parkinsons pharmacology

Question 1

what is the goal of Parkinson’s pharmacology

Answer 1

correct balance between dopamine and ACh

Question 2

dopaminergic

Answer 2

drugs that enhance dopamine

Question 3

anticholenergic

Answer 3

block effects of ACh

Question 4

MOA levodopa/carbidopa

Answer 4

levodopa- converts dopamine in brain and activated dopamine receptors
carbidopa- blocks destruction of levodopa

Question 5

advantages of levodopa/carbidopa

Answer 5

mot effective drug for parkinsons

Question 6

disadvantages of levodopa/carbidopa

Answer 6

takes several months to see improvement
does not work long term
adverse effects

Question 7

levodopa/carbidopa loss of effect

Answer 7

dose wears off, may need shorter dose intervals

Question 8

on-off phenomenon of levodopa/carbidopa

Answer 8

can occur at any time
abrupt loss of effect
off periods increase over time

Question 9

how can you reduce abrupt loss of effect?

Answer 9

avoid high protein meals

Question 10

side effects of carbidopa/levodopa

Answer 10

SE due to levodopa
nausea/vomiting (give with food, but reduces absorption)
dyskinesia’s (annoying to disabling)
postural hypotension, dysrhythmias
psychosis (hallucinations, nightmares, paranoia)
DARK URINE AND SWEAT
ACTIVATES MELANOMA

Question 11

medications that decrease effects of levodopa

Answer 11

vitamin b6
antipsychotics
protein

Question 12

medications that increase effects of levodopa

Answer 12

carbidopa
anticholinergics
MAO inhibitors (can cause toxicity)

Question 13

duopa

Answer 13

carbidopa/levodopa infusion
instilled through feeding tube into small intestine
gel form
continuous infusion for continuous blood level up to 16 hours

Question 14

important info for patients on duopa

Answer 14

do not take within 2 weeks of non-selective MAOI for depression

Question 15

drugs that interact with duopa

Answer 15

anti-HTN, MAOI, antipsychotic, metoclopramide, isoniazid, iron, vitamins
high protein foods

Question 16

side effects of duopa

Answer 16

falls asleep without warning
orthostatic hypotension
hallucinations
unusual urges
depression
dyskinesia
tube placement

Question 17

pramipexole

Answer 17

dopamine receptor agonist

binds with D2 receptors

Question 18

uses of pramipexole

Answer 18

monotherapy in early parkinsons
combine with levodopa/carbidopa in advanced parkinsons
restless leg syndrome

Question 19

side effects of pramipexole when used alone

Answer 19

nausea
sleep attacks
pathological GAMBLING and compulsive behaviors

Question 20

side effects of pramipexole when combined with levodopa/carbidopa

Answer 20

orthostatic hypotension
dyskinesias
hallucinations

Question 21

Ropinirole

Answer 21

dopamine receptor agonist
used to treat idiopathic parkinsons
unknown moa
adverse effects similar to other PD drugs

Question 22

what is at an increased risk of long term use ropinirole?

Answer 22

DM and acromegaly

Question 23

rotigotine

Answer 23

once daily patch

Question 24

apomorphine

Answer 24

short acting sub q injection
for fast relief
used in off phase of Parkinsons