Parkinsons Flashcards
Parkinson’s disease results from a decrease in what activity
Dopamine
Parkinson’s disease results from an increase in what activity
Cholinergic
Classic motor symptoms of Parkinson’s
Tremor at rest
Rigidity
Akinesia or bradykinesia
Postural instability and gait abnormalities
Non motor symptoms of Parkinson’s disease
Sleep disturbances
Other miscellaneous symptoms constipation
Autonomic symptoms drooling
Psychological symptoms depression
Motor complications of Parkinson’s disease progression
Motor fluctuations
Akathisia
Dyskinesia
What scale is used to diagnose Parkinson’s disease
Unified Parkinson’s disease rating scale
Six parts of updrs
Patient history Physical exam Cognition Behavior Mood Adl Motor symptoms Complications of therapy
Non pharm treatment for Parkinson’s
Lifestyle changes
Nutrition
Exercise
Surgery if fail pharm
Two anticholinergic drugs for Parkinson’s
Benztropine
Trihexyphenidyl
Adverse effects of anticholinergic drugs in Parkinson’s
Blurred vision Confusion Constipation Dry mouth Memory difficulty Sedation Urinary retention
Anticholinergic drugs are effective for what symptoms of Parkinson’s
Minimizing resting tremor
Anticholinergic drugs are not effective against which Parkinson’s motor symptoms
Rigidity
Akinesia or bradykinesia
Postural instability or gait problems
Anticholinergic drugs clinical use
Mono therapy under 65
Adjunct with Cambodia/levodopa or other meds
Why avoid anticholinergics in 70+
Less tolerant. Often impair cognition
Amantadine use in Parkinson’s
Modest symptomatic relief
Resting tremor in mild
Suppressing levodopa dyskinesias
Amantadine clinical use
Monotherapy or adjunct with other meds
Aes of amantadine
Confusion Dizziness Dry mouth Hallucinations Livedo reticularis
Mao b inhibitors used in Parkinson’s
Selegiline
Rasagiline
Effects of Mao b inhibitors
Extended effects of levodopa
May delay motor complications I used early
Contraindications for Mao b inhibitors
Meperidine and other analgesics
AEs of MAO-B inhibitors
insomnia
hallucinations
nausea
hypotension
Clinical use of MAO-B inhibitors
Monotherapy in early Parkinson’s disease
adjunct for managing motor fluctuations
dopamine agonists used in Parkinsons
Bromocriptine
Pramipexole
Ropinirole
Apomorphine
Which dopamine agonists in parkinsons disease are ergot derived
bromocriptine
which dopamine agonists in parkinsons disease are non-ergot derived
pramipexole
ropinirole
apomorphine
Why is bromocriptine no longer used for parkinsons
increased risk of pulmonary fibrosis and reduced efficacy compared to other dopamine agonists
AEs of dopamine agonists
nausea confusion hallucinations light-headedness lower extremity edema postural hypotension sedation vivid dreaming
AEs of bromocriptine
same as other dopamine agonists + MI seizures stroke valvular heart disease
clinical use of bromocriptine
adjunct with levodopa
clinical use of dopamine agonists
monotherapy in mild-moderate PD
adjunct with levodopa
effect of dopamine agonists
monotherapy - reduces risk of developing motor complications
adjunct - reduces frequency of off periods during motor fluctuations
which dopamine agonist is available as a subQ injection
apomorphine
effect of apomorphine
triggers an on response within 20 minutes. can benefit for up to 100 minutes
AEs of apomorphine
N/V dizziness hallucinations orthostatic hypotension injection site irritation somnolence syncope
clinical use of apomorphine
advanced PD pts w/ intermittent off episodes
PRN RESCUE medication
contraindications with apomorphine
drugs that block serotonin 5HT3 receptor
What needs to be monitored with apomorphine before and after doses
BP
How soon after an apomorphine injection can another dose be given
2 hours
What other medication needs to be given with apomorphine
antiemetic (trimethobenzamide) 3 days prior and 2 months after apomorphine D/C’ed
therapeutic effect of carbidopa/levodopa
most effective agent for symptomatic treatment of PD
AEs of carbidopa/levodopa
nausea postural hypotension sedation vivid dreaming vomiting
Contraindications with carbidopa/levodopa
non-selective MAOI within 14 days
Levodopa drug-food interaction
high protein diet decreases absorption
Motor fluctuations associated with levodopa
optimal peak but early wearing off
delayed on or no on response
freezing
dyskinesias
Management of levodopa induced end of dose wearing off
increase frequency of carbidopa/levodopa doses
add COMT inhibitor or MAO-B inhibitor or dopamine agonist
consider surgery
management of levodopa associated delayed on or no on response
give carbidopa/levodopa on an empty stomach use carbidopa/levodopa ODT Avoid carbidopa/levodopa CR use apomorphine subQ consider surgery
management of levodopa associated start hesitation or freezing
increase carbidopa/levodopa dose
add a dopamine agonist or MAO-B inhibitor
use physoitherapy, walking devices, sensory cues
management of levodopa associated dyskinesias
provide smaller doses of carbidopa/levodopa
add amantadine
consider surgery
COMT inhibitors used in Parkinsons
entacapone
tolcapone
therapuetic effect of COMT inhibitors
extends effects of levodopa
AEs of COMT inhibitors
Diarrhea Nausea Headache hypotension insomnia urine discoloration
Clinical use of COMT inhibitors
combination with levodopa used to manage wearing off
Tolcapone black box warning
Fatal hepatotoxicity
Advantages of using levodopa
Most effective in treating motor disability and ADL features
Inexpensive
May be better for older pts
Disadvantages of using levodopa
younger patients are more likley to develop motor fluctuations due to long term use
Advantages of using dopamine agonists
reduce risk for developing motor complications
May be better option for younger patients
Disadvantages of using dopamine agonists
older patients may not tolerate adverse effects (hypotension, hallucinations)
All parkinsons patients get what treatment
non pharm and rasagiline (MAO B inhibitor)
Add What agent if pt < 65 and need to control tremor
anticholinergic
Add what agent if pt > 65 and need to control tremor
Amantadine
Add what agent if pt < 65 and need to control bradykinesia, rigidity, and tremor
add amantadine
dopamine agonist
or carbidopa/levodopa
add what agent if pt > 65 and need to control bradykinesia, rigidity, and temor
amantadine
dopamine agonist
or carbidopa/levodopa
Benztropine brand name
cogentin
trihexyphenidyl brand name
artane
Amantadine brand name
Symmetrel
Selegiline brand name
Eldepryl
Rasagiline brand name
Azilect
Bromocriptine brand name
Parlodel
Pramipexole brand name
Mirapex
ropinirole brand name
Requip
Apomorphine brand name
apokyn
carbidopa/levodopa brand name
sinemet
Entacapone brand name
comtan
Tolcapone brand name
Tasmar
