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Pharm Test 5 > Parkinsons > Flashcards

Parkinsons Flashcards

1
Q

Which Neuro degenerative disorder is of the extra pyramidal system, and caused by a disruption of neurotransmission within the stratum

A

Parkinson’s disease

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2
Q

What is the mean onset of Parkinson’s disease?

A

57 years

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3
Q

Which gender is more likely to have Parkinson’s disease

A

Male

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4
Q

What is Parkinson’s with the onset younger than 40 years old caused by?

A

Single gene mutations

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5
Q

What is the classic triad of Parkinson’s disease?

A

Tremor at rest, Brady kinesia and muscle rigidity

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6
Q

What are the non-motor symptoms that are associated with Parkinson’s?

A

Depression, dementia, hallucinations, and behavior disorders

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7
Q

How is Parkinson’s diagnosed?

A

Typically by classic presentation in patients that are 55 years or older, would slowly progress, progressive, and asymmetric onset of symptoms.

Diagnosis is confirmed if there is response to Parkinson’s treatment like levodopa or dopamine agonist

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8
Q

What are the two major neuropathic findings in Parkinson’s?

A

The loss of pigmented dopaminergic neurons and the presence of Lewy bodies and a substantia nigra

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9
Q

What two pathways normally connect the basal ganglia and cortex to send motor signals

A

The direct which is excitatory
The indirect which is inhibitory

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10
Q

What causes the access of acetylcholine in patients with Parkinson’s?

A

There’s a decreased amount of dopamine secreted, resulting in excess of acetylcholine

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11
Q

What must be in balance to process information?

A

Dopamine and acetylcholine

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12
Q

What is the primary pharmacological of Parkinson’s?

A

To restore dopamine receptor function

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13
Q

What is the second dairy pharmacological of Parkinson’s?

A

To inhibit Muscarinc cholinergic receptors

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14
Q

What are the six main categories of Parkinson’s drugs?

A

Levodopa, MOAb inhibitors, dopamine receptor agonists, catechol-o-methyl transferase inhibitors, amantadine, anticholinergics

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15
Q

What are the MAOb inhibitors used to treat Parkinson’s?

A

Selegiline and rasagiline

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16
Q

What are the dopamine receptor agonist used to treat Parkinson’s?

A

Pramipexole, ropinirole, rotigotine

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17
Q

What is the most effective Parkinson’s treatment

A

Levodopa combined with carbidopa

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18
Q

Why is levodopa not recommended to take on its own?

A

Has serious side effects that are out balanced by carbidopa

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19
Q

Why is levodopa not recommended in the first sign of Parkinson’s

A

It has a wearing off effect so it is saved until. Patients can no longer complete tasks

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20
Q

What is the first line of treatment for Parkinson’s?

A

MOAbi like selegiline or rasagline

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21
Q

Which MOAb should only be used as an adjunct

A

Selegiline

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22
Q

What is prescribed typically first when symptomatic therapy is needed

A

Dopamine receptor agonist like pramipexole, ropinirole, rotigotine

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23
Q

What are some advantages of dopamine therapy over levodopa

A

They have a longer half-life, a greater bio and some can be administered transdermally

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24
Q

What med is usually added when patient start experiencing the wearing off effect of levodopa therapy

A

Catechol o methyl transferase inhibitors like tolcapone and entacapone

25
Which antiviral can be administered for Parkinson’s symptoms because they are glutamate antagonist
Amantidine
26
What are anticholinergics used in Parkinson’s?
They are typically reserved for the treatment of tremors that is not medically controlled by dopaminergic medication‘s
27
True or false levodopa has a large first pass effect and only reaches one percent of the brain
True
28
What can delay the absorption of levodopa?
Ingestion with proteins
29
What are the adverse effects of levodopa?
Nausea, anorexia, hypotension, dyskinesia, psychosis, agitation, vivid dreams, insomnia, and the wearing off and on effect
30
What helps to improve the wearing off of fact of levodopa
Adding a dopamine receptor agonist
31
How do MAO – B inhibitors work to treat Parkinson’s
The inhibit mono mean oxidation type, B, which prevents oxidation and destruction of dopamine and intern increases dopamine levels
32
What are the adverse effects of MAO – B inhibitors
Hypertensive crisis, hypothermia, extra pyramidal symptoms, insomnia, hallucinations, orthostatic hypotension, nausea, and headache
33
What medication’s combined with MAO – B inhibitors can cause hyperthermia
Meperidine and fluoxetine
34
How do dopamine receptor agonist work in Parkinson’s?
They directly activate dopamine receptors and have a longer half-life, then leave a dopa without generating the toxic free radicals
35
What is the ergot type of dopamine receptor agonist?
Alkaloid derivatives like bromicriptine
36
What is the non-ergot derivative dopamine receptor agonist type
Primipexole, ropinirole and transdermal rotigotine
37
What medication is used as a rescue medication for dopamine receptor agonist
Apomorphine
38
What are the signs of dopamine receptor agonist overdose?
Dyskinesia, drowsiness, sweating, hypotension
39
Which dopamine receptor agonist have the most concerning side effects?
The older generation of ergot, like bromocriptine
40
What are the most common side effects of dopamine receptor agonist?
G.I. upset, hypertension, digital vasospasm, dyskinesia, mental disturbances, headache, nasal congestion, increased arousal and narcolepsy
41
How do catechol O methyl transferase inhibitors work for Parkinson’s?
Then inhibit the action of OMD that competes with levodopa for active transport carrier and decrease the peripheral metabolism of levodopa and decrease the levodopa clearance
42
What are the three main COMT - inhibitors
Tolcapone, entacapone, opicapone
43
Which is the most potent and longer acting COMT inhibitor
Tolcapone
44
What are the adverse effects of COMT inhibitors
Dyskinesia, confusion, sleep disturbances, hypotension, diarrhea, abdominal pain, nausea, and talcapone specifically is hepatotoxic
45
What are the only medications that can be combined with COMT inhibitors
Levodopa
46
What do you have to monitor in patient taking tolcapone
LFTs every two weeks during the first year
47
What are the adverse effects of amantadine?
Dry mouth, constipation, urinary retention, dizziness, anxiety, and agitation
48
Who is amantadine contraindicated in?
Patient with seizures or psychiatric disorders
49
In what patient is amantadine usually indicated in
Younger patients less than 70 years old with mild symptoms as an alternative to an MAOb inhibitor to block tremors
50
What are the two main anticholinergic drugs used for Parkinson’s?
Benztropine and trihexyphenidyl
51
What are the adverse effects of anticholinergic agents?
Dry mouth, blurred vision, dizziness, constipation, anxiety, confusion, and drowsiness
52
How should anticholinergics be discontinued?
Gradual to avoid withdrawal symptoms that may exacerbate Parkinson’s
53
Which patient population is anticholinergics usually indicated in
Younger patients older patients tend not to tolerate them
54
What is a non-standard therapy that may be considered as a treatment option for Parkinson’s
Deep brain, stimulation and exercise and speech therapy
55
What drug is often indicated in first line patients with very mild symptoms
MAO – B inhibitors
56
What drugs are indicated in first line patients with severe symptoms
Levodopa plus carbidopa or a dopamine agonist
57
What is the assessment scale used to assess Parkinson’s no non-motor symptoms
NMSS that has 30 items with nine dimensions
58
Which Parkinson’s drug can cause a net like rash
Amantadine
59
How should patients be educated when taking levodopa therapy?
They should stand up slowly to avoid postural hypotension They should divide the drug up to avoid nausea and vomiting The drug will improve their symptoms for a period of time, but not indefinite And uncontrollable muscle jerks make occur

Pharm Test 5 (20 decks)

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