Parkinson's Generic/Brand

Question 1

Parkinson’s Disease

- Cause

Answer 1

• Due to depletion of dopamine => tx is to restore dopamine/Ach balance

Question 2

Eldepryl

• MOA
• Indication
• dose
• SEs
• C/I

Answer 2

Selegiline

• MOA: MAOI-B => inhibit the reuptake of DA.
  Reduces “on-off” of levodopa
• Indication: adjunct to levo/carbidopa
• Dose: 5mg QAM n QNOON. Max 10mg qd.
  Do not exceed max rec dose.
• SEs: N/V, vivid dreams, hallucination, confusion, insomnia, orthostatic hypoTN
• C/I: meperidine

Question 3

Azilect

• MOA
• Indication
• Dose
• Do not use with
• Precaution
• SEs

Answer 3

Rasagiline

• MOA: MOAI-B => inhibit the reuptake of DA. Reduces “on-off” of levodopa
• Indication: monothrapy or adjunct w/ levodopa
• Dose: 0.5-1 mg QD

Do not use with:

• Liver disease
• Adrenal gland tumor (pheochromocytoma)
• 14 days b/4 surgery
• Meperidine
• Tramadol
• Propoxyphene
• Methadone
• Dextromethorphan, pseudoephedrine, or phenylephrine
• St. John Wort
• Mirtazapine
• Cyclobenzapine
• Amphetamines
• MAOI
• TCAs, SSRIs, SNRIs, MOAIs

Precaution

• Avoid tyramine rich foods
• Mild hepatic impairment

SEs

• Postural hypoTN
• Flu sx
• Depression
• GI upset

Question 4

Symmetrel

• MOA
• Indication
• SEs

Answer 4

Amantadine

• MOA: Dopamine re-uptake inhibitor and anticholinergic
• Dose: 100 QD to 100 BID

SEs

• Insomnia
• Depression
• Irritablity
• Anticholinergic effects
• Hallucinations
• vasoconstriction

Question 5

Artane

• MOA
• Indication
• Dose

Answer 5

Trihexyphenidyl

• MOA: Anticholinergics
• Indication: adjust tx for all forms of parkinsonism.
  DOC for pseudoPK
• Dose: 1mg QD. Max 15mg/day

Question 6

COGentin

• MOA
• Dose

Answer 6

BENZtropine Mesylate

• MOA: Anticholinergics
• Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK

Question 7

Akineton

• MOA
• Indication

Answer 7

Biperiden

• MOA: Anticholinergics
• Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK

Question 8

Larodopa

• MOA

Answer 8

Levodopa

• MOA: Dopamine Precursors.

Question 9

Sinemet

• MOA
• Need how much carbidopa/day
• Dose
• SEs
• C/I
• DDI

Answer 9

Carbidopa/Levodopa

• MOA: Carbidopa inhibits peripheral dopa decarboxylation to levodopa to dopamines (which doesn’t cross BBB) => increase levodopa level gets into brain.
• Need 75mg of carbidopa to block enzyme
• Dose: start 1 tab 25/100 (carbi/levo) PO TID, increase to max 8 tabs (200 crab/800 levo)

- SEs: 
  Psychosis
  Akinesia: DA
  Dyskinesia: DA
  HypoTN
  Aphrodisias: hypersexuality 

• Caution
  Cardiac abnormalities
  Dietary proteins: take at different time than Sinemet)
• C/I:
  Lactation: incre DA = decrease prolactin
  Narrow angle glaucoma

DDI

• anticholinergic: decrease gastric emptying
• Antipsychotics: decrease DA
• Reglan: blocks DA
• Phenothiazine: block DA
• Pyridoxine (Vit B6): increase SEs
• Food: reduce abs
• Tacrine: inc LFTs
• Iron: chelates to levodopa
• MAOI: HTN crisis
• St. John Wort

Question 10

COMpazine

Answer 10

PROchlorperazine

Question 11

Parlodel

• MOA
• Indication
• Dose
• Dose adjust:
• SEs
• Cautions for all dopamine agonist
• Other agents

Answer 11

Bromociptine

• MOA: dopamine agonist stimulate DA receptor and alpha blocking activity
• Indication: PK mono therapy or adjunct , hyperprolactinemia
• Dose: 1.25mg BID up to 100mg/d
• Dose adj: ok to use in renal failure
• SEs: H/V, HA, hallucination, hypoTN

Cautions:

• Dose depending on peripheral edema
• Increase change of HF
• Falling asleep during activity
• Compulsive behaviors

Other agents:

• Pramipexole (mirapex)
• Rotigotine (Neupro): patch
• Ropinirole (Requip)
• Apomorphine (Apokyn) => SC injection

Question 12

MiraPEX

• MOA

Answer 12

PramiPEXole

• Dopamine agonists

Question 13

Neupro

• MOA
• Indication
• Form
• Frequency

Answer 13

ROTigotine

• MOA: Dopamine agonists
• Indication: PK, restless legs syndrome
• Dose: patch Q24H
  PK: 2mg/24H to 8mg/24H
  RLS: 1mg/24H to 3mg/24H

Question 14

Requip

• MOA
• Dose
• Avd

Answer 14

ROPinirole

• MOA: Dopamine agonists
• Dose: 0.25mg TID. Max 24mg/d
• Adv: good for pts with hypoTN or falls

Question 15

Apokyn

• MOA
• Indication
• Dose
  Instruction
• SEs

Answer 15

APOmorphine => SC injection

• MOA: Dopamine agonists
• Indication: treat “wearing-off” episodes in ppl w/ adv PK
• Dose: Start 0.2mL. Max 0.6mL
  1st dose supervise: monitor BP
• Due to severe N/V, initiate antiemetic Tigan (trimethobenamide) 3 days b/4 initiating APOKYN. Then continue Tigan for at least 2mo on therapy.
  ** Use with 5HT2 (ondansetron, etc) are C/I
• SEs: QT prolongation, falling asleep during activity

Question 16

Comtan

• MOA
• Indication
• Dose
• SEs

Answer 16

Entacapone

• MOA: COMT Inhibitor => must be on Sinemet. COMT allows more levodopa to cross the BBB which incr DA
• Indication: adjunct to Sinemet in pots with wearing off effect.
• Dose: Start 200 mg with each Sinemet. Max 8x (1600mg)
• SEs:
  Hepatotoxicity, anticholinergic, GI, hallucination
  Urine discoloration: brownish orange

Question 17

Tasmar

• MOA
• Indication
• Dose
• Avoid
• SEs

Answer 17

TOLcapone

• MOA: COMT Inhibitor => same as above
• Indication: adjunct to Sinemet in pots with wearing off effect and can’t use other alternative therapy
• Dose: 100-200 TID. Max 200 TID
• Avoid: EtOH and hepatitis => fatal hepatic failure
• SEs: same as above

Question 18

Stalevo

• Disadvantage

Answer 18

Carbidopa + Levodeopa + Entacapone

=> Dopa-Decarboxylase inhibitor + Dopamine Precursor + COMT inhibitor

=> May increase risk of prostate cancer

Question 19

Zelapar

Answer 19

Selegiline

• Form: ODT

Question 20

Emsam

• Indication

Answer 20

Selegiline

• Indication: Major depression disorder

Question 21

Tigan

• Indication

Answer 21

Trimethobenzamide

• I: tx N/V of Apomorphine