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SHPCPJEN3 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Dyskinesia occurs when patients get too much dopamine

A

T

Decrease levodopa dose; add dopamine agonist ( amantadine ) they cause fewer dyskinesias than levodopa

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2
Q

When you think Parkinson’s we use medications like anticholinergics. Why do we use anticholinergics?

A

Recall balance of ach and DA. If DA levels are low and we give an anticholinergic to decrease Ach we bring the levels to balance.

The main reason we use an anticholinergic is if patient has extrapyramidal side effects ( due typical and atypical antipsychotics and if we have a younger patient that has tremor. **Problem with anticholinergic medications is we cant use in BPH, bladder neck obstruction, myasthenia gravis, glaucoma we can not use anticholinergics here.

•diphenhydramine : ( Benadryl ) : if no benztropine around to tx extrapyramidal you can use this ( comes IM /IV )
•Trihelphenidyl : ( Artane ) : PO
•Benztropine ( Cogentin ) : DOC for drug induced extrapyramidal ( acute dystonic reaction ) ( IM /IV /PO)

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3
Q

dopamine precursors

A

Levodopa : you never give levodopa alone. Sinemet : carbidopa levodopa

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4
Q

MAOI- B

A

MAO enzymes metabolize seratonin, dopamine, and epinephrine. Some are more selective MAOI-B

  • selegiline ( eldepryl/ zelapar for Parkinson’s ) ( recall selegiline for depression EMSAM patch once daily )
  • Rasagiline ( azilect )
  • Safinamide ( xadago ) -
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5
Q

Dopamine Reup

A

Amantadine : pretty mild but does increase dopamine and has anticholinergic effect to it.

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6
Q

Dopamine agonist

A
  • bromocriptine ( parlodel )
  • pramipexole ( mirapex/ER )
  • rotigotine ( Neupro ) - a Patch
  • Ropinirole ( Requip/ XL )
  • Apomorphine ( apokyn )
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7
Q

COMT inhibitor

A

COMT Inhibitors : never want to give a COMT inhibitor alone. You give this patients on sinamet ( levodopa Carbidopa ). If you need to allow more of the levodopa not to be metabolized and more to stay in the BBB you can add a COMT inhibitor.
* Stalevo: Carbidopa + levodopa + ENTACAPONE

COMT inhibitor:
• Entacapone
• Tolcapone ( major hepatotoxicity so mainly we use entacapone )

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8
Q

DOC in tx of antipsychotic induced pseudo Parkinson’s

A

Anticholinergic drugs

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9
Q

Additive anticholinergic agents

A

DDIs

-atropine
-scopolamine
-TCA’s
-Dicyclomine ( Bentyl )
- Hyoscyamine

Additive CNS side effects: confusion, hallucination, memory impairment
-anti SLUDGE

Tachycardia , constipation

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10
Q

Sinemet

A

Carbidopa / Levodopa : carbidopa allows levodopa to NOT BE metabolized in the periphery so you can have more in BBB

First line agent with older patients

CR, ER , ODT

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11
Q

Need at least 75 mg of carbidopa a day to block enzyme ( dopa decarboxylase in periphery )

A

T so you can benefit of increase of dopamine in brain.
Some patients need up to 200 mg carbidopa a day

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12
Q

Rytary

A

IR + ER beads of ( carbidopa / levodopa ) in a capsule. Works within 1 hour and lasts 6 hours

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13
Q

If you go from non CR carbidopa + levodopa to CR you must _____ dose by _____

A

Increase dose by 10 - 30%

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14
Q

What is the rate limiting factor of using carbidopa levodopa ?

A

Dyskinesia ( 80% at 1 year : major limiting factor in dosing )

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15
Q

carbidopa levodopa counseling point. With food?

A

Avoid high protein. Intestinal protein will compete with levodopa and decrease levodopa’s effectiveness. Take protein at a different time. Take with food for GI effects but less protein

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16
Q

Drugs to avoid in patients with Parkinson’s?

A

Drugs that decrease dopamine

1) antipsychotics : haldol : decreases dopamine
2) Reglan : blocks dopamine
3) phenothiazines ( prochlorperazine ) : blocks DA
4) avoid combination of non selective MAOIs: increase DA, NE nad seratonin: too much dopamine in system: HTN crisis
Also caution with MAOI ( Linezolid , tedizolid , Procarbazine )

5) iron : chelates to levodopa

6) pyridoxine ( VB6 ) not a problem with added carbidopa

17
Q

Cyclobenzaprine chemically structurally looks like…

A

TCAs which looks like carbamazepines.

DDI similar. Dont give with MAOIs

18
Q

Amantadine

A

Symmetrel

An antiviral drug that acts as antagonist at N-methyl-D- aspartame ( NMDA ) receptors

Used to be used for influenza A however due to resistance no longer recommended.

•MOA : it increases dopamine and is slightly anticholinergic for use in Parkinson’s
100% renally excreted

19
Q

If younger patient gets parkinsons you should start with

A

Dopamine agonists instead of carbidopa and levodopa. Why? Bc carbidopa levodopa have a high chance of dyskinesia so thats why we wait to use those later on disease state.

You can use dopamine agonist in combination with other medications

20
Q

Anytime you increase dopamine you have increase chance of orthostatic hypotension

A

T

Yes because when you increase dopamine you have increased vasodilatory effects so you get more orthostatic hypotension.

Also with dopamine agonists you need to worry about dose dependent peripheral edema. May increase chance of heart failure.

21
Q

When you increase dopamine you decrease prolactin

A

T and vice versa

Recall antipsychotics for schizophrenia ( Aripiprazole, Risperidone, paliperidone, asenaphine these all block dopamine so increases prolactin. Worst was Risperidone )

So in schizophrenic patients I’m blocking dopamine ( increase prolactin ) but in Parkinson’s patient I’m increasing dopamine ( decrease prolactin )

Thats why bromcriptine ( parlodel ) a parkinsons drug also used for hyperprolactinemia

22
Q

When you increase dopamine you decrease prolactin

A

T and vice versa

Recall antipsychotics for schizophrenia ( Aripiprazole, Risperidone, paliperidone, asenaphine these all block dopamine so increases prolactin. Worst was Risperidone )

So in schizophrenic patients I’m blocking dopamine ( increase prolactin ) but in Parkinson’s patient I’m increasing dopamine ( decrease prolactin )

Thats why bromcriptine ( parlodel ) a parkinsons drug also used for hyperprolactinemia

23
Q

Apomorphine causes severe nausea. Can you use Ondansetron?

A

NOOO

Ondansetron and other serotonin agonists and apomorphine can causes severe hypotension and loss of consciousness

24
Q

Prochlorperazine and metoclopramide should be avoided in Parkinson’s patients because

A

We want to avoid dopamine antagonists in parkinsons

25
Q

Requip ; Requip XL

A

Ropinirole

26
Q

Mirapex ; Mirapex ER

A

Pramipexole

27
Q

Parlodel

A

Bromocriptine

28
Q

Cogentin

A

Benztropine

29
Q

Apokyn

A

Apomorphine

30
Q

Selegline

A

Eldepryl and Zelapar( ODT ) for parkinsons

Emsam : MDD

31
Q

Non selective MAO inhibition can cause what issue?

A

Can causes a hypertensive crisis

32
Q

Zelapar

A

Selegline : irreversible inhibitor of MAOB

33
Q

Azilect

A

Rasagline

34
Q

Artane

A

Trihexyphenidyl: anticholinergic agent

SHPCPJEN3 (13 decks)

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