parkinson drugs csv

Question 1

Parkinson’s dz

Answer 1

most common movement do in 1-2% of pt > 65 yo with mortality 3x that of general population; #2 common neurodegenerative (#1 is alzheimer)

Question 2

parkinson’s dz is aka

Answer 2

shaky palsy

Question 3

what neurotransmitter is low in parkinson

Answer 3

dopamine loss of arm swing

Question 4

what neurotransmitter is high in parkinson

Answer 4

ach (tremors)

Question 5

why give drugs for parkinsons

Answer 5

ease s/s of dz and hep pt be mobile and function for as long as possible

Question 6

parkinson drugs treat what

Answer 6

tremor; rigidity; akenisia and bradykinesia, postural instability; affective flattening

Question 7

what kind of drugs are used for parkinson

Answer 7

anticholinergic, dopaminergic, adjunctive

Question 8

valerian and kava kava with anticholinergic leads to

Answer 8

more sedation

Question 9

1 drug for parkinson is

Answer 9

anticholinergic (also used to tx s/e of phenothizine)

Question 10

can you use anticholinergic with dopaminergic

Answer 10

yes. Use alone or with dopaminergic

Question 11

antcholinergic action

Answer 11

it inhibits parasympathomimetic so it blocks ach release

Question 12

anticholinergic suppress

Answer 12

tremors and muscle rigidity

Question 13

anticholinergic don’t really affect (x) that well

Answer 13

mobility and muscle weakness

Question 14

name 7 parkinson drugs

Answer 14

benztropine cogentin (decrease memory and thinking), trihexyphenidyl artane, phenadrine norflex, diphenhydramine benadril (antiH2 for elder d/t can’t tolerate dopaminergic), procyclidine kemardin, ethopropazine parisdol

Question 15

anticholinergic effects

Answer 15

dry mouth (hard candy, ice chips, sugarless gum, CONTRA COPD EMPHYSEMA will get thick dry mucous secretion; CONTRA DYSPHAGIA), flush from vasodilation, blurred vision (A SAFETY CONCERN, photophobia sunglassess, NOT FOR GLAUCOMA, get routine eye exam), dizziness, urinary retention (pee before taking anticholinergic), dysuria, tachycardia, muscle weakness, confusion, nervousness, disorientation, constipation (consume more fiber and 2-3L water)

Question 16

dopaminergic increases what, stimulates (x) receptors

Answer 16

dopamine in substantia nigra to restore balance between inhibitory and stimulating neurons inhibit the enzyme dopa decarboxylase allowing LEVODOPA to reach brain.

Question 17

dopaminergic act on what

Answer 17

sympathetic nervous system

Question 18

dopamine affect what in the brain

Answer 18

the content.

Question 19

name 6 dopaminergic drugs

Answer 19

levodopa dopar larodopa, carbidopa-levodopa sinemet combo 10/100, 25/100, 25/250, 50/200

Question 20

levodopa crosses what and becomes what?

Answer 20

cross blood brain barrier to become dopamine; carbidopa-levodopa sinemet does this better than plain levodopa BUT LEVODOPA IS THE GOLD STANDARD

Question 21

GOLD STANDARD drug for parkinson

Answer 21

levodopa; it increases dopamine, reduce muscle rigidity and tremor; BENEFIT IS INCREASED MOBILITY

Question 22

how long before levodopa works

Answer 22

2-4 mon to achieve max benefit

Question 23

early s/s of levodopa toxicity

Answer 23

spasmodic eye winking and muscle twitching; WATCH FOR EPS

Question 24

Levodopa contra for

Answer 24

cardiac, renal, psych pt

Question 25

can you stop levodopa abruptly?

Answer 25

no.

Question 26

levodopa s/e

Answer 26

n/v, diskinesia, ortho low bp, cardiac dysrhthmia, psychosis

Question 27

PROS and CONS of carbidopa levodopa sinemet

Answer 27

PRO: more dopamine reach the basal ganglia, small dose needed for effect (can increase dose to protect from nausea); CON: more levodopa, more s/e (combo IS NOT THE GOLD STANDARD)

Question 28

carbidopa levodopa sinemet a/e

Answer 28

suicidal ideation, hallucination

Question 29

carbidopa levodopa sinemet die

Answer 29

agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmia, NEUROLEPTIC MALIGNANT SYNDROME

Question 30

carbidopa levodopa sinemet s/e

Answer 30

anorexia, n/v, dysphagia, fatigue, dizzy, HA, dry mouth, bitter taste, blurred vision, insomnia, DARK URINE

Question 31

how long to take sinemet

Answer 31

2-4 days

Question 32

when to stop sinemet

Answer 32

when pt get rebound parkisonism; and definitely do NOT stop abruptly

Question 33

sinemet not for (x) pt

Answer 33

glaucoma, heart dz, peptic ulcer, kidney, liver, psychosis

Question 34

can you chew extended release sinemet, but do take with food to avoid GI upset even if it's slower in absorption

Answer 34

nope

Question 35

what interferes with sinemet

Answer 35

high protein diet

Question 36

what color urine with sinemet

Answer 36

dark urine

Question 37

what to report for dopamine amantadine

Answer 37

skin lesion, seizure, depression, SE intense with antiparkinson drugs

Question 38

what to report for dopamine bromocriptine

Answer 38

lightheaded with position change (ortho low bp), dysrhythmia; NO ETOH, do not stop abruptly

Question 39

s/e of dopamine bromocriptine

Answer 39

n/v, ortho low bp, palpitation, chest pain, BLE edema, vivid dreams, delusion, tolerance; so DECREASE THE DOSE

Question 40

what sort of drug-drug interaction with sinemet

Answer 40

levodopa or bromocriptine (ortho low bp), anticholinergic, increased tyramine with MAOI so HTN crisis

Question 41

do you want to do an EKG if pt on sinemet?

Answer 41

yes. Do ekg to monitor dysrhythmia

Question 42

sinemet does not go with which vitamin

Answer 42

pyridoxine Vit B6 (in beans and cereal); but if Vit B6 is too low pt gets peripheral neuritis and muscle weakness; solution is to give Vit B6 before dopaminergic tx

Question 43

adjunt parkinson drugs are

Answer 43

pram pexole mirapex

Question 44

s/e adjuct PD pram pexole mirapex

Answer 44

nausea, dizzy, somnolence, weak, constipation, dyskinesia, hallucination

Question 45

what does adjunct PD pram pexole mirapex do?

Answer 45

D2, D3 agonist; use in combo with levodopa; it has fewer s/e than amantidine

Question 46

CONTRAS FOR DOPAMINERGIC

Answer 46

angle closure glaucoma, suspicious skin lesion (might be melanoma), CVD, bronchial asthma, urinary obstruction, peptic ulcer dz

Question 47

why use adjunctive pram pexole mirapex

Answer 47

extends sinemet effectiveness so less sinemet needed; for pt who can't tolerate max dose of sinemet

Question 48

MOA-B inhibitors are used in

Answer 48

parkinson dz

Question 49

list 2 MAOB inhibitors

Answer 49

selegiline eldepryl, rasagiline azilect

Question 50

how does selegiline eldepryl work?

Answer 50

inhibit onoff fluctuation; prolong levodopa actions or delay more need for levodopa; mets tyramine in GI, so risk of HTN crisis

Question 51

drug-drug interaction with MAOB inhibitor

Answer 51

TCA and SSRI

Question 52

parkinson patient teaching

Answer 52

assess tremors, gait, strength, drooling, speech pattern, frustration level, injury prevention, bowel function, avoid high pyridoxine Vit B6 foods (beef, ham, egg yolk, sweet potato, oatmeal, fortified cereal); dry mouth, avoid high protein meals, day time sleepiness, dark urine/sweat/saliva, avoid OTC, increase fiber and water, monitor renal and liver function, takes several months for full effect, change position slowly, caution about low bp, caution on-off effect, fucking horny and gonna wanna gamble

Question 53

ANTIDOTE FOR antiPD drug

Answer 53

APOMORPINE apokyn

Question 54

8 Ds of dopaminergics

Answer 54

dizzy/drowsy/avoid driving, dyskinesia/vivid dream; decrease bp, decrease reality/hallucination; decrease protein diet/eat shortly after med; decrease pyridoxine Vit B6; discolored sweat/urine is harmless; decrease dry mouth with good hygiene.