Parkinsons

Question 1

what percentage of dopamine producing cells must be lost before tremor appears?

Answer 1

70-90%

Question 2

symptoms of parkinsons

Answer 2

tremor at rest
pill rolling remor
bradykinesia: slowness of movement
postural instability

Question 3

Levodopa

Answer 3

• replaces dopamine with L-Dopa (levodopa) which can cross BBB
• SE: nausea/v (less N with combination drug), choreiform movements, hypotension, insomnia, anxiety

Question 4

levodopa is often combined with what drug?

Answer 4

carbidopa which prevents peripheral breakdown so it can be used for central sensitization.

• less nausea with carbidopa
• peripheral dopa-decarboxylase inhibitor
• Levodopa with Carbidopa / Sinemet - most common

Question 5

L-dopa with carbidopa/sinemet

Answer 5

dopamine percursor with peripheral dopamine decarbyoxylase inhibitor
increases dopamine levels in brain, especially in substantia nigra
- can drop dose by 75% when add enzyme blocker (carbidopa)

Question 6

Can dopamine cross BBB

Answer 6

No, but precursor can

Question 7

dopamine agonists

Answer 7

used early in tx of Parkinsons so delay of L-dopa tx can be delayed

Question 8

Bromocriptine

Answer 8

dopamine agonist - mimics dopamine in stimulation of dopamine receptor sites
used in parkinsons and prolactin secreting adenomas and acromegaly
SE: nausea, hypertension or hypotension, confusion, hallucinations, headache, depression, dyskinesia and possible seizures.
- pulmonary fibrosis at high doses
- possibly could reverse insuline resistance
- have to monitor BP and heart rate

Question 9

pay attention to what with which drug in pt who have used BP medication

Answer 9

heart rate and BP with bromocriptine

Question 10

anticholinergics for parkinsons

Answer 10

• useful adjunct treatment for tremor and or drooling

- MOA: antagonize affects of acetylcholine, blocking impulses in parasympathetic system.

Question 11

Benztropine/congentin

Answer 11

anticholinergic
drooling/tremor in parkinsons or to diminish side effects of antipsychotic drugs
SE: dry mouth, blurred vision, urinary retention, constipation, confusion, drowsiness, memory loss.

Question 12

tx
combination
anticholinergic adjunct

Answer 12

• levodopa
• Sinemet
• benztropine/congentin

Question 13

overdose of benztropine/congentin

Answer 13

physostigmine

Question 14

amandatine

Answer 14

• antiviral (inlfluenza A) and antiparkinsons
• acts on NMDA receptors in parkinsons
• diminished dopamine reuptake
• SE: lightheadedness, confusion, drowsiness, nightmares, dry mouth, constipation, urinary retention, n/v
• short acting therapy (6 months)

Question 15

***order of efficacy of meds used to treat Parkinsons

Answer 15

L-Dopa -> Bromocriptine -> Amantadine -> anticholenergics

* Selegiline - MAO -B inhibitors sometimes used at early stages of PD

Question 16

NMDA

Answer 16

mimics action of glutamate on that receptor

Question 17

Selegiline

Answer 17

MAO-B inhibitors

used for depression and for early parkinsons to delay use of other drugs.