parkinson's disease

Question 1

Parkinson’s disease

Answer 1

a progressive, degenerative disorder of basal ganglia function

characterized by tremor, rigidity, and bradykinesia

Question 2

basal ganglia function

Answer 2

function with cerebellum to make smooth, coordinated movement

the substantia nigra in the basil ganglia has cells that produce dopamine

Question 3

primary and secondary parkinson’s

Answer 3

primary

• idiopathic
• genetic or sporadic

secondary

• infection
• intoxication
• trauma
• drug-induced (antiemetics, antidepressants) - usually reversible

Question 4

Parkinson’s disease risk factors

Answer 4

Age: after 40, peak in the 70s
gender: men > women 3:2
genetics: both dominant and recessive
Other risk factors in can develop earlier with:
 - anxiety/depression
 - head trauma
 - hysterectomy
 -coffee consumption (protective)

Question 5

dopamine

Answer 5

inhibitory neurotransmitter
controls movement and balance
helps muscles work smoothly, controllably, & w/o unwanted movements

Question 6

acetylcholine

Answer 6

excitatory neurotransmitter

works in conjunction with dopamine - balance is crucial

Question 7

Primary parkinson’s

Answer 7

damage to dopamine producing cells

Question 8

secondary parkinson’s

Answer 8

something has altered production of dopamine

Question 9

clinical manifestations

Answer 9

bradykinesia
cogwheel rigidity
resting tremor (pill rolling)
shuffling gait
mask-like expression
postural instability

Question 10

classic triad of manifestations

Answer 10

tremor
rigidity
bradykinesia

gradual onset and progression
may only involve one side of body at first

Question 11

tremor with parkinson’s

Answer 11

often the first sign
handwriting affected
more prominent at rest (improve with movement)
aggravated by stress of concentration
pill roll

Question 12

bradykinesia

Answer 12

loss of automatic movements
no blinking
no swinging of arm while walking
no swallowing of saliva (drooling)
flat affect (lose ability to use facial muscles)
overall lack of spontaneous movement

Question 13

parkinson’s disease complications

Answer 13

dementia (Lewy bodies)
depression/anxiety (lose independence)
decreased mobility
 - malnutrition
 - aspiration
 - PNA
 - UTI's (urinary retention)
 - skin breakdown
drug related complications

Question 14

goal of pharmacotherapy

Answer 14

help pts maintain motor fx as long as possible and maintain independence

drugs either enhance dopamine or block ACh

Question 15

levodopa/carbidopa

Sinemet

Answer 15

MOA: levodopa - converts to dopamine in the brain and activates dopamine receptors
carbidopa - blocks destruction of levodopa

most effective drug for PD

takes several months to see improvements
does not work long-term
adverse effects

Question 16

Sinemet loss of effect

Answer 16

gradual loss of drug effect, varies with individual
dose wears off
may need shorter dose intervals

abrupt loss of effect
on-off phenom
can occur anytime during dosing interval
when it's off, all sxs return
"off" periods increase over time
can be reduced with drugs and avoiding high PRO meals

Question 17

levodopa adverse effects

Answer 17

N/V
- give low doses with food (not pro rich food)

Dyskinesias (80%)
- range from annoying to disabling (may have to switch meds)

Postural hypotension

Dysrhythmias

Psychosis (20%)

• hallucinations
• nightmares
• paranoia

Darken sweat and urine

Activate malignant melanoma

Question 18

Sinemet interactions

Answer 18

decrease effects of levodopa

• B6 (pyridoxine)
• antipsychotics
• protein

increase effects of levodopa

• carbidopa
• anticholinergics
• MAOIs (can cause toxicity)

Question 19

duopa

Answer 19

carbidopa-levodopa infusion (J tube)

continuous infusion for constant blood level (up to 16 hrs a day, can stop while sleeping)

used for pts who respond to drug but response fluctuates

• on-off phenom
• decreased effects

keeps more consistent levels of drug in body

Question 20

duopa SEs

Answer 20

falling asleep without warning
orthostatic hypotension
hallucinations
unusual urges
depression
dyskinesia
r/t placement of tube

do not start this drug within 2 weeks of taking MAOI

Question 21

pramipexole

Mirapex

Answer 21

dopamine receptor agonist

MOA: stimulates dopamine receptors

Uses:
monotherapy in early PD and younger pts
combined with Sinemet in advanced PD
restless leg syndrome

Question 22

pramipexole

AEs

Answer 22

Nausea
sleep attacks
pathologic gambling and other compulsive behaviors

with levodopa:
profound orthostatic hypotension
dyskinesias
hallucination risk doubles

Question 23

ropinirole

Answer 23

dopamine receptor agonist

idiopathic/primary PD

AEs similar to other PD drugs

with long term use may be an increased risk of DM and acromegaly

Question 24

other dopamine agonists

Answer 24

rotigotine (Neupro)
- once daily patch

apomorphine (Apokyn)

• short acting subcut inj
• fast relief of sxs
• used in off phases of PD