Parkinson Disease Flashcards
Pathophysiology of PD
Neurons in the substantia nigra die or become impaired
These cells usually produce dopamine
When 80% of these cells die, symptoms of the disease appear
Parkinson disease symptoms
TRAP Tremor Rigidity Akinesia/Bradykinesia Postural Instability
What scale is used to measure involuntary movements from medications?
Abnormal Involuntary Movement Scale (AIMS)
What medications can worsen PD?
Phenothiazines (Prochlorperazine) used for psychosis, nausea, agitation
Butyrophenones (haloperidol, droperidol) used for psychosis and behavior disorders or nausea
First and second generation antipsychotics (risperidone, paliperidone)
Metoclopramide
What comorbid condition commonly occurs with PD?
Depression
SSRIs, SNRIs, TCAs, pramipexole
What is the antipsychotic of choice for PD? Why?
Quetiapine
Low risk of movement disorders but can cause metabolic complications including increased cholesterol and BG
What medications are used to treat PD?
Carbidopa/Levodopa Entacapone Pramipexole Ropinerole Apomorphine Amantadine Selegiline Rasagiline Safinamide Benztropine
What is the primary treatment principle for PD?
Replace dopamine
Why is carbidopa given with levodopa
To prevent peripheral metabolism of levodopa
Why is levodopa the most effective agent for PD?
It is a prodrug of dopamine
Carbidopa/levodopa MOA
Levodopa is a precursor to dopamine - replenishes dopamine
Carbidopa - inhibits dopa decarboxylase enzyme, preventing peripheral metabolism of levodopa
Carbidopa/levodopa CI, SE, and notes
CI: Non-selective MAOi within 14 days, narrow angle glaucoma
SE: nausea, dizziness, orthostasis, dyskinesias, hallucinations, psychosis
Notes: 70-100mg/d carbidopa required to be effective
Entacapone MOA
Increase duration of action of levodopa; inhibit enzyme COMT to prevent peripheral conversion of levodopa
Pramipexole (Mirapex), Ropineral (Requip) MOA
Dopamine agonist
Pramipexole (Mirapex) and Ropineral (Requip) warnings
Somnolence (sudden daytime sleeping attacks), orthostasis, hallucinations, dyskinesias
Apomorphine indication, CI, SE, and notes
Indication: “rescue” movement drug for “off” periods; advanced disease
CI: do not use with 5HT-3 antagonist d/t severe hypotension
SE: N/V, hypotension
Must give test dose
Amantadine MOA
blocks dopamine reuptake
Amantadine warnings and SE
Warnings: Somnolence, psychosis
SE: dizziness, orthostatic hypotension, livedo reticularis (skin reaction)
Selegiline, rasagiline, safinamide (selective MAO-Bi) MOA
block breakdown of dopamine
Selective MAO-B inhibitor CI and warnings
CI: use in combo with other MAOi (including linezolid), opioids, SNRIs
Warnings: serotonin syndrome, HTN
Benztropine (Cogentin) MOA and SE
MOA; anticholinergic and antihistamine effects - used for tremor
SE: anticholinergic
Alpha/beta agonist Droxidopa (Northera) SE
syncope, falls, HA
