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PHRM 845 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q
A

dopamine

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2
Q
A

carbidopa

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3
Q
A

L-DOPA

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4
Q
A

selegiline

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5
Q

PD symptoms

A

tremor
rigidity
akinesia (slow movement)
postural instability

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6
Q

PD is characterized by ___

A

loss of dopamine neurons in substantia nigra

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7
Q

studies suggest that 50% of ______ or 70-80% of ____ in striatum are lost before patients present with motor symptoms

A

dopamine neurons
nerve terminals

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8
Q

PD can be characterized by presence of what ?

A

Lewey bodies

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9
Q

what is a Lewey body

A

spherical protein deposit that is enriched with protein alpha synuclein

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10
Q

where are Lewey bodies found

A

substantia nigra, cortex

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11
Q

stages of Braak and what is it

A

Braak is measure of spreading aloha synuclein
1. brainstem
2. raphe
3. substantia nigra
4.meocortex/thalamus
5. neocortex/prefrontal cortex
6. entire neocortex

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12
Q

basal ganglia includes what

A

striatum and globus pallidus

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13
Q

striatum includes what

A

caudate nucleus and putamen

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14
Q

signaling from the substantia nigra to ______ receptors in the striatum favors ____

A

D1 and D2 receptors
thalamocortical signaling
(this is disrupted in PD)

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15
Q

antimuscarinic used in PD

A

benztropine

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16
Q

loss of dopamine results in ____ activity the cholinergic pathway

A

excess

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17
Q

why is there a bioavailability difference in L-DOPA and dopamine

A

L-DOPA can cross BBB
dopamine positive at pH 7

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18
Q

L-DOPA side effects

A

nausea, hypertension, psychosis

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19
Q

how can we lower a dose of L-DOPA?

A

add carbidopa which is peripherally acting DDC inhibitor

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20
Q

carbidopa MOA

A

inhibits Dopa decarboxylase in periphery, does not penetrate BBB

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21
Q

we can eliminate on/off ausciltations with L-DOPA therapy how

A

continuous administration of L-DOPA with infusion

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22
Q

if we cant convert L-DOPA to dopamine what can we use?

A

dopamine agonists - postsynaptic dopamine receptors are still present in striatum

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23
Q

what is apomorphine

A

D1/D2 dopamine agonist

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24
Q

apomorphine MOA

A

relieves off state rapidly but causes vomitting

25
Q

non-ergoline dopamine agonists

A

ropinirole, pramipexole, rotigotine

26
Q

non-ergolines are what

A

D2/D3 agonists with fewer side effects than ergolines

27
Q

dopamine agonist that is a patch

A

rotigotine

28
Q

MAO-B inhibitors irreversible

A

selegiline
rasagiline

29
Q

MAO-B inhibitor reversible

A

safinamide

30
Q

COMT inhibitors

A

entacapone
tolcapone
opicapone

31
Q

COMT inhibitors MOA

A

inhibit methylation 3-OH group of dopamine

32
Q

which drugs inhibit COMT to decrease metabolism of L-DOPA in the periphery

A

entacapone
opicapone

33
Q

which drugs inhibit COMT in CNS to keep CNS dopamine levels high

A

tolcapone

34
Q

L-DOPA, carbidopa, and entacapone combo drug

A

Stalevo

35
Q

cardinal sign of parkinsons

A

bradykinesia (slow movement)

36
Q

non motor symptoms of parkinsons

A

anxiety, depression
constipation
dementia
insomnia
orthostatic hypotension
psychosis / delirium
sexual dysfunction

37
Q

1st line before adding an agent

A

rule out drug induced PD

38
Q

drugs that could worsen/cause sx of PD

A

antipsychotics, metoclopramide, prochlorperazine, promethazine

39
Q

dopamine precursors hold a higher risk of what?

A

dyskinisias (abnormal movement)

40
Q

first line agents

A

dopamine precursors
dopamine agonists
MOA inhibitors

41
Q

when to use dopamine agonist as first line

A

if < 60 years and high risk for dyskinesias

42
Q

when to avoid dopamine agonists

A

> 70
history CID, cognitive impairment, daytime sleepiness, hallucinations

43
Q

therapy should be initiated with ___ dosage form at ____ dose

A

IR, lowest dose

44
Q

dopamine precursors and side effects

A

levodopa and carbidopa
motor fluctuations, dyskinesias, hallucinations

45
Q

carbidopa/levodopa dosing

A

25/100 mg PO BID-TID with meals
increase to 5-6 x per day

46
Q

dopamine agonists drugs and side effects

A

ropinirole, pramipexole, rotigatone
se: ICD, hallucination, edema
fewer motor fluctuations

47
Q

MAO B inhibitors and side effects

A

selegiline, rasagiline, safinamide
se: n/v, insomnia
risk serotonin syndrome

48
Q

which drugs adjunct for PD depression

A

MAOis

49
Q

selegiline
rasagiline
safinamide
dosing

A

selegiline 5 mg PO BID
rasagiline 0.5 mg PO daily
safinamide 50 mg PO daily

50
Q

COMT inhibitors place in therapy

A

manage symptom fluctuation, wearing offen

51
Q

entacapone side effect

A

brown urine

52
Q

tolcapone side effect

A

hepatotoxicity

53
Q

entacapone
tolcapone
opicapone dosing

A

entacapone 200 mg PO with CD/LD dose
tolcapone 100 mg TID
opicapone 50 mg qhs

54
Q

amantadine use

A

manages peak dose dyskinesias and motor symptoms

55
Q

amantadine dosing

A

100 mg PO BID

56
Q

when can we use anticholinergics

A

<65 yo tremor dominant pts

57
Q

starting dose benztropine

A

0.5 mg PO qhs

58
Q

starting dose trihexphenidyl

A

1 mg PO daily

59
Q

how to treat psychosis in PD

A

clozapine or quetiapine
avoid: olanzapine, halloperiodol, paliperidone, risperidone

PHRM 845 (38 decks)

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