Parkinson's Disease Flashcards

1
Q

Classification of Parkinson’s

A
  • idiopathic -> just get it
  • latrogenic -> drug induced particularly in antipsychotics
  • post-traumatic -> after brain injury
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2
Q

In those with parkinsons’s disease, there is more

A

ACh and less dopamine

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3
Q

Drugs that raise dopamine levels

A
  • l-DOPA
  • selegiline/deprenyl inhibits metabolism of dopamine by MAO-B
  • entacapone inhibits COMT
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4
Q

Drugs that stimulate post-synaptic dopamine receptors

A
  • bromocryptine, pergolide, pramipexole
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5
Q

Drug that stimulates release of dopamine

A

amantadine

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6
Q

Drugs that reduce cholinergic activity
centrally acting muscarinic antagonists

A

benztropine
diphenhydramine (BENADRYL)

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7
Q

addition of Carbidopa to l-DOPA can

A

reduce metabolism of DOPA to dopamine by about 75% and decreases severity of some peripheral side effects

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8
Q

Therapeutic effects of l-DOPA

A
  • takes 3-4 weeks before full effect
  • less pronounced effects as disesase progresses
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9
Q

Side effects of l-DOPA

A
  • nausea and vomiting due to stimualtion of chemoreceptor trigger zone by dopamine
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10
Q

Cardiovascular effects of l-DOPA

A

postural hypotension
tachycardia
arrhythmias

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11
Q

Behavioral effects of l-DOPA

A

-psychotic rxns, hallucinations, nightmares, mood changes
- increased libido and release of inhibitions
antipsychotic clozapine effective for managing psychiatric side effects

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12
Q

Choreiform movements (writhing movements)

A

after long term therapy or when used with carbidopa

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13
Q

end of dose phenomenon

A

decline in blood levels of l-DOPA near the end of dosage interval

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14
Q

on-off phenomenon

A

can occur at any time in dosage interval and appears to be related to the progression of disease
effects minimized by using sustained release preparation or by adding COMT inhibitor or dopamine agonist

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15
Q

Contraindications of l-DOPA

A
  • cardiac arrhythmias
  • psychosis
  • melanoma
  • glaucoma
  • active peptic ulcer disease
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16
Q

Sinemet =

A

carbidopa + l-DOPA

17
Q

Bromocryptine

A

nonspecific DA receptor agonist
less effective than l-DOPA

18
Q

Bromocryptine side effects

A
  • nausea vomiting
  • postural hypotension
  • mental disturbances
  • choreiform movements
19
Q

Ropinirole, Pramipexole, and Rotigotine

A

newer non-ergot dopaminergic agonists that target D2 and D3 receptors
now being used as first line drugs
less severe side effects
Rotigotine is a new long-acting patch product

20
Q

Amantadine (activity, side effects)

A

antiviral agent
stimualtes release of dopamine
side effects:
mental disturbances, choreiform movements

21
Q

Selegiline

A

selectively inhibits MAO-B and prevents breakdown of dopamine in CNS

22
Q

Entacapone and tolcopone

A

inhibit metabolism of dopamine and l-DOPA by COMT
provide more sustained blood level of I-DOPA

23
Q

Anticholinergic drugs

A

effective in milk parkinsons
more effective agonist tremor than rigidity
side effects: dry mouth, constipation, dry hot skin, blurring of vision