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PHM 701 > Parkinson's > Flashcards

Parkinson's Flashcards

(46 cards)

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1
Q

What are the approaches to treating Parkinson’s

A
  • Increase endogenous dopamine
  • Decrease cholinergic activity
  • Activate dopamine receptors with synthetic dopamine agonists
  • Block adenosine A2A receptor activity
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2
Q

How do you increase endogenous dopamine?

A
  • Use of L-dopa
  • Inhibit metabolism of dopa decarboxylase
  • Inhibit metabolism by COMT
  • Inhibit central/peripheral metabolism by MAO-B
  • Increase dopamine release and inhibits reuptake
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3
Q

Drugs that inhbit COMT

A
  • Entacapone
  • Tolcapone
  • Opicapone
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4
Q

Drugs that inhbit MAOB

A
  • Rasagiline
  • Selegiline
  • Safinamide
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5
Q

What PK drugs that induce endogenous dopamine can also be used as monotherapy?

A

MAOB inhibitors

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6
Q

Which PK drug can produce methamphetamines if a toxicology report is done?

A

Selegiline

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7
Q

What PK drug increases dopamine release and inhibits it reuptake?

A

Amantadine

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8
Q

Dosing for Rasagiline as adjunctive and as monotherapy

A

Adjunctive: 0.5 mg
Monotherapy: 1 mg

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9
Q

What should you be cautious with in Safanimide therapy?

A

Hepatic impairment (Child Pugh Class C)
Abrupt discontinuation - withdrawal emergent NMS-like syndrome

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10
Q

What is the effect of Amantadine?

A

It reduces rigidity, tremor, bradykinesia and L-Dopa induced dyskinesia

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11
Q

What should you monitor with Amantadine dosing?

A

Renal elimination; adjust dose with renal impairment

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12
Q

What’s a transient adverse effect of Amantadine

A

Livedo reticularis; mottling of the skin

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13
Q

What is a side effect of selegiline?

A

It can cause insomnia and jitteriness

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14
Q

What PK drug is potentially disease modifying?

A

Rasagiline

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15
Q

What is the PKPD and dosing strategy surrounding Opicapone?

A

With a mod fat/calorie meal, its Cmax, AUC and Tmax decrease
It is also to be dosed at bedtime at least 1 hour before and 1 hour after eating

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16
Q

What PK drug is available in combo with Carbidopa/Levodopa?

A

Entacapone (200 mg)
STALEVO

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17
Q

True or False. Carbidopa can be used a monotherapy to help treat Parkinson’s

A

False. Never you give it alone

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18
Q

True or False. COMT inhibitors can be used as monotherapy to help treat Parkinson”s

A

False. No effect in absence of L-Dopa

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19
Q

True or false. MAOB inhibitors can be used as monotherapy to help treat Parkinson’s.

20
Q

How can you activate dopamine receptors?

Study These Flashcards
A

With the use of synthetic dopamine agonists

21
Q

True or False. Dopamine agonists can be used a monotherapy to help treat Parkinson’s

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A

True. Only in young healthy patients

22
Q

What are your synthetic dopamine agonsits?

Study These Flashcards
A
  • Pramipexole
  • Ropinirole
  • Rotigotine
  • Apomorphine
23
Q

What is the benefit of using a synthetic dopamine agonist over L-Dopa

Study These Flashcards
A

It has a reduced risk of developing motor complications when used as monotherapy

24
Q

What are the side effects of dopamine agonists?

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A

Impulsive behaviors, psychosis
n/v, vivid dreams, daytime sedation, orthostatic hypotension

25
What formulation is Rotigotine and what is a side effect?
Patch Application site reaction
26
When is Apomorphine used?
In advanced Parkinson's as needed for "off" episodes
27
How should you initiate Apormorphine therapy?
A test dose of 2mg SC done under medical supervision Be sure to pre-treat with an antiemetic that is is not a 5HT3 antagonist or an antidopamingeric
28
What is the PK profile of Apormorphine?
It has a short half life of 40 mins that is why it is used for refractory, acute off episodes.
29
What is a serious DDI with Apomorphine pre-treatment?
It is contraindicated with 5HT3 antagonits and antidopaminergics due to hypotensive effects
30
Why might we need to block adenosine A2A receptor activity?
Its appears as so that inhibition of motor function occurs when there is overactivation of adenosine A2A receptor pathway
31
What drug can you use to block adenosine A2A receptor activity?
Istradefylline (A2A receptor antagonist)
32
How is Istradefylline used?
It's used in combo with levodopa/carbidopa in patients experiencing off episodes
33
When might you need to dose adjust Istradefylline?
In concomitant tobacco smoking by increasing the dose
34
What are your non-pharm options for treatment of Parkinson's
- Surgery: Deep Brain Stimulation - Physical therapy/Exercise - Nutrition (Fluids, Fiber, Omega 3) - Occupational Therapy
35
What are L-Dopa related long term complications?
There are fluctuations in motor performance with wearing off and response deterioration as well as peak effect dyskinesia phenomenon There is also dyskinesias/abnormal involuntary movement
36
What should you do if there is a wearing off or an "on-off" response?
Increase the frequency or switch to Sinemet CR or use an adjunctive dopa agonist/COMTi/MAOBi *The med isn't working long enough
37
What should you do if there is an "off, no on" response?
Increase the dose, the frequency or drink more water with med OR use an ODT. If it's advanced Parkinson's use Apomorphine. *The med isn't working well enough
38
What should you do if there is a delayed onset of the medication?
Take on an empty stomach, drink a lot of water and avoid protein. You can also switch to Sinemet CR or add IR to CR *The med isn't working fast enough
39
What should you do if you have peak-effect dyskinesia?
Decrease the dose, increase the frequency, add amantadine, use Sinemet CR, dopa agonist
40
What should you do if you experience dystonia?
Take in early morning, take Sinemet CR at bedtime, a dopa agonist, baclofen or botox
41
What should you do if you experience freezing?
Increase dose, dopa agonist, gait modification, physical therapy***
42
What can you give a Parkisnson's patient with depression?
Pramipexole or Venlafaxine
43
How can you manage dementia and cognitive impairment in Parkinson's patients?
Anticholinesterase inhibitors
44
How should you deal with Psychosis in Parkinson's
- Evaluate hypoxia, infection or Elyte imbalance - Simply regime; d/c anticholi's, taper, selegiline - Consider atypicals like quietapine and clozapine (and nuplazid)
45
What new drug is indicated for hallucinations and delusions in Parkinson's?
Nuplazid
46
How does Nuplazid work?
inverse agonist at the 5HT2A/2C receptor

PHM 701 (8 decks)

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