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Spring 15 - Pharm Unit II > Parkinson's > Flashcards

Parkinson's Flashcards

1
Q

What causes Parkinson’s?

A

loss of nigrostriatal dopamine neurons

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2
Q

What is key in providing clinical improvement?

A

activation of D2 dopamine receptor

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3
Q

How is PD diagnosed?

A

bradykinesia plus 2 or more of following:

  • limb muscle rigidity
  • resting tremor
  • posutral instability
  • micrographia

also responsiveness to L-dopa

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4
Q

Modified Hoehn and Yahr Staging

A
  • staging from 0 to 5 where 0 is no sign of dz and 5 is w/c bound and bedridden
  • PD is progressive and sxs worsen over time
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5
Q

Tx Goals

A
  • maintain independence, ADLs, QOL
  • alleviate sxs
  • minimize development of response fluctuations
  • limit medication-related adverse effects
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6
Q

Possible Tx Approaches

A
  • lifestyle changes, nutrition, exercise
  • pharmacologic intervention
  • surgical treatment
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7
Q

What is the most effective tx for PD?

A

levodopa/carbidopa

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8
Q

Levodopa/Carbidopa MOA

A

increases DA in CNS

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9
Q

Why is levodopa used instead of straight dopamine?

A

-levodopa crosses BBB but DA does not

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10
Q

Amantadine

A

-antiviral w/ mild therapeutic effects in PD

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11
Q

Amantadine MOA

A
  • NMDA receptor antagonist
  • blocks glutamate (excitatory NT) transmission
  • promotes DA release
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12
Q

What can happen if amantadine is abruptly discontinued?

A

rebound PD

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13
Q

Name 2 MAO-B inhibitors.

A

selegiline and rasagiline

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14
Q

MAO-B Inhibitor MOA

A
  • prevent breakdown of DA

- rasagiline may be neuroprotective and neurorestorative

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15
Q

Drug Interactions of MAO-B Inhibitors

A
  • TCA, SSRI, SNRI, meperidine: CNS toxicity, HTN, increased temp, death
  • MAOI: HTN crisis
  • tyramine containing foods: risk of HTN crisis
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16
Q

Name 2 catechol-o-methyltransferase (COMT) inhibitors.

A

entacapone and tolcapone

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17
Q

COMT MOA

A

inhibit breakdown of levodopa –> increase DA

18
Q

What is the benefit of COMT meds?

A

increase half life of levodopa by 50% –> more continuous stimulation of DA receptors

19
Q

Levo/carbidopa, amantadine, MAO-B inhibitors and COMT inhibitors all increase the amount of DA in CNS. What are their adverse effects?

A
  • agitation, confusion
  • insomnia, psychosis
  • HA, dizziness
  • orthostasis, dyskinesias
  • N/V
20
Q

Which COMT med is preferred and why?

A

entacapone is preferred b/c tolcapone can cause liver toxicity

21
Q

Why might dopamine agonists be used?

A

may delay need for use of levodopa in early dz or decrease levodopa dose in advanced dz

22
Q

Give a couple examples of dopamine agonists.

A

bromocriptine
pramiprexole (Mirapex)
ropinirole
rotigotine

23
Q

What are adverse effects of DA agonists?

A
  • confusion, dizziness
  • hallucinations, orthostasis
  • nausea, asthenia
  • syncope, peripheral edema
24
Q

What is a side effect that can happen with pramiprexole or ropinirole?

A

episodes of suddenly falling asleep (sleep attack)

25
Q

If a pt is having CNS effects like confusion and hallucinations, how should their carbidopa be adjusted?

A

decrease carbidopa

26
Q

If a pt is having systemic effects like GI complaints and orthostatic HoTN, how should their carbidopa be adjusted?

A

increase carbidopa

27
Q

What can develop in some patients who are on dopamine therapy like dopamine enhancement or dopamine agonists?

A

-impulse control disorders/addictive behaviors

28
Q

Anticholinergics MOA

A
  • increased striatal cholinergic activity causes tremor

- anticholinergics decrease that cholinergic activity and improve tremor

29
Q

Give an example of an anticholinergic med used in PD.

A

-benztropine (Cogentin)

30
Q

AEs of Anticholinergics

A
  • anti-SLUD
  • confusion, memory loss
  • sedation, depression
  • drowsiness, orthostasis
31
Q

Why would you use a combinatino drug with carbidopa/L-dopa/entacapone?

A

-more steady levels of DA in CN b/c entacapone increases the levodopa half life

32
Q

If a patient experiences end of dose “wearing off,” what are possible tx options?

A
  • decrease levodopa dosing interval
  • add COMT inhibitor if on levodopa
  • add DA agonist to levodopa or vice versa
  • add MAO-B inhibitor to levodopa
33
Q

If a patient experiences a delayed on or no on response, what can be done?

A
  • give levodopa on empty stomach
  • avoid levodopa controlled release, use levo ODT
  • use apomorphine subQ
34
Q

If a pt experiences start hesitation/freezing, what can be done?

A
  • increase levodopa dose
  • add DA agonist or MAO-B inhibitor
  • PT and assistive walking devices or sensory cues
35
Q

If a pt experiences peak dose dyskinesia, what can be done?

A
  • decrease levodopa dose and add/increase DA agonist
  • add amantadine
  • if COMT inhibitor recently added, consider decreasing levodopa dose
36
Q

What is used to treat hypomobility in PD?

A
  • apomorphine (DA agonist w/ strong emetic properties)

- give with an anti-emetic (not 5-HT3 antagonist)

37
Q

Efficacy of Selegiline

A

mild, symptomatic benefit

38
Q

Efficacy of Dopaminergic Therapy

A
  • effective in ameliorating motor and ADL disability
  • levodopa more effective than DA agonists
  • DA agonists have fewer motor complications, but more frequent adverse effects
39
Q

What can be used to treat PD psychosis and dementia?

A
  • quetiapine (seroquel) is recommended
  • clozapine considered, but required frequent lab monitoring
  • typical antipsychotics are contraindicated
40
Q

Pt Education for PD

A
  • educate about PD
  • community support
  • tx: adverse effects and optimizing care
41
Q

Why should anticholinergics not be used in PD pts over 65?

A

-due to higher risk of cognitive adverse effects

Spring 15 - Pharm Unit II (9 decks)

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