Parkinsons Disesae Flashcards by Blade Joneson

What’s the role of substantia nigra that dies or becomes impair in PD?

Dopamine (that’s why there’s a dopamine shortage in PD)

How well did you know this?

Not at all

Perfectly

Primary s/sx of PD?

TRAP

Tremor - seen during rest, usually worsened by anxiety

Rigidity - arms, legs, trunk and face (mask-like face)

Akinesia/bradykinesia - lack of movement or slow initiation of
movement

Postural instability - poor balance, which may lead to freq falls

How well did you know this?

Not at all

Perfectly

Other signs of PD?

Small, cramped handwriting (micrographia)

Shuffling walk

Stiff facial expression, reduced eye blinking

Muffled speech, drooling, dysphagia

Depression, anxiety (psychosis in advanced dx)

Constipation, incontinence

How well did you know this?

Not at all

Perfectly

What’s frustrating and challenging about PD complications?

Eventually, even with high doses of the 2 most effective classes of drugs (Carbidopa/Levodopa and dopamine agonists) the “off” periods will increase

How well did you know this?

Not at all

Perfectly

What has the highest efficacy for tx in PD pts with depression?

Tricyclic antidepressants

How well did you know this?

Not at all

Perfectly

Whats preferred antipsychotic in PD pts (psychosis can present with advanced dx)?

Quetiapine (low risk of movement disorders, but will require monitoring due to metabolic complications, including blood glucose & cholesterol)

How well did you know this?

Not at all

Perfectly

List drugs that may induce PD (drug-induced PD)?

Phenothiazines (Prochlorperazine, etc)

FGAs (esp, haloperidol)

SGAs (Risperidone (Risperdal) at higher doses)

Metoclopramide (Reglan) - dopamine blocking agent

How well did you know this?

Not at all

Perfectly

Which agent is most commonly used and most effective and is sometimes tolerated for initial tx in elderly?

Carbidopa-Levodopa (Sinemet)

How well did you know this?

Not at all

Perfectly

What could be used for initial tremor in younger pts?

Anticholinergic

Amantadine

How well did you know this?

Not at all

Perfectly

MOA of Carbidopa/Levodopa?

Carbidopa Inhibits dopa decarboxylase, preventing peripheral metabolism of levodopa

(Levodopa is a precursor of dopamine)

How well did you know this?

Not at all

Perfectly

Brand name of Carbidopa/Levodopa

Sinemet

Sinemet CR

How well did you know this?

Not at all

Perfectly

T/F? Sinemet SR tab can be cut into half?

But don’t crush or chew

How well did you know this?

Not at all

Perfectly

How much Carbidopa is required to inhibit peripheral conversion (dopa decarboxylase) and to reduce nausea?

70-100mg of Carbidopa

How well did you know this?

Not at all

Perfectly

SEs of Sinemet (Carbidopa/Levodopa)?

Nausea

Dizziness

Orthostasis

Dyskinesia (abnormal movement)

Brown, black or dark urine, saliva or sweat and discolor clothing

How well did you know this?

Not at all

Perfectly

Sinemet (Carbidopa/Levodopa) and unusual sexual urges?

Sinemet (Carbidopa/Levodopa) may cause unusual sexual urges, priapism

How well did you know this?

Not at all

Perfectly

Effect of Long-term use of Sinemet (Carbidopa/Levodopa)?

Response may fluctuate after long-term use

How well did you know this?

Not at all

Perfectly

What does Sinemet (Carbidopa/Levodopa) need to be separated from?

Iron

May be protein

How well did you know this?

Not at all

Perfectly

MOA of COMT-INHIBITOR?

Inhibit enzyme COMT to prevent peripheral and central conversion of levodopa

How well did you know this?

Not at all

Perfectly

Role of COMT-inhibitor in therapy?

Used only with levodopa to increase levodopa duration of action

How well did you know this?

Not at all

Perfectly

COMT-inhibitor agents?

Entacapone (Comtan)

Levodopa/Carbidopa + Entacapone (Stalevo)

How well did you know this?

Not at all

Perfectly

Brand name of Entacapone? (COMT-inhibitor agent)

Comtan

How well did you know this?

Not at all

Perfectly

Brand name of Levodopa/Carbidopa + Entacapone? (Sinemet + COMT-inhibitor agent)

Stalevo

How well did you know this?

Not at all

Perfectly

List dopamine (DA) agonists agents

Pramipexole (Mirapex, Mirapex ER)

Ropinirole (Requip, Requip XL)

Rotigotine (Neupro)

Brand name of Pramipexole (DA-agonist)?

Mirapex

Mirapex ER

Brand name of Ropinirole (DA-agonist)?

Requip Requip XL

SEs of Pramipexole (Mirapex, Mirapex ER) & Ropinirole (Requip, Requip XL) - DA agonists?

NODD-H Nausea Orthostasis Drowsiness, including sudden daytime sleep attacks Dizziness Hallucinations Dyskinesias

SEs of Rotigotine (Neupro) - DA agonists?

Peripheral edema Drowsiness HA Fatigue Orthostasis Sleep disturbances (trouble irritating/ maintaining sleep) Hallucinations Application site (skin) rxns Hyperhidrosis

How should Rotigotine (Neupro) be applied?

Same time each day (don't apply to same site for at least 14 days) Don't apply heat source over patch Remove patch in MRI Avoid if sensitive to sulfites

Role of DA-agonist injection (Apomorphine - Apokyn) in therapy?

For advanced dx: a "rescue" movement agent for "off" periods

SEs of Apomorphine (Apokyn) - DA-agonist injection?

Severe nausea and vomiting Hypotension

Look at counseling points on pg 880-883

Look!

MOA of Amantadine?

Blocks DA reuptake into presynaptic neurons, increases DA release from presynaptic fibers

Role of Amantadine in PD?

Used for mild dx Or For Dyskinesias in advanced dx

SEs of Amantadine?

Dizziness Toxic delirium (with renal impairment, reduce dose) Cutaneous rxn called livedo reticularis (reddish skin mottling - d/c drug)

Role of selective MAO-B inhibitors?

Used with levodopa (or Azilect) with levodopa or as initial monotherapy Note: may need to reduce levodopa dose when beginning therapy with selective MAO-B inh

Selective MAO-B inhibitors agents used in PD?

Selegiline (Eldepryl) Zelapar-ODT Rasagiline (Azilect) Emsam (Selegiline patch)

Dose of Selegiline (selective MAO-B inhibitors in PD)?

5-10 mg daily

Dose of Zelapar (selective MAO-B inhibitors in PD)?

1.25-5 mg daily

Dose of Radagiline (selective MAO-B inhibitors in PD)?

0.5-1 mg daily

Why is bedtime dose of Selegiline prohibited?

Selegiline is activating... Don't dose at bedtime If dose twice, take 2nd dose at mid-day

When is Selegiline beneficial in PD?

Only when used with Levodopa

Role of Rasagiline (Azilect) in PD therapy?

Initial monotherapy Or Adjunctive with Levodopa

SEs of selective MAO-B inhibitors?

Tyramine interactions: Low risk, but possible, HTN crises can occur

Drug interactions with selective MAO-B inhibitors?

Meperidine (Demerol) - can be fatal Tramadol Methadone Propoxyphene Dextromethropan St. John's wort Mirtazapine Cyclobenzaprine

List centrally acting anticholinergics used in PD?

Benztropine (Cogentin) Trihexyphenidyl

Role of centrally-acting anticholinergics in therapy?

Used primarily for tremor in younger patients

What's the correct titration schedule for ropinirole or pramipexole?

Wait about 1 wk b4 increasing dose

Advantage of using Carbidopa with Levodopa?

Decrease nause

Common SE of Ropinirole use?

Somnolence

Which PD med req dose reduction in renal impairment?

Pramipexole Amantadine

Howz Pramipexole (Miraplex) dosed?

Start at 0.125mg TID Titrate weekly to 0.5-1.5mg TID

Howz Pramipexole (Miraplex ER) dosed?

Start at 0.375mg daily, can increase approx 5-7 d to max dose of 4.5mg/d

Howz Ropinirole (Requip) dosed?

Start at 0.25mg TID Titrate weekly to 1-4mg TID

Howz Ropinirole (Requip XL) dosed?

Start 2mg daily Can increase approx 1-2 wks dose of 24mg/d

What's Parkinson's Dx (PD)?

Brain disorder that occurs when neurons in a part of the brain called the substantia nigra die or become impaired