Parkinson's Flashcards
Pramipexole (Sifrol®)
Ropinirole (Repreve®)
Rotigotine (Neupro®)
A) Non-ergot dopamine agonist
B)
1. Restless Leg Syndrome
PRAMIPEXOLE + ROTIGOTINE:
2. Parkinson’s Disease
C)
PRAMIPEXOLE:
#RLS: Conventional: 375 mcg - 4.5 mg ONCE daily
#PD: Conventional 125 mcg - 1.5 mg TDS
#PD: Controlled: 375 mcg - 4.5 mg ONCE daily
ROPINIROLE:
#PD: 0.25 - 4 mg daily
ROTIGOTINE:
#RLS: 1mg/24hr - 3mg/24 hr patch ONCE daily
#PD: 2mg/24hr - 16mg/24 patch ONCE daily
D) 1. Impulse control disorder ** 2. Worsening in RLS 3. Drugs that may worsen Parkinson's PRAMIPEXOLE + ROPINIROLE 4. Renal ROTIGOTINE: 4. Opthalmological examinations (visual disturbance) 5. Blood Pressure 6. Application site reactions + compliance
E)
Labels: 12, PRAMIPEXOLE+ROTIGOTINE (1, 9, 16)
PRAMIPEXOLE (A*)
ROTIGOTINE (21)
#Tell Dr - changes in behaviour (gambling, OCD)
#Tell Dr - Sudden onset of sleepiness without warning during day
#Can cause nausea, vomiting, drowsiness, dizziness and headache - decrease/disappear with cont. use
ROPINIROLE:
#Take 1 - 3 hrs before bedtime
ROTIGOTINE:
#Apply at same time each day - dry, clean, hairless skin (hip, abdo, thigh, upper arm or shoulder)
#Rotate site of application - avoid 14 days
#Make sure you know how to dispose safely
#Do not cute patches
Bromocriptine (Kripton®/Parlodel®)
Cabergoline (Cabaser®)
A) Ergot-derived dopamine agonists
B) 1. Parkinson's disease 2. Hyperprolactinaemia BROMOCRIPTINE: 3. Acromegaly (radioTx or surgery have failed) CABERGOLINE: 3. Prevention of onset of lactation
C) BROMOCRIPTINE: 1.25 - 30 mg daily (in divided doses) CABERGOLINE: 0.5 - 3 mg ONCE daily
D)
1. Nausea and Vomiting (give domperidone 30-60 mins before)
2. Symptoms of progressive FIRBROTIC DISORDERS (pleuropulmonary, retroperitoneal fibrosis)
3. Changes in mood or behaviour (impulse control, OCD)
4. Pituitary enlargement
BROMOCRIPTINE:
5. Symptoms of NMS (fever, muscle rigidity, rhabdomyolysis, profuse sweating, tachycardia)
CABERGOLINE:
5. Regular cardiovascular evaluation + echo (cardiac vulvulopathy)
E)
Labels: 12, 16, B (lessen nausea or stomach upset)
BROMO (5)
CABERGOLINE (A)
#Tell Dr - shortness of BREATH, cough, or chest pain
#Tell Dr - change in behaviour (gambling)
#Daily doses should be taken at night - sudden onset of sleep
#Avoid alcohol - worsens S/E
S/E:
Leg cramps
Benzhexol (Artane®)
Benztropine (Benztrop®)
Biperiden (Akineton®)
A) Anticholinergics
B) 1. Parkinson's disease 2. Drug-induced EPSE (except TD) BENZTROPINE 3. Acute dystonic reactions (IM/IV)
C) BENZHEXOLE: #start 1 mg daily #usual: 5 - 15 mg daily (3 or 4 doses) BENZTROPINE: #start: 0.5 mg daily #max: 6 mg daily (PD) or 4mg BD (EPSE) BIPERIDEN #start: 1 mg BD (PD) or 1 - 2 mg daily #max: 4 mg QID (PD) or 2 mg QID (EPSE)
D)
1. Fever or high ambient temperature (risk of hyperthermia)
2. GORD (may exacerbate)
3. Arrhythmias, CHD, HF (may exacerbate)
4. MENTAL status** (worsen cognitive impairment = confusion) (opposite of anticholinesterases)
5. Intra-ocular pressure (precipitate narrow-angle glaucoma)
NO renal or liver
E)
Labels: 1, 9 (long-term regular therapy - prevents acute exacerbation)
#Initially cause dizziness, blurred vision, nausea or dry mouth. These often decrease or disappear with continued use
#temp. relief of dry mouth, use sugarless gum or sweets, or a saliva substitute.
S/E (anticholinergic):
dry mouth, urinary retention, constipation, blurred vision, hallucinations, euphoria, delirium)
Rasagiline (Azilect®)
Selegiline (Eldepryl®/Selgene®)
A) Selective MAO-B inhibitor
B)
1. Parkinson’s Disease
C)
Rasagiline: 1 mg ONCE daily
Selegiline: 2.5 d - 5 mg TWICE daily (max10daily) - mane and midi
D) 1) Drug INTERACTIONS 2) SEROTONIN toxicity 3) DOPAMINERGIC S/E (dyskinesia, hallucinations - reduce dose) 4) Clinical improvement NO renal or liver
E)
Labels: 5
RAS: (9), (A)
SELE: (12)
#Avoid eating MATURED CHEESE while you are taking this medicine
SELEGILINE:
#Take in the MORNING and LUNCHTIME to minimise sleep disturbance
S/E
Dry Mouth, Headache, Insomnia, Nausea and VOMITING
Amantadine
Symmetrel®
A) NMDA antagonist
B)
Parkinson’s disease
Prevention of influenza type A (in non-immunised people)
C) 100 mg d - 100 mg TDS (in 3 doses)
D) 1. Compliance (NMS risk) 2. Neuroleptic Malignancy Syndrome symptoms (fever, muscle rigidity, rhabdomyolysis, profuse sweating, tachycardia) 3. Anticholinergic drugs (increase SE) 4. Worsen Epilepsy 5. Renal NO liver
E)
Labels: 9, 12, 16, B (with food to reduce stomach upset)
S/E:
PSYCH (nervousness, depression, nightmares, hallucinations)
CNS (dizziness, insomnia, headache)
ANTICHOL (dry mouth, nausea, orthostatic hypotension, blurred vision)
Entacapone
Comtan®
A) COMT inhibitor
B)
1. Parkinson’s disease (adjunct to Levodopa)
C)
200 mg (with each levodopa-carbidopa or -benserazide dose)
Max: 2g daily
D) 1. Rhabdomylosis (contraindicated) 2. Withdrawal symptoms resembling NMS (fever, muscle rigidity, rhabdomyolysis, profuse sweating, tachycardia) 3. Hepatic (raised liver enzymes) NO renal
E)
Labels: 4a, 5, 9, 12, 16
#May increase S/E of Levodopa (dizziness and drowsiness)
#Take this medicine at the same time as each dose of Levodopa
#May colour your urine reddish brown
#S/E - Nausea, vomiting, abdominal pain, constipation, diarrhoea and dry mouth - decrease or disappear with continued use.
**DR - develop persistent diarrhoea, loss of appetite or weight loss, episodes of sudden onset of daytime sleep
Levodopa + Benserazide (Madopar®)
Levodopa + Carbidopa (Sinemet®/Kinson®)
Levodopa + Carbidopa + Entacapone (Stalevo®)
A)
Levodopa (dopamine precursor/agonist)
Benserazide or Carbidopa (decarboxylase inhibitor)
B)
1. Parkinson’s disease
C)
(Doses expressed as Levodopa - 4:1 or 10:1 ratio)
50 mg BD or TDS - 2 g (max)
D)
- Development of impulse control disorders (pathological gambling, hyper sexuality, compulsive buying)
- Regular skin examinations (melanomas)?
- Withdrawal syndrome (like-NMS)
E) Labels: 4a, 9, 16, A* (CR + Stalevo) #Take doses at SAME TIME each day #This medication may cause DROWSINESS #Protein in food reduces absorption of Levodopa **DR - episodes of DAYTIME SLEEPINESS S/E GIT (anorexia, n+v, constipation) CNS (insomnia or sleepiness, agitation, confusion, hallucination)
