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Pnt Exam 2 > Parkinsons > Flashcards

Parkinsons Flashcards

0
Q

Parkinson’s disease results from a decrease in what activity

A

Dopamine

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1
Q

Parkinson’s disease results from an increase in what activity

A

Cholinergic

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2
Q

Classic motor symptoms of Parkinson’s

A

Tremor at rest
Rigidity
Akinesia or bradykinesia
Postural instability and gait abnormalities

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3
Q

Non motor symptoms of Parkinson’s disease

A

Sleep disturbances
Other miscellaneous symptoms constipation
Autonomic symptoms drooling
Psychological symptoms depression

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4
Q

Motor complications of Parkinson’s disease progression

A

Motor fluctuations
Akathisia
Dyskinesia

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5
Q

What scale is used to diagnose Parkinson’s disease

A

Unified Parkinson’s disease rating scale

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6
Q

Six parts of updrs

A 
Patient history
Physical exam
Cognition
Behavior
Mood
Adl
Motor symptoms 
Complications of therapy
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7
Q

Non pharm treatment for Parkinson’s

A

Lifestyle changes
Nutrition
Exercise
Surgery if fail pharm

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8
Q

Two anticholinergic drugs for Parkinson’s

A

Benztropine

Trihexyphenidyl

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9
Q

Adverse effects of anticholinergic drugs in Parkinson’s

A 
Blurred vision
Confusion
Constipation 
Dry mouth 
Memory difficulty 
Sedation 
Urinary retention
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10
Q

Anticholinergic drugs are effective for what symptoms of Parkinson’s

A

Minimizing resting tremor

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11
Q

Anticholinergic drugs are not effective against which Parkinson’s motor symptoms

A

Rigidity
Akinesia or bradykinesia
Postural instability or gait problems

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12
Q

Anticholinergic drugs clinical use

A

Mono therapy under 65

Adjunct with Cambodia/levodopa or other meds

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13
Q

Why avoid anticholinergics in 70+

A

Less tolerant. Often impair cognition

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14
Q

Amantadine use in Parkinson’s

A

Modest symptomatic relief
Resting tremor in mild
Suppressing levodopa dyskinesias

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15
Q

Amantadine clinical use

A

Monotherapy or adjunct with other meds

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16
Q

Aes of amantadine

A 
Confusion
Dizziness
Dry mouth
Hallucinations 
Livedo reticularis
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17
Q

Mao b inhibitors used in Parkinson’s

A

Selegiline

Rasagiline

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18
Q

Effects of Mao b inhibitors

A

Extended effects of levodopa

May delay motor complications I used early

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19
Q

Contraindications for Mao b inhibitors

A

Meperidine and other analgesics

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20
Q

AEs of MAO-B inhibitors

A

insomnia
hallucinations
nausea
hypotension

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21
Q

Clinical use of MAO-B inhibitors

A

Monotherapy in early Parkinson’s disease

adjunct for managing motor fluctuations

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22
Q

dopamine agonists used in Parkinsons

A

Bromocriptine
Pramipexole
Ropinirole
Apomorphine

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23
Q

Which dopamine agonists in parkinsons disease are ergot derived

A

bromocriptine

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24
Q

which dopamine agonists in parkinsons disease are non-ergot derived

A

pramipexole
ropinirole
apomorphine

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25
Q

Why is bromocriptine no longer used for parkinsons

A

increased risk of pulmonary fibrosis and reduced efficacy compared to other dopamine agonists

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26
Q

AEs of dopamine agonists

A 
nausea
confusion
hallucinations
light-headedness
lower extremity edema
postural hypotension
sedation
vivid dreaming
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27
Q

AEs of bromocriptine

A 
same as other dopamine agonists + 
MI
seizures
stroke
valvular heart disease
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28
Q

clinical use of bromocriptine

A

adjunct with levodopa

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29
Q

clinical use of dopamine agonists

A

monotherapy in mild-moderate PD

adjunct with levodopa

30
Q

effect of dopamine agonists

A

monotherapy - reduces risk of developing motor complications

adjunct - reduces frequency of off periods during motor fluctuations

31
Q

which dopamine agonist is available as a subQ injection

A

apomorphine

32
Q

effect of apomorphine

A

triggers an on response within 20 minutes. can benefit for up to 100 minutes

33
Q

AEs of apomorphine

A 
N/V
dizziness
hallucinations
orthostatic hypotension
injection site irritation
somnolence
syncope
34
Q

clinical use of apomorphine

A

advanced PD pts w/ intermittent off episodes

PRN RESCUE medication

35
Q

contraindications with apomorphine

A

drugs that block serotonin 5HT3 receptor

36
Q

What needs to be monitored with apomorphine before and after doses

A

BP

37
Q

How soon after an apomorphine injection can another dose be given

A

2 hours

38
Q

What other medication needs to be given with apomorphine

A

antiemetic (trimethobenzamide) 3 days prior and 2 months after apomorphine D/C’ed

39
Q

therapeutic effect of carbidopa/levodopa

A

most effective agent for symptomatic treatment of PD

40
Q

AEs of carbidopa/levodopa

A 
nausea
postural hypotension
sedation
vivid dreaming
vomiting
41
Q

Contraindications with carbidopa/levodopa

A

non-selective MAOI within 14 days

42
Q

Levodopa drug-food interaction

A

high protein diet decreases absorption

43
Q

Motor fluctuations associated with levodopa

A

optimal peak but early wearing off
delayed on or no on response
freezing
dyskinesias

44
Q

Management of levodopa induced end of dose wearing off

A

increase frequency of carbidopa/levodopa doses
add COMT inhibitor or MAO-B inhibitor or dopamine agonist
consider surgery

45
Q

management of levodopa associated delayed on or no on response

A 
give carbidopa/levodopa on an empty stomach
use carbidopa/levodopa ODT
Avoid carbidopa/levodopa CR
use apomorphine subQ
consider surgery
46
Q

management of levodopa associated start hesitation or freezing

A

increase carbidopa/levodopa dose
add a dopamine agonist or MAO-B inhibitor
use physoitherapy, walking devices, sensory cues

47
Q

management of levodopa associated dyskinesias

A

provide smaller doses of carbidopa/levodopa
add amantadine
consider surgery

48
Q

COMT inhibitors used in Parkinsons

A

entacapone

tolcapone

49
Q

therapuetic effect of COMT inhibitors

A

extends effects of levodopa

50
Q

AEs of COMT inhibitors

A 
Diarrhea
Nausea
Headache
hypotension
insomnia
urine discoloration
51
Q

Clinical use of COMT inhibitors

A

combination with levodopa used to manage wearing off

52
Q

Tolcapone black box warning

A

Fatal hepatotoxicity

53
Q

Advantages of using levodopa

A

Most effective in treating motor disability and ADL features
Inexpensive
May be better for older pts

54
Q

Disadvantages of using levodopa

A

younger patients are more likley to develop motor fluctuations due to long term use

55
Q

Advantages of using dopamine agonists

A

reduce risk for developing motor complications

May be better option for younger patients

56
Q

Disadvantages of using dopamine agonists

A

older patients may not tolerate adverse effects (hypotension, hallucinations)

57
Q

All parkinsons patients get what treatment

A

non pharm and rasagiline (MAO B inhibitor)

58
Q

Add What agent if pt < 65 and need to control tremor

A

anticholinergic

59
Q

Add what agent if pt > 65 and need to control tremor

A

Amantadine

60
Q

Add what agent if pt < 65 and need to control bradykinesia, rigidity, and tremor

A

add amantadine
dopamine agonist
or carbidopa/levodopa

61
Q

add what agent if pt > 65 and need to control bradykinesia, rigidity, and temor

A

amantadine
dopamine agonist
or carbidopa/levodopa

62
Q

Benztropine brand name

A

cogentin

63
Q

trihexyphenidyl brand name

A

artane

64
Q

Amantadine brand name

A

Symmetrel

65
Q

Selegiline brand name

A

Eldepryl

66
Q

Rasagiline brand name

A

Azilect

67
Q

Bromocriptine brand name

A

Parlodel

68
Q

Pramipexole brand name

A

Mirapex

69
Q

ropinirole brand name

A

Requip

70
Q

Apomorphine brand name

A

apokyn

71
Q

carbidopa/levodopa brand name

A

sinemet

72
Q

Entacapone brand name

A

comtan

73
Q

Tolcapone brand name

A

Tasmar

Pnt Exam 2 (11 decks)

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