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pharmacy 358 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Pathophysiology of parkinsons?

A

progressive death of dopamine neurone in substantial nigra (basal ganglia)

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2
Q

Role of dopamine in parkinsons?

A

important for smooth, controlled movements

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3
Q

Protective factors for parkinsons?

A

smoking, high coffee use
intense exercise

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4
Q

Hallmark movement sx of parkinsons?

A

Tremor
Rigidity
Akinesia
Postural instability

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5
Q

What do you need for diagnosis of parkinsons?

A

bradykinesia, tremor or rigidity, dopamine helps

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6
Q

What patients usually get tremors?

A

younger and more slow progression

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7
Q

What patients get the rigid subtype?

A

older and much more rapid progression

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8
Q

What can cause sx similar to parkinsons?

A

dopamine blocking agents such as AP and metoclopramide

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9
Q

When is parkisnons atypical?

A

if no response to levodopa

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10
Q

Other types of parkinsons?

A

Vascular and secondary due to other substances

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11
Q

Medications that can cause Parkinsonism?

A

antipsychotics
metoclopramide
lithium
VA

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12
Q

What antinauseant has less affects on dopamine?

A

domperidone

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13
Q

What AP has less risk for Parkinsonism?

A

quetiapine, clozapine

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14
Q

Sx of Parkinson’s in early stage?

A

loss of smell
constipation
depression
fatigue
act out dreams
flat affect
soft speech, dry eyes

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15
Q

What are later parkinsons sx?

A

hallucinations
drooling
sex dysfunction
urinary incontinence
orthostatic hypotension
dementia

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16
Q

Treatment to reduce progression of PD?

A

NONE

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17
Q

Non pharm for PD?

A

Physical/occupational therapy
speech therapy
psych support
hearing/vision/ dental care

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18
Q

Why use carbidopa/benserazide?

A

prevents conversion of levodopa to dopamine outside the brain= better efficacy and a/e

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19
Q

What is levodopa best for?

A

bradykinesia and rigidity
benefit in 2 weeks

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20
Q

What sx is levodopa not good for?

A

tremor, balance and non motor sx

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21
Q

Why do you need to taper off parkinsons meds if needed?

A

neurolep[tic malignant syndorme

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22
Q

Why titrate slow of levodopa?

A

nausea and gi sx

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23
Q

What to avoid congesting with levodopa?

A

protein, iron, antacids

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24
Q

S/e of levodopa?

A

gi
dizzy
fatigue
vivid dreams

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25
Q

What happens after around 5 years of levocarb treatment?

A

doesn’t last as long
inability to move
dyskinesias

26
Q

When is dyskinesia the worst on levocarb?

A

after a dose

27
Q

Other formulations of Levocarb?

A

enteral PEG J tube-continuous
intestinal gel
subcut infusion-continuous

28
Q

Dopamine agonist drugs?

A

bromocriptine and carbergoline, pramipexole, ropinirol
rotigotine

29
Q

Why do we never use bromocriptine and carbergoline?

A

ergot= pulmonary and cardio toxicity

30
Q

Place in therapy for dopamine agonists?

A

usually younger due to tolerability in older
‘save’ levodopa

31
Q

S/e of Dopamine agonists?

A

gi, ortho hypo, hallucination, confusion= WORSE than levodopa

drowsy
impulse control disorders!!!!!!

32
Q

HUGE s/e of dopamine agonists/

A

impulse control issues= gambling, sexual, compulsive buys

33
Q

Where is place for apomorphine?

A

VERY potent dopamine agonist for rescue of freezing
bad nausea though

34
Q

What causes dose changes for pramipexole?

A

renal issues

35
Q

Are dopamine agonists better than levocarb?

A

No

36
Q

Which MAO for parkinsons?

A

B

37
Q

MAO-B drugs?

A

selegiline and rasagiline

38
Q

Do we need to worry about diet with MAO-B?

A

No as long as at PD doses

39
Q

PLace in therapy for MAO-B?

A

only for mild
fewer s/e and less frequent dosing
may be used later to manage motor complications of levodopa

40
Q

When to take MAO-B?

A

morning to prevent insomnia/ vivid dreams

41
Q

Important DI of MAO-B?

A

SSRI- serotonin syndrome but is rare, DONT freak out

42
Q

Bad OTC to use with MAO-B?

A

DM in cough suppresants= serotonin syndrome

43
Q

How does entacapone work?

A

COMT inhibitor= stops breakdown of levocarb in periphery

44
Q

What other drug must you be on if on entacapone?

A

levocarb duhhhh

45
Q

S/e of entacapone?

A

gi
turn urine and sweat orange

46
Q

Dose adjustment if adding entacapone?

A

about 30 percent

47
Q

Purpose of amantadine?

A

for bothersome dyskinesias later in disease course

48
Q

S/e of amantadine?

A

nausea, confusion, hallucinations

49
Q

What treatment for tremor in parkinsons?

A

anticholinergics

50
Q

Why don’t we generally use anticholinergics in parkinsons?

A

bad in older people

51
Q

What anticholinergics for PD?

A

benztropine, trihexylphenidyl, procyclidine

52
Q

What can we do if issues of dyskinesia on levocarb?

A

smaller more frequent dosing, add MAO or amantadine

53
Q

What can we do to help constipation in PD?

A

PEG or domperidone

54
Q

What can we do for depression in PD?

A

NO bupropion
give citalopram, sertraline, venlafaxine, duloxetine

55
Q

If we do need drugs for orthostatic hypotension what can we do?

A

fludricortisone, domperidone
midodrine

56
Q

If ED is an issue what can we do?

A

PDE5i- not if on ergot

57
Q

What can we do for sialorrhea (less swallowing)

A

chew/suck on something
ipratropium

58
Q

What can we do for better sleep?

A

melatonin, dose-in, trazadone

59
Q

If sleep moving disorder what should we do for that?

A

NO hs AD dosing
give melatonin or benzo

60
Q

How can we improve restless leg syndrome?

A

hs dopamine therapy, gabapentin or pregabalin

61
Q

If hallucinations what can we do?

A

clozapine but bad s/e
quetiapine

62
Q
A

pharmacy 358 (16 decks)

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