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pr 3153 > parkinsons > Flashcards

parkinsons Flashcards

1
Q

cardinal symptoms

A

tremor, rigidity, bradykinesia

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2
Q

non-cardinal symptom

A

postural instability

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3
Q

pathophysio

A

Impaired clearing of abnormal INTRACELLULAR PROTEINS by ubiquitin-proteasomal system →

Leads to accumulation of aggressomes, known as Lewy bodies →

Degeneration of dopaminergic neurons with Lewy body inclusions in the substantia nigra →

Dysfunction of nigrostriatal pathway causing movement disorder

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4
Q

direct pathway of loss of dopaminergic input

A

Hypoactivation of excitatory D1 receptors → weakens striatal inhibition of GPi (globus pallidus internal) → hypokinesia

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5
Q

Indirect pathway of loss of dopaminergic input

A

Hypoactivation of excitatory D2 receptors → weakens striatal inhibition of GPe (globus pallidus external)→ hypokinesia

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6
Q

medications associated with drug induced parkinsonism

A

antipsychs (haloperidol, CPZ)
alpha methyl dopa
metocloperamide
tetrabenazine

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7
Q

dopamine agonists moa

A

Mimics action of dopamine by acting on D2 receptors in basal ganglia

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8
Q

dopamine agonists space out with

A

iron, protein

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9
Q

dopamine agonists avoid

A

dopamine antagonists (antipsych, metoclopramide)

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10
Q

examples of ergot derivatives

A

bromocriptine, cabergoline

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11
Q

examples of non ergot derivatives

A

ropinirole (IR/SR), pramipexole (IR/SR), rotigotine

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12
Q

levodopa benefits

A

bradykinesia, rigidity.

less effective for speech and gait disturbances

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13
Q

levodopa food interactions

A

high fat or protein meals. space 2h

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14
Q

side effects of levodopa

A

Dyskinesias
Dystonia
NV (domperidone)
Orthostatic hypoT
Drowsiness
Hallucinations / Psychosis

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15
Q

dopaminergic side effects of dopamine agonists

A

NV
Orthostatic hypoT
Led oedema
Compulsive behaviours
Hallucinations
Somnolence

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16
Q

non-dopaminergic side effects (mostly ergot) of dopamine agonists

A

Fibrosis
Valvular heart disease

17
Q

ropinirole / pramipexole: renal or liver

A

Ropinirole: liver metabolism
Pramipexole: renal clearance

18
Q

maobi moa and examples

A

Irreversible MAOb inhibitors, inhibiting dopamine breakdown
selegiline
rasagiline

19
Q

which has hepatic metabolism to ampetamines, which is stimulating, hence must not be taken at night

A

selegiline

20
Q

maobi or comti preferred for early stage PD

A

maob-i

21
Q

foods to avoid with maobi

A

tyramine, soy sauce, aged cheese, fermented food, beer

22
Q

se of maobi

A

gi: heartburn, loss of appetite
CNS: Anxiety, palpitations, insomnia, nightmares, visual hallucinations

23
Q

comti moa

A

Selective, reversible catechol-o-methyltransferase (COMT) inhibitor, preventing COMT conversion of L-DOPA into inactive form.

24
Q

comti administration requirement

A

Requires concurrent levodopa

25
Q

comti drugs to avoid

A

iron/calcium, concurrent non-selective maobi, warfarin, catecholamine drugs

26
Q

comti side effects

A

dyskinesias upon initiation, potentiation of dopaminergic effects, diarrhoea, urine discolouration (orange)

27
Q

comti benefits

A

decreases ‘off’ time

28
Q

levodopa food interactions

A

high fat or protein meals. space 2h

29
Q

issues with levodopa

A

‘on off phenomenon’: unpredictable and unrelated to dosing’
‘wearing off’: shortened on time
peak dose dyskinesias

30
Q

amantadine moa

A

nmda antagonist and antichol, increases sensitivity of d2 receptors

31
Q

amantadine place in therapy

A

adjunctive and monotherapy (ad)

32
Q

se of nmda

A

Stimulating
Nausea
Light-headed
Insomnia
Confusion
Hallucinations
Livedo reticularis

33
Q

dopamine agonist what to counsel pts/caregivers on

A

compulsive behaviours

34
Q

livedo reticularis is caused by?

A

amantadine

35
Q

which drug class interacts with warfarin

A

com ti

36
Q

example of com ti

A

entacapone

pr 3153 (8 decks)

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