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Pharm test 3 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

Patho of Parkinson’s Disease?

A

degeneration of substantia nigra

loss of DA producing neurons (opposite of SZP)

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2
Q

As DA decreases, ACh….

A

increases

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3
Q

What is the classic triad?

A

bradykinesia, rigidity, tremor

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4
Q

What is the on-off phenomenon?

A

On - periods of dyskenesia

Off - hypokinesia

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5
Q

What is the treatment?

A

much with DA or ACh

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6
Q

What is Levodopa?

A

naturally occuring amino acid precursor of DA

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7
Q

Why can DA not be given to these patients?

A

rapidly metabolized in the gut, blood, and liver by COMT and MAO, and it will not cross the BB

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8
Q

Why can’t you give IV DA?

A

it cannot cross the BBB – poor lipophilicity

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9
Q

Is L dopa rapidly absorbed across the gut? Then what?

A

Yes. Reaches CNS and is converted to DA by an enzyme

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10
Q

What enzyme converts Ldopa to DA?

A

dopa decarboxylase

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11
Q

Can Ldopa be converted to DA in the periphery? Why is a problem to consume too much Vitamin B6?

A

yes! its converted by Vitamin B6. if pts take in too much Vitamin B6 then it can cause their Ldopa to convert to DA in the periphery, NOT the CNS where they need it.

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12
Q

What are decarboylase inhibitors used for? What is an example?

A

co-administration with L-dopa to avoid peripheral conversion of Ldopa
Carbidopa (won’t cross BBB)

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13
Q

What is the drug that combines Ldopa and decarboxylase inhibitor?

A

Sinemet

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14
Q

interactions of ldopa?

A

non-selective MAOIs - HTN urgency/emergency

antipsychotics- decrease DA

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15
Q

what are MAO inhibitors used for?

A

anti-depressants – inhibits MAO that chews up NTs like DA, serotonin…

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16
Q

Bromocriptine (Parlodel) was what MOA? what is a downside?

A

D2 agonist

it has to be dosed several times a day - rapidly absorbed in the gut

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17
Q

Bromocriptine is often dose with what other drug?

A

l-dopa

18
Q

AEs of bromocriptine?

A

N/V at low doses

hallucinations and confusion at high doses

19
Q

What is another use of bromocriptine?

A

hyperprolactinemia and galactorrhea (DA antagonizes Prolactin)

20
Q

Bromocriptine is used in the emergent treat of what life threatening condition?

A

Nueroleptic Malignant Syndrome - side effect from anti-psych meds like Haladol used to sedate people - decreases DA

21
Q

What are the S/S of NMS?

A

high fever 104.5
increased CPK
Rhabdo
rigidity

22
Q

What is another drug used to treat hyperprolactinemia that is easier to dose?

A

Cabergoline (Dostinex)

23
Q

Pramipexole (Mirapex) is a non-ergot ______. what is it highly effective in treating?

A

D2 agonist

tremor

24
Q

What is another indication of pramipexole?

A

Restless leg syndrome (RLS)

25
Q

What is AE of taking pramipexole?

A

reward seeking behavior - gambling, binge eating, sexual urges

26
Q

Rompinirole is a non-ergot….. How does it compare to pramipexole?

A

D2 agonist

more D2 affinity than P

27
Q

Rotigotine (Neupro) is a…. how is it available?

A

non-ergot DA agonist

transdermal patch available in many strengths

28
Q

AEs of rotigotine?

A

psychosis, acute compulsive behavior

29
Q

Entacapone (Comtan) has what MOA?

A

COMT inhibitor that crosses the BBB and prolongs the activity of L-dopa

30
Q

How is entacapone specifically helpful?

A

adjunct in patients with early l-dopa end of dose phenomenon

31
Q

AE of entacapone?

A

increase incidence of dyskenesia

32
Q

Tolcapone is stimilar to Entacapone but with… why is rarely used?

A

greater lipophilicty and CNS penetration

risk of hepatic necrosis

33
Q

How does Amantidine work? Was it effective for Parkinson’s?

A

Increases the synthesis and release of DA and may also block reuptake.
Not as effective as l-dopa

34
Q

What other use did Amantidine have? What was it called?Was it effective?

A

Anti-viral agent for Influenza A
Rimantidine - hydrophilic analogue
Limited efficacy

35
Q

What are the AEs of Amantidine?

A

insomnia and hallucinations

36
Q

What are some examples of anticholinergic drugs used for parkinsons? What is the father of them all?

A

Diphenhydramine
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Atropine - father

37
Q

What are some anticholinergic side effects?

A 
Tachycardia
dry mouth
constipation
urinary retention
sedation
38
Q

What drug can treat essential/benign tremor?

A

propanolol

39
Q

What drug treats restless leg syndrome?

A

ropinirole, pramipexole

40
Q

what drug is used to treat MS?

A

corticosteroids, interferon-Beta

Pharm test 3 (9 decks)

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