Parkinsons Flashcards
What is the most important risk factor for parkinsons?
Age
What are the clinical symptoms of PD?
Resting tremor, bradykinesia, cogwheel rigidity, postural instability
What is the most common 1st symptom of PD?
Resting tremor?
What is the primary criteria?
TRAP- tremor, rigidity, akinesia, postural instability
What is the drug challenge?
When non-responsive to levodopa or apomorphine, if they improve, itís probably PD
There is a loss of what in PD?
DA neurons
What is a frozen addict?
Induced PD among heroine users, NOT REVERSIBLE
What indicates pre-symptomatic PD?
Lewy bodies
What are the mechanisms for tx of PD?
Increased endogenous DA, DA agonist, adenosine Aza, anticholinergics
What is the gold standard for tx of PD?
Levodopa
Can levodopa cross the BBB
Yes
How long until tolerance to levodopa happens?
3-5 yrs
What are the symptoms of ìwearing offî
PD symptoms
What are the strategies to address “wearing off”
Increased levodopa dose or # of daily doses
Adding a dopa agonist or increase its dose
Using a COMT inhibitor
What are the ADRs usually caused by
DA in the periphery
What are the levodopa/ carbidopa interactions
B6- increases periphery breakdown
MAO-I, HTN crisis
Antipsychotic meds
Adding x mg of carbidopa prevents peripheral ADRS?
75
How are DA agonists potentially neuroprotective
Interact w/ presynaptic DA autoreceptors and decreased autooxidation, free radical formation
Decreased levodopa requirements, requirements, reducing toxic levodopa mediated metabolites
Antioxidant properties
What is the half life of ropinirde? Bromocriptine? Pramipexole?
6 hr, 3 hr, 8-12hr
What are the ADR of DA agonist
Sedating effects, including somnolence and unintended sleep episodes, hypotension, hallucinations or psychosis, dyskinesias, N/V, and leg edema
What are the MAO-B inhibitor suggestive uses?
Pt w/ intact cognition, pt w/ wearing off of L-dopa actions
What are the ADRs of Selegiline?
Insomnia, HTN, can worsen preexisting symtpoms such as hallucinations and delisions, rare serotonin syndrome w/ ???
How do COMT inhibitors increase levodopa bioavailability in brain?
Inhibits COMT both peripherally and centrally
Which COMT I has a warning for liver failure?
tolcapore
