Parkinson Disease

Question 1

What are the different classes of Parkinson Disease drugs?

Answer 1

• dopamine precursors
• Catechol-O-Methyl-Transferase Inhibitors
• MAO-B Inhibitors
• dopamine agonists
• centrally acting anti-cholinergics

Question 2

What are some dopamine precursors?

Answer 2

• L-Dopa
• Carbidopa

Question 3

What do dopamine precursors treat?

Answer 3

• Gold Standard for Parkinson Disease
• Restless Leg Syndrome (RLS)

Question 4

What is L-Dopa?

Answer 4

Precursor to Dopamine that needs to reach the CNS

Question 5

What is Carbidopa?

Answer 5

L-DOPA Decarboxylase Inhibitor

• “Body Guard # 1” to L-DOPA
• Pack the “CAR” up with L-DOPA and drive it across the BBB

Question 6

What are some adverse effects of Parkinson Disease drugs?

Answer 6

Behavioral/Hallucinations
Impulse Control
Narcolepsy
GI symptoms
Orthostatic Hypotension

Question 7

What is an adverse effect unique to L-Dopa?

Answer 7

dyskinesia - impaired movement

Question 8

Why should protein be avoided when administering L-Dopa?

Answer 8

• oral L-Dopa competes with protein for absorption
• give with small snack

Question 9

What are some Catechol-O-Methyl-Transferase Inhibitors?

Answer 9

• entacapone
• tolcapone

Question 10

What do Catechol-O-Methyl-Transferase Inhibitors treat?

Answer 10

Adjunct for Parkinson Disease (given with L-Dopa/Carbidopa)

Question 11

What is entacapone?

Answer 11

• “Body Guard # 2” to L-DOPA
• protect L-Dopa to cross the BBB
• works peripherally only

Question 12

What is tolcapone?

Answer 12

• works peripherally and centrally
• Higher A/E profile

Question 13

What is an adverse effect unique to entacapone?

Answer 13

orange/brown urine discoloration (harmless)

Question 14

What is an adverse effect unique to tolcapone?

Answer 14

hepatotoxicity

Question 15

What are some MAO-B Inhibitors?

Answer 15

selegiline

Question 16

What do MAO-B Inhibitors treat?

Answer 16

Parkinson Disease

Question 17

What are some adverse effects unique to selegiline?

Answer 17

• insomnia
• serotonin syndrome
• hypertensive syndrome

Question 18

What are manifestations of serotonin syndrome?

Answer 18

Shivering
Hyperreflexia
Increased Temp
Vital Signs
Encephalopathy
Restlessness
Sweating

Question 19

What to avoid when administering MAO-B Inhibitors?

Answer 19

avoid foods/beverages high in tyramine

• cheese
• alcohol
• avocado
• caffeine

Question 20

How do you prevent hypertensive crisis?

Answer 20

• AVOID FOOD AND/OR BEVERAGES HIGH IN TYRAMINE WHILE TAKING AN MAO-I
• AVOID ALL HERBALS/MEDICATIONS UNLESS APPROVED BY PROVIDER WHILE
  TAKING AN MAO-I
• Avoid anything SYMPATHETIC (adrenergic)

Question 21

What are some dopamine agonists?

Answer 21

• ropinirole
• pramipexole
• apomorphine

Question 22

What do dopamine agonists treat?

Answer 22

• Parkinson Disease
• Restless Leg Syndrome

Question 23

What is an adverse effect unique to dopamine agonists?

Answer 23

“sleep attacks”

Question 24

What are some centrally acting anti-cholinergics?

Answer 24

• benztropine
• trihexyphenidyl

Question 25

What do centrally acting anti-cholinergics treat?

Answer 25

• Parkinsonism
• Drug Induced Extrapyramidal Symptoms

Question 26

What are some adverse effects of centrally acting anti-cholinergics?

Answer 26

Can’t see
Can’t pee
Can’t spit
Can’t shi*
Can’t schvitz

• CNS sedation
• tachycardia

Question 27

What is an Anti-Parkinson drug?

Answer 27

amantadine

Question 28

What does amantadine treat?

Answer 28

• Drug Induced Parkinsonism
• Tardive Dyskinesia
• Neuroleptic Malignant Syndrome
• Parkinson Disease
• Dyskinesias

Question 29

What are some adverse effects unique to amantadine?

Answer 29

• livedo reticularis (1-6% of patients)
  
  • livere - bluish
  • reticular - net like pattern

(anti-cholinergic 5S’s and BINGO)