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Pharm OTL > Parkinson's Drugs > Flashcards

Parkinson's Drugs Flashcards

1
Q

Why does levodopa lose it’s effect later in the progression of Parkinson’s disease?

A

Taken up by dopaminergic neurones in the substantia nigra.

These neurones graduallt die off during the course of Parkinson’s, so can’t work with levodopa.

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2
Q

Why shouldn’t levodopa be taken with high-protein meals?

A

Competes for absorption with amino acids

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3
Q

What is the MoA of DOPA decarboxylase inhibitors?

A

Inhibit DOPA decarboxylase to reduce the conversion of levodopa to dopamine in the gut and peripheries.

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4
Q

Why are levodopa and DOPA decarboxylase inhibitors often prescribed together as one tablet?

A

Increases the amount of levodopa reaching the brain, and reduces systemic side effects of excess dopamine in the body

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5
Q

Name two drugs containing a combination of levodopa and DOPA decarboxylase inhibitor

A
  • Co-careldopa (sinemet)

- Co-beneldopa (madopar)

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6
Q

What is ‘wearing off’?

A

When pts feel like they need another dose before thier next dose is due

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7
Q

State two motor and two systemic adverse effects of levodopa

A
  • Wearing off
  • Dyskinesia
  • Spasms
  • Freezing
  • On/of
  • Nausea and anorexia
  • Dry mouth
  • Hypotension, tachycardia
  • Impulse control disorders,
  • Paranoia, hallucinations
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8
Q

What effect does VitB6 have on levodopa?

A

Increases the peripheral breakdown

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9
Q

Name a monoamine oxidase (MAOI) type B inhibitor

A

Selegiline

Rasagaline

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10
Q

What is the mechanism of action of MAOI type B inhibitors?

A

Inhibits the breakdown of dopamine in the gut and the brain to increase the action of levodopa

MAOI type B inhibitors can be used alone to smooth the motor response

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11
Q

Name a COMT inhibitor

A

Entacapone

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12
Q

What is the MoA of COMT inhibitors?

A

Prevents the peripheral breakdown of dopamine to increase the duration of action of levodopa

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13
Q

Why are COMT inhibitors ineffective without levodopa?

A

Acts peripherally

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14
Q

Which three drug classes does Stalevo consist of?

A

Levodopa
DOPA decarboxylase inhibitor
COMT inhibitor

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15
Q

Name two dopamine receptor agonists and their administration routes

A

Rotigotine - patch
Apomorphine - SC
Ropinirole - tablet
Pramipexole - tablet

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16
Q

How do dopamine receptor antagonists compare to levodopa?

A
  • Less effective
  • Fewer motor complications
  • Impulse control disorders e.g. pathological gambling, hypersexuality
  • Hallucinations more common
  • Sedation and confusion
17
Q

Name an anticholinergic

A

Procyclidine
Orphenadrine
Trihexyphenidydyl

18
Q

What are anticholinergics used for in Parkinson’s?

A

Tremor

19
Q

What does deep brain stimulation involve?

A

Stimulation of the subthalamic nucleus

Used in pts who can’t tolerate levodopa, or levodopa doesn’t have much effect anymore

20
Q

What does cutting the thalamus treat?

A

Tremor

21
Q

What does cutting the globus pallidus internus treat?

A

Dyskinesia

22
Q

Name two drugs that can exacerbate myasthenia gravis

A 
Beta-blockers, ACEIs, CCBs
Chloroquine
Succinylcholine
Magnesium
Aminoglycoside and quinilone antibiotics
23
Q

What is a myasthenic crisis?

A

Acute exacerbation when the pt is on no/little treatment

24
Q

What is a cholinergic crisis?

A

Overtreatment leading to too much ACh in the neuromuscular junction. Causes a depolarising block.

Pt presents with the same symptoms as a myasthenic crisis

25
Q

Name an acetylcholinesterase inhibitor

A

Pryridostigmine*

Neostigmine

26
Q

State two side effects of acetylcholinesterase inhibitors

A 
Miosis
SSLUDGE:
- Sallivation
- Sweating
- Lacrimation
- Urinary incontinence
- Diarrhoea
- GI upset
- Emesis
27
Q

State two other drugs that can be used in the management of myasthenia gravis

A

Corticosteroids e.g. prednisolone

Steroid-sparing e.g. azathioprine, mycophenylate mofetil

28
Q

State two treatments for an acute myasthenic crisis

A

Plasmapheresis

IV immunoglobulin

Pharm OTL (18 decks)

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