Parkinsons

Question 1

Cardinal signs

Answer 1

TRAP
tremors at rest
rigidity
akinesia/bradykinesia
postural instability

Question 2

progression of symptoms

Answer 2

unilateral
bilateral
balance issues
restricted to walking w cane
bed bound

Question 3

Levadopa

Answer 3

• most effective single drug for PD
• side effects: GI, CV, psych, hypotension, dyskinesia, neuropathy after prolonged use, nausea and vomiting
• Nausea caused by conversion of levodopa to DA in the periphery due to being unable to cross the BBB, administer with cabidopa to prevent conversion in the periphery

Question 4

COMT inhibitors

Answer 4

increase action of enzyme that degrades NT; to increase its availability

Question 5

Dopamine agonists

Answer 5

used in early stages of PD to reduce symptoms
MOA: stimulates DA receptors, may prolong or decrease need for levodopa
Side effects: N/V, orthostatic hypotension, drowsiness, dizziness, hallucinations, confusion, unsteadiness, dyskinesias, hypersexuality, compulsive gambling

Question 6

DA agonist meds

Answer 6

bromocriptine
pramipexole
ropinirole
cabergoline

Question 7

Apomorphine

Answer 7

DA agonist
used for akinetic off episodes when patient is stuck
Used in advanced disease

Question 8

Amantadine

Answer 8

DA agonist, anti-viral
MOA: symptomatic benefit: tremor, rigidity, bradykinesia
SE: blurred vision, dizziness, trouble sleeping, depression/anxiety, swelling feet/hands, sob, difficulty urinating
Only beneficial for

Question 9

Selegiline

Answer 9

• an irreversible MAO-B inhibitor to decrease breakdown of serotonin, DA and tyramine
• high doses can lead to HTN crisis if taken with fermented pickled foods
  SE: confusion, nausea, orthostatic hypotension, tachycardia, dry mouth, sob

Question 10

On off phenomenon

Answer 10

abrupt loss of effect: can occur any time during dosing interval: off time may last minutes to hours

• over course of treatment, off periods increase
• certain drugs can help to reduce off times