ParkinsonFC Flashcards
Parkinson Disease pathophysiology
Neurons in the substantia nigra die or become impairedDopamine production decreases
symptoms of parkinsons
TRAP symptoms (Tremor, Rigidity, Akinesia, Postural instability)Other signs: small, cramped handwriting; shuffling walk; stiff facial expression; reduced eye blinking; muffled speech; drooling; constipation; incontinence
Drug-Induced Parkinson Disease is based on what aspect of drug delivery?
Dose dependent
which medications can cause parkinsons or be a risk factor?
Phenothiazines (prochlorperazine)
First generation antipsychotics (haloperidol)
Second generation antipsychotics (paliperidon, risperidone)
Metoclopramide
Cholinesterase inhibitors used for dementia (donepezil, rivastigmine) can worsen symptoms
Initial Therapy Selection parkainsons
Carbidopa/levodopa (Sinemet) is most effective for elderly
Anticholinergic for tremors in younger patients
Amantadine for tremors in younger patients
Carbidopa/Levodopa (Sinemet) MOA
levodopa is a precursor of Dopamine, Carbidopa inhibits breakdown of levodopa
can you crush the sinemet tab?
SR tab can be cut into half (do not crush)
what is the effective dose for sinemet
70-100mg of carbidopa is required to be effective
how long does it take for sinemet to be effective?
May take several weeks for full effects (do not stop abruptly)
sinemet SE?s
SE: Nausea, vomiting, dry mouth, dizziness, orthostasis, dyskinesias, dystonias, confusion, hallucinations, psychosis, dark urine, saliva or sweat, unusual sexual urges, priapism
what do you need to separate sinemet from?
Separate from iron and protei
Di of sinemet ?
DI: MOAIs, Dopamine blockers, and iron & protein can decrease absorption
Entacapone (Comtan) moa and use
COMT Inhibitor: used only with levodopa to increase duration of action
levodopa/Carbidopa + entacapone (Stalevo)
entacapone Ses
SE: Nausea, dizziness, orthostasis, hypotension, dyskinesia, dark urine, diarrhea
entacapone dosing?
Dose: 200mg with each dose of levadopa/carbidopa
why is tolcapone not used much?
Tolcapone (Tasmar) not used much due to hepatotoxicity
Pramipexole (Mirapex) moa
Dopamine agonist
pramipexole dosing
Titrate dose slowly: start 0.125mg TID (dose adjust if CrCl <60)
pramipexole Ses
SE: drowsiness, Nausea, vomiting, dry mouth, dizziness, orthostasis, peripheral edema, hallucination, dyskinesias, falling asleep during routine activity, renal damage
what is another indication of pramipaxole?
IR also approved for restless leg syndrome
Ropinirole (Requip)
Dopamine agonist
se of ropinirole
SE: drowsiness, Nausea, vomiting, dry mouth, dizziness, orthostasis, peripheral edema, hallucination, dyskinesias, falling asleep during routine activity, renal damage
dosing of ropinirole
Titrate dose slowly: start 0.25mg TID
another indicaiton of ropinirole
IR also approved for restless leg syndrome
Rotigotine (Neupro) MOA
Dopamine agonist (patch)
se of rotigotine
SE: peripheral edema, drowsiness, headache, fatigue, orthostasis, sleep distubance, hallucinations, hyperhidrosis, dyskinesias, arthralgias
how to apply rotigotine patch
Apply once daily, at same time (stomach, thigh, hip, side of body, shoulder, or upper arm)
Do not apply to same site for at least 14 days
do not Apply heat source over patch
Remove patch prior to MRI
another indication for rotigotine
approved for restless leg syndrome
Apomorphine (Apokyn) MAO
-Dopamine agonist (SQ injection): used as a “rescue” movement agent during “off” periods
how frequent and when to use the apomorphine med?
-Used during “off periods” up to 5 times/day
apomorphine CI
-CI: use with 5HT-receptor antagonist (ondansetron, granisetron, etc.)
apomorphine Se
SE: severe Nausea and vomiting, hypotension, yawning, dyskinesias, somnolence, dizziness, QT-prolongation
which med must you use before using apomorphine
start using trimethobenzamide (Tigan) before using this drug
dose of apomorphine
Dose: start 0.2mL SQ injected up to 5x/day
Amantadine (Symmetrel) MOA
Dopamine reuptake Inhibitor
when to use amantadine
used for mild disease, or dyskinesias
side effects of amantidine
SE: Nausea, dizziness, insomnia, toxic delirium, cutaneous reaction called livedo reticularis
dosing of amantadine
-Dose: 100mg BID-TIDdecrease Dose in renal impairment
MOA-B Inhibitors names
-Selegiline (Eldepryl, Zelapar-ODT, Emsam), Rasagiline (Azilect)
when to use rasagiline for therapy?
Rasagiline can be used as initial monotherapy or adjunctive
DI of MAOIs
DI: meperidine, tramadol, methadone, dextromethorphan, St. John’s wort, mirtazapine, cyclobenzaprine
Centrally-Acting Anticholinergics names
Benztropine (Cogentin), trihexyphenidyl
use of centrally acting anticholinergis
-Used primarly for tremor in young; aviod in elderly
SE of centrally acting anticholinergis
SE: dry mouth, constipation, urinary retention, blurred vision, drowsiness, confusion, tachycardia
