Parkinson's

Question 0

Why use a peripheral dopa-decarboxylase inhibitor?

Answer 0

it prevents L-dopa from being prematurely converted so that more L-Dopa reaches the brain.
This allows you to give a lower dose with fewer side effects

Question 1

Side effects of L-Dopa

Answer 1

nausea/vomit anorexia
hypotension
choreiform movements
visual hallucinations
insomnia
anxiety

Question 2

L Dopa precautions

Answer 2

Never use with MAOI!

Can worsen psychotic sxs and should not be used with dopamine blocking psychotic agents

Dopamine can’t cross BBB but L-dopa CAN!!

Question 3

L-Dopa with Carbidopa/Sinemet

Answer 3

Ldopa with peripheral decarboxylase inhibitor

could cause hallucinations, nightmares, dyskinesias, and chorea

Question 4

why is permax no longer used as a dopamine agonist?

Answer 4

increased cardiac valve dysfunction

Question 5

Bromocriptine/Parlodel

Answer 5

Dopamine agonist for parkinson’s, proalctinomas, and acromegaly
It crosses the BBB
high doses can lead to pulmonary fibrosis

Question 6

Anticholinergics in Parkinson’s

Answer 6

Great for treating the tremor and drooling

not very useful with bradykinesia and rigidity

Question 7

Benztropine/Cogentin

Answer 7

anticholinergic for Parkinson’s or to diminish side effects of psychotics
works at muscarinic receptors
sides: dry mouth, blurred vision, urinary retention and constipation, memory impairment.
MINIMAL EFFICACY WHEN USED ALONE

Question 8

Amantadine/Symmetrel

Answer 8

anti-viral that’s used for parkinson’s and the flu
antagonizes NMDA >diminished dopamine reuptake
pts stop responding in about 6 months

Question 9

order of efficacy with parkinson’s meds

Answer 9

Ldopa>Bromocriptine>Amantadine> anticholinergics

Question 10

Surgical txs for parkinsons

Answer 10

neurostim
pallidotomy
thalamotomy
fetal cell implantation