Parkinsons Flashcards
Dopamine blocking drugs that can worsen PD
4 total
- Prochloperazine
- Halopiridol
- Risperidone
- Metcopramide
Primary treatment of PD?
Replace dopamine
What is the preferred antipsychotic in PD?
Quitiapine due to the reduced risk of movement disorders
Preferred Drug treatment for PD?
Levodopa prodrug of dopamine most effective
What is given with levodopa and why?
Carbidopa prevents peripheral metabolism of levodopa
Why are dopamine agonists commonly given in PD?
Reduces off periods and limits dyskinisia (abnormal movements)
What is the dose of carbidopa that is needed to hibit dopa decarboxylase?
70-100 mg/day
Sinemet or Sinemet CR
Levo/carbidopa
Notes about Sinemet?
CR tab can be cut in half but dont crush or chew
4 SEs of Sinemet?
- Nausea
- Dizziness
- Orthostatis
- Dyskinesia
Sinemet can cause what?
Brown black or dark urine
Positive combs test discontinue: hemolysis
What do COMT inhibitors do?
Increase duration of action of levodopa
Dosing of COMT inhibitors?
200 mg PO with each levo/carbi dose
2 dopamine agonists used in PD?
Pramipexole
Ropinorole
Neupro?
Rotigotine patch
dopamine agonists
Neupro patch instructions?
Apply once daily dont use the same spot for at least 14 days
remove before MRI
aovid if allergic to sulfites
Apomorphine contra?
DOnt used with 5HT3s severe hypotension
How is the apomorphine dose written?
mL not mg
Contraindications to SInemet?
Dont use with non-selective MAOs
Iron and protein rich food decrease absoprtion
Selective MAO B inhibitors?
Selegiline
COntaindications to MAO B
COmbo with other MAOs including other MAOs linezolid, opioids, SNRIs,
Xadago severe hepatic impairment
2 warnigns for MAO Bs?
Serotonin syndrome
HTN
WHen should selegiline be taken?
Can be activating dont take at night
Cogentin?
Benztropine
Central acting anticholinergic
What score on the MMSE is considered a memory disorder?
<24
What can cause acute memory impairment?
Centrally acting anticholinergics
What vitamin has shown some benefit for alzheimerz?
VIt E
Gingko?
Also thought to help memory but increases bleeding risk
8 drugs that can worsen dementia?
- Antihistmines, antiemetics
- Antipyschotics
- barbiturates
- BZDs
- Central acting anticholnergics benztropine
- Peripheral anticholinergics oxybutynin
- Skeleta muscle relaxants
- Other CNS depressants
What is used for pharmacotherapy in dementia?
Acetylcholenesterases
donepezil used alone or with memantine for severe stages
What is donepezil taken?
Can cause nausea taken at night for that reasons
If insomonia is present can take in the morning if issue
Namzaric?
Donepezil/Memantine
Pts stablaized with 10 mg donepezil can switch to combo
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Namenda?
Memantine
can be used alone or in combo with donepezil
Aricept?
Donepezil
What do acetylcholinesterases inhibitors do?
inhibit central active acetylcholinesterase
this cause an increase in acetylcholine
Warning for Aricept?
Bradycardia
SEs of Aricept?
Insomnia and Nausea
What AcH formulations do what?
Exelon patch and donepezil ODT have less GI SEs
ER capsules or Namzaric?
Do not crush or chew but can be opened and sprinkled on applesauce
Caution for acetylcholinesterase Inhibitors?
Caution with other drugs that lower HR and with other drugs that can cause dizziness
Drugs that have anticholinergic effects can reduce efficacy of these drugs
Exelon
Rivastigmine
Exelon patch use instructions?
Saem time each day to the upper or lower back, or upper arm or chest
rotate sites
