Parkinson's important stuff

Question 1

Chlorpromazine demonstrates _____________ with PD

Answer 1

pharmacotoxicity

Question 2

For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Anxiety
2) Cognitive impairment
3) Depression
4) Drooling

“memorize this”

Answer 2

1) Venlafaxine, SSRIs
2) Eliminate anticholinergic agents, add cholinesterase inhibitor
3) Newer generation SNRI
4) Atropine SL drop, glycopyrrolate, ipratropium SL spray

Question 3

For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Dysphagia
2) Fatigue
3) Hallucinations/ psychosis

“memorize this”

Answer 3

1) Avoid anticholinergic meds
2) Armodafinil, modafinil
3) Dose reduction and/ or elimination of adj. meds, esp. anticholinergics. Consider adding pimavanserin (FDA approved for psychosis in PD too)

Question 4

For each of the following nonmotor Sx of Parkinson’s, list possible Txs:
1) Insomnia
2) Overactive bladder
3) RLS

“memorize this”

Answer 4

1) Non-benzo GABA-A agonists
2) Antimuscarinics
3) Gabapentin; dopamine agonist at bedtime

Question 5

1) What anticholinergic drug is also called Cogentin?
2) Carbidopa/ldopa is also called?
for extra credit, “may be one from this slide”

Answer 5

1) Benztropine
2) Sinemet

Question 6

The dopamine agonist pramipexole is also called ____________ and ropinirole is also called _____________
for extra credit, “may be one from this slide”

Answer 6

Mirapex; Requip

Question 7

Carbidopa/ldopa has what 3 adverse effects?

“specific”

Answer 7

1) Drowsiness
2) Dyskinesias
3) Nausea

Question 8

Only __________________ has an FDA-approved indication for PD psychosis

“This will be a test question”

Answer 8

Pimavanserin

Question 9

Livedo reticularis can be caused by what?

Answer 9

Amantadine

Question 10

What are the 2 really odd side effects of Carbidopa / levodopa (L-dopa)?

Answer 10

1) Priapism (uncommon)
2) Can discolor body fluids (i.e., brown or black)

Question 11

List a unique complication of Carbidopa / levodopa (L-dopa) therapy

Answer 11

“On” period dyskinesias that are involuntary choreiform movements involving usually the neck, trunk, and lower/upper extremities

Question 12

Iron and protein-rich meals decrease the absorption of what?

Answer 12

Carbidopa / levodopa (L-dopa)

Question 13

Monoamine oxidase B (MAO-B) inhibitors: Which are reversible and irreversible?

Answer 13

1) Irreversible: Rasagiline & selegiline
2) Reversible: Safinamide

Question 14

Carbidopa/ldopa:
1) The terms “off” and “on” refer to what?
2) What can be used PRN for rapid relief of acute episodes?
3) What is the usual maintenance dose?
4) What does it reduce?

Answer 14

1) Periods of poor movement (i.e., return of tremor, rigidity, or slowness) and good movement, respectively
2) Apomorphine or a L-dopa dry powder for inhalation
3) 25/100 mg TID
4) Unwanted peripheral conversion of L-dopa to dopamine

Question 15

L-methamphetamine and L-amphetamine are the end products of what?

Answer 15

Selegiline

Question 16

1) Monoamine oxidase B (MAO-B) inhibitors are contraindicated with what due to serotonin syndrome risk?
2) Why is it contraindicated with dextromethorphan?
3) What is it not technically contraindicated in? Should you still avoid concomitant therapy?

Answer 16

1) Meperidine, cyclobenzaprine, linezolid, St. John’s wort
2) Psychosis and bizarre behavior
3) Serotonergic antidepressants; avoid combination; allow washout period of two weeks when stopping MAOI or SSRI / SNRI / TCA

Question 17

What has a very long half-life and requires a five-week washout before using MAO inhibitors?

Answer 17

Fluoxetine

Question 18

Monoamine oxidase B (MAO-B) inhibitors:
1) What from foods may reach excessive systemic levels and increase the pressor response following MAOi ingestion?
2) Give examples of these foods
will be on exam

Answer 18

1) Tyramine
2) Avocado, cheeses, cured meats, beer

Question 19

Entacapone:
1) How much needs to be given? When? Up to how many times a day?
2) Is it hepatotoxic?
3) What are the 2 (weird) adverse effects?

Answer 19

1) 200 mg needs to be given with each dose of carbidopa/L-dopa up to a maximum of eight times per day
2) No hepatotoxicity
3) Brownish-orange urinary discoloration
-Delayed onset of diarrhea (weeks to months later)

Question 20

Brownish-orange urinary discoloration is an adverse effect of what?

Answer 20

Entacapone

Question 21

Dopamine agonist: list 3 non-ergot agonists (safer than ergot-derived) that are practically the same

Answer 21

1) Apomorphine
2) Pramipexole
3) Ropinirole
(the different one is Rotigotine)

Question 22

Out of clozapine, pimavanserin (Nuplazid), or quetiapine, which have/has FDA-approved indications for PD psychosis?

Answer 22

Only pimavanserin

Question 23

1) Which dopamine agonist should be administered subq?
2) What are are common side effects of this drug? What can be done about these?

Answer 23

Apomorphine
2) Nausea and vomiting are common side effects; prior to initiation, pts can be premedicated with the antiemetic trimethobenzamide (Tigan)

Question 24

How do you dose trimethobenzamide (Tigan) for potential apomorphine nausea?

Answer 24

300mg PO TID; start three days prior to use

Question 25

Pramipexole (dopamine agonist)
1) How is it dosed?
2) What are 2 reversible and rare SEs?

Answer 25

1) 0.125 mg TID
Titrate weekly as needed by 0.125 mg per dose; up to 4.5 mg / day
2) Postural deformity and rhabdomyolysis

Question 26

Pramipexole (dopamine agonist) initial dosage must be adjusted in renal insufficiency in what 3 ways?

Answer 26

1) 30-50 mL/min: 0.125 mg twice daily; max 0.75 mg TID
2) 15-29 mL/min: 0.125 mg once daily; max 1.5 mg daily
3) < 15 mL/min: 0.125 mg once daily; max 0.5 mg daily

Question 27

What are the drug interactions of ropinirole with inducers and inhibitors?

Answer 27

CYP1A2 drug interactions
1) Inhibitors: fluoroquinolones
2) Inducers: Cigarette smoking

Question 28

What dopamine agonist is a transdermal patch?

Answer 28

Rotigotine