Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacology II Quiz 6 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

0
Q

Classic primary symptoms of PD

A

Tremor
Rigidity
Bradykinesias

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Cause of Parkinson’s Disease (PD)

A

Changes in the substantia nigra and striatum occur and decreased levels dopamine are a result.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MOA PD

A

Dopamine disappears in presynaptic terminal and post synaptic cleft.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PD Drug therapy aims to

A

Increase amount of dopamine in the CNS

Decrease acetylcholine levels or block acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

When dopamine decreases acetylcholine…

A

… increases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you decide pharmacological therapy for PD?

A

Note nothing provides neuroprotection.

Choose either Levodopa or dopamine agonist.

Levodopa predominates in the market and is the “old” one in the crowd.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Levodopa is never prescribed…

A

… by itself.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the keys to managing PD therapy

A

Individualized - Provider’s judgement.

No therapy is disease-modifying. It will continue to progress as it is a progressive disease.

When to initiate:

- A diagnosis or symptom manifestation? - When you have a definitive diagnosis.
- Levodopa- start early or delay? -
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Why wouldn’t you start Levodopa too early?

A

Levodopa must turn into Dopamine (A to B) and throws off extra electrons causing damage to surrounding tissues. If you start therapy early and buy the theory of free radical formation it could quite possible make PD worse.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Dopamine Precurser Class Drug

A

L-Dopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

MOA of Levodopa

A

Levodopa passes the blood brain barrier (Dopamine cannot!) into the CNS and brain where it needs to work.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What percentage of Levodopa ends up in the brain?

A

1-3%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Where does metabolism of levodopa occur?

A

Outside CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How can you improve Levodopa penetration into the brain?

A

Make the dose smaller - 10% can enter the brain and less metabolism occurs in the GI tract or peripheral tissues (toxicity).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is the extended release tablet of Levodopa absorbed?

A

Extended release is less completely absorbed.

Start with immediate release then review options for combined therapy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is notable about discontinue Levodopa (dopamine precurser)?

A

Abrupt withdrawal may result in neuroleptic malignant syndrome.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Immediate release Levodopa may cause…

A

… waxing and waning.

Motor fluctuations, dyskinesias, abnormal cramps/postures (dystonia)

Good days vs bad days which is due to progressive degeneration of dopamine terminals.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

To decrease waxing and waning…

A

… you can add immediate release Levodopa to the extended release Levodopa.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Adverse Drug Reactions of Levodopa

A

Nausea

Somnolence, dizziness, headache.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Older patients on levodopa may experience…

A

… confusion, hallucinations, delusions, agitation, psychosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Does Levodopa cause neurotoxicity?

A

Possibly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Dopamine Precursor class drug

A

Levodopa/carbidopa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Levodopa/carbidopa

A

Levodopa/carbidopa
X/X dose (variable)
every 8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Dopamine Agonists

A

Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
On the prescription for levodopa/carbedopa the smaller number is for ...
carbedopa
25
Which dopamine agonists comes as a patch?
Rotigotine (Neupro)
26
MOA of dopamine agonists
Exploit structure activity relationship. Molecules look like dopamine and pass through the blood brain barrier. NOT DONE - COMPLETE
27
Choice agent of dopamine agonists
Dopamine agonist patients more likely to develop side effects when compared to levodopa use - Pt more likely to discontinue therapy.
28
Do dopamine agonists have withdrawal syndrome?
Yes - same as dopamine precurser.
29
ADRs of Dopamine Agonists
``` Postural hypotension Hallucinations Nausea Somnolence Worsen dyskinesias ``` Unique side effect: Induces compulsive behavior. - Pathologic gambling. - Compulsive shopping. - Compulsive sexual behavior.
30
Requip XL
Requip XL 12 mg two tablets once a day
31
Dopamine Agonist class drug
Requip XL
32
MAO-B inhibitors
Rasagiline (Azilect) | Selegeline (Eldepryl)
33
MOA of MAO-B inhibitors
MAO-B can break down dopamine products. If you inhibit MAO-B free-floating dopamine is less likely to be broken down. Inhibition of enzyme MAO-B. More dopamine available to support nerve transmission.
34
Does MAO-B monotherapy reduce disease progression?
By themselves they do not have the same effect as other products (dopamine precursors, dopamine agonists). Is this a neuroprotective agent? Maybe? No one can prove it occurs but some clinicians try to add it on early as it is a complimentary agent.
35
Do MAO-B inhibitors increase cancer risk?
Increased cancer risk accompanies Parkinson's - probably not the drug.
36
Drug interactions for MAO-B inhibitors
Tramadol Methadone Cyclobenzaprine St.John's Wart MAO-B increases drug effect of these drugs as they are not metabolized and can cause toxicity.
37
ADRs of MAO-B inhibitors
Insomnia, nervousness confusion Nausea Orthostatic hypotension
38
When should you take your MAO-B? Soledjeline
Morning and Lunchtime
39
MAO-B inhibitor class drug
Azilect
40
Azilect
Azilect 1 mg once daily
41
What does Amantadine do?
``` Old drug - no one really does research on it and it may... increase dopamine release inhibit dopamine reuptake stimulate dopamine receptors etc... ```
42
Kinetics of Amentidine
Renal dose adjustment with lowest level dosing at 200 mg every 7 days
43
Benefits of Amantidine
Transient Short-term treatment in mild disease Temporary "add-on" in advance Parkinsons Not used in frontline therapy.
44
If the PD patient's primary complaint is rigidity prescribe...
Amentidine
45
ADRs of Amentidine
Pretty well toelrated with low sie effect profile: -CNS: Confusion, hallucinations, nightmares. Caution with patients with pre-existing psychiatric diagnoses. Anke edema Livedo NOT DONE
46
Amantadine
Amantadine 100 mg Twice a day
47
Anticholinergics
Benztropine (Cogentin) | Trihexyphenidyl (Artane)
48
MOA of anticholinergics
Blocks acetylcholine receptor.
49
What must you dopamine and acetylcholine levels?
Level them out. As dopamine decreases you must decrease acetylcholine.
50
Anticholinergics work well when trying to...
... control tremor.
51
Be careful using anticholinergics when...
... the pt has a CV condition.
52
Anticholinergics are good for...
Slow resting tremor. Monotherapy in patients less than 70 yo with no significant akinesia or gait disturbance.
53
ADRs of anticholinergics
Tachycardia Constipation, urinary retention Hypotension CNS effects such as disorientation, hallucinations, toxic psychosis
54
Anticholinergic class drug
Trihexyphenidyl
55
Trihexyphenidyl
Trihexyphenidyl 2 mg XXXXX
56
COMT inhibitors MOA
Stop COMT from breaking down dopamine
57
COMT Inhibitors
Tolcapone (Tasmar) | Entacapone (Comtan)
58
COMTs are always combined with...
.. Levodopa.
59
When do you use a COMT inhibitor?
Always an addition to levodopa/carbidopa. Assist when motor fluctuations; "off" periods
60
ADRs of COMT inhibitors
Heightened reactions from levodopa/carbidopa Historic issue with hepatotoxicity
61
Practice parameters for Parkinson's Disease from American Academy of Neurology
Reduction of "off" time: use rasagiline, entacapone, pramipexole, Ropinirole. No one agent is better than the others. Dyskinesias? Consider amantadine. Levodopa does not appear to accelerate disease progression. No treatments are neuroprotective. No evidence that vitamins can improve motor function. Exercise may help improve motor function, speech therapy may improve speech volume.
62
Treatment of depression, psychosis, and dementia in Parkinson disease:
Screening tools should be used for detection of depression. Screening tools should be used for detection of dementia.

Pharmacology II Quiz 6 (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions