parkinson's pharm

Question 1

goal

Answer 1

maint motor function for as long as possible -> independence, decrease s/s

Question 2

tm started

Answer 2

if s/s affect dom hand, interfere with work, ADLs, social/leizure functions

Question 3

correct balance btw ADH and dope

Answer 3

increase dope = dopaminergic
decrease ACH = antichol

Question 4

other dopamine agonists

Answer 4

rotigotine = 1/day patch
apomorphine = short acting SQ, fast relief of s (off phase PD)

Question 5

Levodopa/carbidopa

Answer 5

dopaminergic
L: convert to dopamine in brain and activate dopamine receptors
C: block destruction of levodopa before it reaches brain
Most effective drug for PD

Question 6

Levodopa/carbidopa: SE

Answer 6

Due to L
n/v: give low doses with food but this reduces drug abs (don’t give with protein rich food)
dyskinesias: range from annoying to disabiling
CV: postural hypoT change position slowly, dysR – monitor, esp if increasing dose
Psychosis: hallucinations, nightmares, paranoia
Darken sweat and urine (stain), activate malignant melanoma (skin assessment before)

Question 7

Levodopa/carbidopa: nc

Answer 7

Several months to see effect
Not long term – dose wears off, may need shorter dose intervals
Abrupt loss of effect: on-off phenomenon, can occur anytime during dosing interval (impossible to predict), off periods increase over time, can be reduced with drugs and avoiding high protein meals
Drug hx – interactions:
Decrease L: vit B6 (pyridoxine), antipsychotics, protein
Increase L: carbidopa, anticholinergics, MAOis (tox)

Question 8

duopa

Answer 8

dopaminergic
Feeding tube with PD

Question 9

duopa: SE

Answer 9

Interactions: antihtn, antipsych, maoi, metoclopramide, isoniazid, Fe, vits
r/t placement of tube (J tube)
fall asleep w/o warning (impact job), ortho hypoT, hallucinations (visual, auditory, tactile), unusual urges, depression, dyskinesia

Question 10

duopa: nc

Answer 10

Duopa: infused via feeding tube into SI, gel form (suspension), continuous infusion for continuous blood level, up to 16hr/day, for pt that respond to drug but the response fluctuates

Question 11

Pramipexole

Answer 11

Dopamine receptor agonist
Bind D2 receptor
Monotherapy in early PD (younger pt)
Combo with Sinemet in advanced PD
RLS N, sleep attack, pathologic gambling and compulsive behaviors
With levodopa: ortho hypoT, dyskinesias, 2x hallucination risk

Question 12

Ropinirole

Answer 12

Dopamine receptor agonist
Unknown – increase in nerve impulses within substantia nigra
Idiopathic PD
Similar to other PD drugs
Long term use: may increase r/o DM and acromegaly