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psych 1166 > Parkinsons Disesae > Flashcards

Parkinsons Disesae Flashcards

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1
Q

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

A

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

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2
Q

Primary s/sx of PD?

A

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

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3
Q

Other signs of PD?

A

Small, cramped handwriting (micrographia)

Shuffling walk

Stiff facial expression, reduced eye blinking

Muffled speech, drooling, dysphagia

Depression, anxiety (psychosis in advanced dx)

Constipation, incontinence

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4
Q

What’s frustrating and challenging about PD complications?

A

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

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5
Q

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

A

Tricyclic antidepressants-preferably secondary amines (desipramine and nortriptyline)

SSRIs or SNRIs commonly used but some concern they may contribute to tremor or increased serotonin syndrome risk in patients taking other serotonergic drugs

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6
Q

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

A

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

clozapine has low risk of worsening movement but high risk for agranulocytosis, seizures and other serious complications

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7
Q

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

A

Phenothiazines (Prochlorperazine, etc)-used for psychosis, nausea & agitation

FGAs-butyrophenones (esp, haloperidol-used for psychosis and behavior disorders) or droperidol used for nausea

SGAs Risperidone (Risperdal) at higher doses and paliperidone

Metoclopramide (Reglan) - dopamine blocking agent that is really cleared and can accumulate in elderly patients

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8
Q

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

A

Carbidopa-Levodopa (Sinemet)

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9
Q

What could be used for initial tremor in younger pts?

A

centrally acting anticholinergic-Beers criteria recommends to avoid these in elderly

Amantadine-useful for dyskinesia

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10
Q

MOA of Carbidopa/Levodopa?

A

Carbidopa Inhibits dopa decarboxylase, preventing peripheral metabolism of levodopa

(Levodopa is a precursor of dopamine-dopamine prodrug that’s converted to dopamine in the brain)

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11
Q

Brand name of Carbidopa/Levodopa

A

Sinemet

Sinemet CR

Rytary ER capsule

Duopa (enteral J-tube suspension)

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12
Q

T/F? Sinemet can be cut into half?

A

True-the CR tab can be cut in half at thescore line

BUT don’t crush or chew

ER (Rytary)-take whole or sprinkle on applesauce

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13
Q

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

A

70-100mg of Carbidopa

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14
Q

SEs of Sinemet (Carbidopa/Levodopa)?

A

Nausea

Dizziness

Orthostasis

Dyskinesia (abnormal movement)

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

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15
Q

Sinemet (Carbidopa/Levodopa) and unusual sexual urges?

A

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

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16
Q

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

A

Response may fluctuate after long-term use and lead to dyskinesias

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17
Q

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

A

Iron

May be protein

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18
Q

MOA of COMT-INHIBITOR?

A

Inhibit enzyme COMT to prevent peripheral and central conversion of levodopa

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19
Q

Role of COMT-inhibitor in therapy?

A

Used only with levodopa to increase levodopa duration of action- take 200mg PO with each dose of carbidopa/levodopa-max 1600mg/d

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20
Q

COMT-inhibitor agents?

A

Entacapone (Comtan)

Entacapone+Carbidopa/Levodopa (Stalevo)

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21
Q

Brand name of Entacapone? (COMT-inhibitor agent)

A

Comtan

22
Q

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

A

Stalevo

23
Q

List dopamine (DA) agonists agents

A

Pramipexole (Mirapex, Mirapex ER)

Ropinirole (Requip, Requip XL)

Rotigotine (Neupro)

24
Q

Brand name of Pramipexole (DA-agonist)?

A

Mirapex

Mirapex ER

25
Q

Brand name of Ropinirole (DA-agonist)?

A

Requip

Requip XL

26
Q

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

A

NODD-H

Nausea

Orthostasis

Drowsiness, including sudden daytime sleep attacks

Dizziness

Hallucinations

Dyskinesias

27
Q

SEs of Rotigotine (Neupro) - DA agonists?

A

Peripheral edema

Drowsiness

HA

Fatigue

Orthostasis

Sleep disturbances (trouble irritating/ maintaining sleep)

Hallucinations

Application site (skin) rxns

Hyperhidrosis

28
Q

How should Rotigotine (Neupro) be applied?

A

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

29
Q

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

A

For advanced dx: a “rescue” movement agent for “off” periods

30
Q

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

A

Severe nausea and vomiting

Hypotension

31
Q

MOA of Amantadine?

A

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

32
Q

Role of Amantadine in PD?

A

Used for mild dx

Or

For Dyskinesias in advanced dx

33
Q

SEs of Amantadine?

A

Dizziness

Toxic delirium/psychosis (with renal impairment, reduce dose)

Cutaneous rxn called livedo reticularis (reddish skin mottling - d/c drug)

34
Q

Role of selective MAO-B inhibitors?

A

Primarily used as carbidopa/levodopa adjunct. rasagaline (Azilect has an indication for mono therapy)

Note: may need to reduce levodopa dose when beginning therapy with selective MAO-B inh

35
Q

Selective MAO-B inhibitors agents used in PD?

A

Selegiline (Eldepryl, Zelapar ODT, Emsem patch—patch is only used for depression NOT PD)

Rasagiline (Azilect)

Safinamide (Xadago)

36
Q

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

A

5 mg BID with breakfast & lunch-second dose midday-activating

selegiline is activating-don’t take Eldepryl or Zelapar at bedtime-

37
Q

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

A

1.25-5 mg daily

selegiline ODT

38
Q

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

A

0.5-1 mg daily

Azilect

39
Q

When is Selegiline beneficial in PD?

A

Only when used with Levodopa

selefiline & safinamidea re adjust only…rasagaline can be adjunct or mon

40
Q

SEs of selective MAO-B inhibitors?

A

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

41
Q

Drug interactions with selective MAO-B inhibitors?

A

Contraindicated with other MAOi (including linezolid), opioids, SNRIs, TCAs

Meperidine (Demerol) - can be fatal

Tramadol

Methadone

Propoxyphene

Dextromethropan

St. John’s wort

Mirtazapine

Cyclobenzaprine

42
Q

List centrally acting anticholinergics used in PD?

A

Benztropine (Cogentin)

Trihexyphenidyl

43
Q

Role of centrally-acting anticholinergics in therapy?

A

Used primarily for tremor in younger patients

BEERS criteria says avoid use in elderly

44
Q

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

A

Wait about 1 wk b4 increasing dose

45
Q

Advantage of using Carbidopa with Levodopa?

A

Decrease nause

46
Q

Common SE of Ropinirole use?

A

Somnolence

47
Q

Which PD med req dose reduction in renal impairment?

A

Pramipexole

Amantadine

48
Q

Howz Pramipexole (Miraplex) dosed?

A

Start at 0.125mg TID

Titrate weekly to 0.5-1.5mg TID

49
Q

Howz Pramipexole (Miraplex ER) dosed?

A

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

50
Q

Howz Ropinirole (Requip) dosed?

A

Start at 0.25mg TID

Titrate weekly to 1-4mg TID

51
Q

Howz Ropinirole (Requip XL) dosed?

A

Start 2mg daily

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

52
Q

What’s Parkinson’s Dx (PD)?

A

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

psych 1166 (20 decks)

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