Parkinson Disease Flashcards
MOA: directly stimulates dopamine receptors
Dopamine Agonist: Bromocriptine, Pramipexole, Ropinorole
What type of patient would you consider dopamine agonist?
Young patient to delay use of levodopa.
**fewer side effects than levodopa
Why are carbidopa and levodopa mixed?
Carbidopa reduces amount of Levodopa needed–>reducing the SE from Levodopa
Which two conditions are anticholinergics contraindicated for Parkinson Disease?
- BPH
2. Glaucoma
What are the side effects of anticholinergics?
Dry mouth, constipation, blurred vision, tachycardia, urinary retention
“blind as a bat, red as a beet, mad as a hatter, dry as a bone”
Who are anticholinergics (Trihexyphenidyl, Benztropine) indicated for?
<70 years old with tremor predominance
doesn’t improve bradykinesia
Amantadine MOA
Increases presynaptic dopamine release
Blocks glutamatergic N-methyl-D-aspartate (NMDA) receptors
Amatadine effect
improves long-term levodopa induced dyskinesias. May help early on with mild symptoms.
What does MAO-B do?
MAO-B breaks down dopamine
MAO-B Inhibitors (Selegiline, Rasagiline) MOA
Prevent MAO-B from breaking down dopamine–>increasing dopamine
Treatment of choice for a PD patient with bradykinesia/rigidity under 65 years of age?
Dopamine agonist (Bromocriptine, Pramipexole, Ropinirole)
What are the 2 main adverse effects from the dopamine agonists?
- Impulsive behaviors
2. Postural hypotension
When are the two times Amantidine is helpful?
- Young patient/early in disease progression with mild symptoms
- When dyskinesia becomes problematic
What is the first line treatment to treat tremor in PD for a patient under 65 years?
Anticholinergics (Trihexyphenidyl, Benztropine)
What are the potential fixes for “wearing off bradykinesia”
- increase frequency of Cabidopa/levodopa
- Switch to extended release
- Add COMT inhibitor
- Add MAO-B inhibitor
- Add dopamine agonist
What are the potential fixes for “delayed” response
- give levodopa/carbidopa on empty stomach
- Avoid CR
- Use apomorphine sub Q
Start hesitation “freezing”
- Increase levodopa/carbidopa
- Add dopamine agonist or MAO-B inhibitor
- Sensory cues
- Physical therapy
Peak-dose dyskinesia
- lower dose of carbidopa/levodopa
- Add amantadine
What is important to monitor with Catechol-O-Methlytransferase (COMT) inhibitors?
COMT inhibitors (Entacapone, Tolcapone) can be hepatoxic, so need to monitor LFTs
If the patient is on Antidiarrheals or COMT inhibitors, what needs to be done to the L-Dopa dose?
L-dopa dose needs to be lowered
Who are anticholinergic medications (Benztropine, Trihexyphenidyl) helpful for?
- Mild, tremor-predominant PD
- <70 years (monotherapy)
- Advanced disease with persistent tremor despite levadopa or dopamine agonists
What is a common adverse drug reaction with MAO-B inhibitors (Selegiline, Rasagiline)?
insomnia
Which two PD drugs prevent the breakdown of Dopamine?
COMT inhibitors (Entacapone, Tolcapone)
MAO-B inhhibitors (Selegiline, Rasagiline)
