Parkinsons Flashcards
Death of neurons in what area of the brain cause Parkinson’s
substantia nigra
What neurotransmitter decreases in PD due to neuronal death?
Dopamine
What type of functions does dopamine assist with
smooth, coordinated function
movement
What are the major symptoms
TRAP tremor rigidity akinesia/bradykinesia postural instability
Does PD start unilateral or bilateral?
unilateral then progresses to bilateral
What is the AIMS scale?
measures involuntary movements caused by meidcations
which medications can worsen PD
dopamine blockers phenothiazines (pyschosis) butyrophenones (haloperidol) FGAs and SGAs metoclopramide (renally cleared, can accumulate in elderly)
what is anosmia?
loss of sense of smell
what is an off period in PD
symptoms of disease worsen before the next dose of the med is due
What antidepressants are often used in PD patients?
SSRIs however secondary amine tricyclics could be used if worried about worsening tremors or sertonin syndrome (nortriptyline)
Which drug is preferred in pyschosis in PD patients
quetiapine
low risk of movement disorders s
role of levodopa
assists with movement issues
prodrug of dopamine
most effective agent
Why is carbidopa given with levodopa
prevents peripheral metabolism of levodopa so that it can cross the BBB
Which patient population do we mainly use dopamine agonists first line in?
younger patients
Why are multiple drugs needed in PD
to reduce “off” periods and limit dyskinesias
what can be used to in tremor predominant younger patients
centrally acting anticholinergics
MAO inhibitors can also be used (amantadine)
how are the MAO inhibitors in PD different from the ones used in depression?
they are selective
ones in depression are non-selective and are CI with dopaminergic drugs due to blocking the metabolism
What is our primary treatment goal with PD and the options?
REPLACE DOPAMINE
- give a precursor like Sinemet
- give a dopamine agonist
- give drugs for specific symptoms
what drug can help with the symptoms of resting tremor?
benztropine
Side effects with carb/levo
pyschosis, dyskinesias, orthostasis, dizziness, nausea
darkening of body secretions
When can a COMT inhibitor be initiated?
only if levodopa is on board
it increases the duration of action of levo
COMT inhibitor
Entacapone
warnings with dopamine agonists
sudden daytime sleep attackces
hallucinations
dyskinesias
Which dopamine agonist comes as a patch
rotigotine
list of dopamine agonists
pramipexole
ropinirole
what type of drug is benztropine?
anticholinergic
