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Pharmacology Sem 3 > parkinson drugs csv > Flashcards

parkinson drugs csv Flashcards

1
Q

Parkinson’s dz

A

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

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2
Q

parkinson’s dz is aka

A

shaky palsy

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3
Q

what neurotransmitter is low in parkinson

A

dopamine loss of arm swing

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4
Q

what neurotransmitter is high in parkinson

A

ach (tremors)

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5
Q

why give drugs for parkinsons

A

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

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6
Q

parkinson drugs treat what

A

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

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7
Q

what kind of drugs are used for parkinson

A

anticholinergic, dopaminergic, adjunctive

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8
Q

valerian and kava kava with anticholinergic leads to

A

more sedation

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9
Q

1 drug for parkinson is

A

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

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10
Q

can you use anticholinergic with dopaminergic

A

yes. Use alone or with dopaminergic

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11
Q

antcholinergic action

A

it inhibits parasympathomimetic so it blocks ach release

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12
Q

anticholinergic suppress

A

tremors and muscle rigidity

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13
Q

anticholinergic don’t really affect (x) that well

A

mobility and muscle weakness

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14
Q

name 7 parkinson drugs

A

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

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15
Q

anticholinergic effects

A

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)

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16
Q

dopaminergic increases what, stimulates (x) receptors

A

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

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17
Q

dopaminergic act on what

A

sympathetic nervous system

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18
Q

dopamine affect what in the brain

A

the content.

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19
Q

name 6 dopaminergic drugs

A

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

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20
Q

levodopa crosses what and becomes what?

A

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

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21
Q

GOLD STANDARD drug for parkinson

A

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

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22
Q

how long before levodopa works

A

2-4 mon to achieve max benefit

23
Q

early s/s of levodopa toxicity

A

spasmodic eye winking and muscle twitching; WATCH FOR EPS

24
Q

Levodopa contra for

A

cardiac, renal, psych pt

25
Q

can you stop levodopa abruptly?

A

no.

26
Q

levodopa s/e

A

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

27
Q

PROS and CONS of carbidopa levodopa sinemet

A

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)

28
Q

carbidopa levodopa sinemet a/e

A

suicidal ideation, hallucination

29
Q

carbidopa levodopa sinemet die

A

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

30
Q

carbidopa levodopa sinemet s/e

A

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

31
Q

how long to take sinemet

A

2-4 days

32
Q

when to stop sinemet

A

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

33
Q

sinemet not for (x) pt

A

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

34
Q

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

A

nope

35
Q

what interferes with sinemet

A

high protein diet

36
Q

what color urine with sinemet

A

dark urine

37
Q

what to report for dopamine amantadine

A

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

38
Q

what to report for dopamine bromocriptine

A

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

39
Q

s/e of dopamine bromocriptine

A

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

40
Q

what sort of drug-drug interaction with sinemet

A

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

41
Q

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

A

yes. Do ekg to monitor dysrhythmia

42
Q

sinemet does not go with which vitamin

A

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

43
Q

adjunt parkinson drugs are

A

pram pexole mirapex

44
Q

s/e adjuct PD pram pexole mirapex

A

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

45
Q

what does adjunct PD pram pexole mirapex do?

A

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

46
Q

CONTRAS FOR DOPAMINERGIC

A

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

47
Q

why use adjunctive pram pexole mirapex

A

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

48
Q

MOA-B inhibitors are used in

A

parkinson dz

49
Q

list 2 MAOB inhibitors

A

selegiline eldepryl, rasagiline azilect

50
Q

how does selegiline eldepryl work?

A

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

51
Q

drug-drug interaction with MAOB inhibitor

A

TCA and SSRI

52
Q

parkinson patient teaching

A

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

53
Q

ANTIDOTE FOR antiPD drug

A

APOMORPINE apokyn

54
Q

8 Ds of dopaminergics

A

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.

Pharmacology Sem 3 (26 decks)

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