of dopamine and increases dopaminergic activity.
A pt is using rasagiloine for early-onset Parkinson disease. The pt should be considered to avoid certain foods while using this medicine. These foods include:
a. Aged cheeses
b. Dairy products like milk and yogurt
c. Air-dried or cured meats
d. Sauerkraut
e. Grass-fed beef and pork
a, c, d
Hypertensive crisis (a dangerous rise in BP) could occur if rasagiline is combined with foods that high in tyramine. Foods can become high in tyramine when they have been aged, fermented, pickled, or smoked.
BD is a pt who’s been diagnosed with Parkinson disease. What is the cause of this condition?
a. Impairment of dopamine-producing cells in the substantia nigra of the brain
b. Impairment of serotonin-producing neurons in the spinal cord
c. Development of lewy body plaques in the part of the brain responsible for movement
d. Autoimmune dysregulation of lower motor neurons
e. The cause of Parkinson disease is unknown
a
Which of the following meds can make movement disorder worse?
a. Reglan
b. Requip XL
c. Nexium
d. Dulcolax
e. Spiriva
a
Dopamine blocking drugs that can worsen PD:
-Phenothiazines (e.g., prochlorperazine) used for psychosis, nausea, agitation
-Butyrophenones (e.g., haloperidol, droperidol) used for psychosis and behavior disorders or nausea
-1st and 2nd gen antipsychotics (e.g., risperidone at higher doses, paliperidone); lowest risk with quetiapine
-Metoclopramide, a renally-cleared drug that can accumulate in elderly pts
HPI: CH is a 70 y/o male who presents to the clinic on 9/10 for a follow up of his PD and COPD. He currently has symptoms of tremor on his right side, slow movement, and poor balance. He also complains of dry mouth. He confirms adherence with all meds noted in the order hx.
Allergies: Penicillin (swelling)
Rx Meds Order Hx:
8/10: Spiriva Respimat 18 mcg daily (3 refills)
8/10: Reglan 10 mg TID-AC and QHS (3 refills)
8/10: Requip XL 2 mg daily (0 refills)
6/10: Combivent Respimat 1 inhalation QID (6 refills)
6/10: Sinemet 10/100 mg TID (2 refills)
6/10: Toprol XL 50 mg daily (6 refills)
6/10: Zestril 10 mg daily (6 refills)
6/10: Amitriptyline 50 mg PO QHS (6 refills)
6/10: Hydrochlorothiazide 12.5 mg daily (6 refills)
6/10: Crestor 20 mg daily (6 refills)
OTC Meds:
Dulcolax 5 mg PRN constipation
Nexium 20 mg daily
PMH: COPD, GERD, HTN, MI with stenting 5 years ago, idiopathic constipation, mild memory impairment, PD
CH is still having symptoms of PD despite having starting Sinemet 3 months ago. Which of the following is true regarding his Sinemet dose?
a. The dose of Sinemet is appropriate; it can take 3-6 months to observe improvements.
b. The dose of levodopa is too low for initial tx.
c. The dose of carbidopa is too low for initial tx.
d. The dose of carbidopa is too high for initial tx and is causing side effects.
e. The dose of levodopa is too high for initial tx and is causing side effects.
c
When carbidopa/levodopa (Sinemet), the carbidopa component should be within range of 70-100 mg/day. This is important for 2 reasons: A minimum dose is required for effectiveness, and higher doses will cause nausea. Carbidopa is a decarboxylase inhibitor that prevents the peripheral breakdown of levodopa (the precursor of dopamine) by the enzyme decarboxylase.
Choose the correct statement regarding Cogentin:
a. This drug can worsen constipation.
b. This drug will also help with his mild memory impairment.
c. This drug will cause HTN.
d. This drug isn’t indicated for PD.
e. This drug will cause extrapyramidal symptoms.
a
-Benztropine (Cogentin) is a centrally-acting anticholinergic with 2 primary indications: Adjunctive therapy in PD and prevention of extrapyramidal symptoms
-AEs include peripheral anticholinergic effects (constipation, urinary retention, blurred vision, dry mouth) and central anticholinergic effects (drowsiness, confusion, cognitive impairment)
HPI: CH is a 70 y/o male who presents to the clinic on 9/10 for a follow up of his PD and COPD. He currently has symptoms of tremor on his right side, slow movement, and poor balance. He also complains of dry mouth. He confirms adherence with all meds noted in the order hx.
Allergies: Penicillin (swelling)
Rx Meds Order Hx:
8/10: Spiriva Respimat 18 mcg daily (3 refills)
8/10: Reglan 10 mg TID-AC and QHS (3 refills)
8/10: Requip XL 2 mg daily (0 refills)
6/10: Combivent Respimat 1 inhalation QID (6 refills)
6/10: Sinemet 10/100 mg TID (2 refills)
6/10: Toprol XL 50 mg daily (6 refills)
6/10: Zestril 10 mg daily (6 refills)
6/10: Amitriptyline 50 mg PO QHS (6 refills)
6/10: Hydrochlorothiazide 12.5 mg daily (6 refills)
6/10: Crestor 20 mg daily (6 refills)
OTC Meds:
Dulcolax 5 mg PRN constipation
Nexium 20 mg daily
PMH: COPD, GERD, HTN, MI with stenting 5 years ago, idiopathic constipation, mild memory impairment, PD
The following plan is implemented for CH:
Increase Sinemet to 25/100 mg TID
Add entacapone 200 mg TID
Continue Requip XL at current dose
Follow up in 3 months
In 3 months, CH presents to the clinic and lab values show low hemoglobin. A Coombs test is positive. What is the most likely cause?
a. Sinemet
b. Requip XL
c. Entacapone
d. Progression of PD
e. Diet low in iron-rich foods
a
Levodopa is one of the meds known to cause drug-induced hemolysis.
RK is an 84 y/o male who resides in a SNF. He’s transferred to a hospital for tx of a UTI and N/V. His current meds include carbidopa/levodopa, ropinirole, amlodipine, and acetaminophen-hydrocodone PRN. He was given 2 doses of ondansetron in the past few hrs d/t N/V.
The Dr inquires if the pt can be given an injection of apomorphine so they can provide rescue from an “off” period and better communicate with him at the bedside. The pharmacist should inform the team that:
a. Apomorphine is contraindicated because the pt is taking an opioid.
b. Apomorphine can be given, but a dose of trimethobenzamide should be given first.
c. He can receive apomorphine now, but his BP should be monitored carefully.
d. Apomorphine is currently contraindicated d/t the recent use of ondansetron.
e. Apomorphine can be given, and the dose should be written in mg/kg.
d
The concomitant use of apomorphine with drugs of the 5HT3 antagonist class (ondansetron, granisetron, dolasetron, palonosetron, and alosetron) is contraindicated. Profound hypotension and loss of consciousness can occur.
LN takes carbidopa/levodopa 25/250 PO TID. He was experiencing symptoms in between doses, so his Dr prescribed entacapone 200 mg PO daily. What is wrong with this Rx?
a. Entacapone is only available as a patch.
b. Entacapone shouldn’t be used with levodopa.
c. This drug cause liver toxicity. It’s safer to use tolcapone.
d. The dosing is incorrect. It should be 200 mg with each dose of levodopa.
e. The carbidopa/levodopa dose should be decreased to daily.
d
The dose is always the same: 200 mg of entacapone with each dose of levodopa, up to 8 tabs of entacapone per day (1600 mg max/day). Entacapone and levodopa/carbidopa come in a combo product called Stalevo.
