PARKSINSONS HIGH YIELD Flashcards
degeneration of DA producing neurons in the _____?
substantia nigra
hallmark of the disease?
lewey bodies
how does it present?
tremor, bradykinesia, rigidity
this is the most single most effective agent for treatment of PD?
reserved for when symptoms become intrusive with daily activity or uncontrolled by other anti PD drugs
more effective for rigidity and bradykinesia and less effective for postural instability and tremor
levodopa (L-Dopa)
Levadopa gets quickly absorbed in the small intestines and gets decarboxylated and ends outside the brain and must be given with?
carbidopa, an L-amino acid decarboxylase inhibitor
this can occur if the levodopa dose is too high and dose breaches that levodopa threshold
treatment strategy
peak dose dyskinesia
lower the dose and give more frequently
use long acting formulations
add amantadine***
this is the phenomenon where we start to see the problems at the end of dose effect, patient then usually re doses
-usually seen at the 3-5 year mark of using L-Dopa
wearing off phenomenon
profound severe unpredictable return of PD symptoms w/out respect to the dosing interval
off period (drug not working) means?
treated how?
on-off phenomenon
akinesia over a few hours, on period with improved mobility bit w disabling dyskinesias
add COMT-I or DA-agonist
adverse reactions of levodopa?
dyskinesias -treated w/ amantadine N/V -treated w/ promethazine cardiovascular -orthostatic hypotension, arrythmias behavioral/CNS -depression, anxiety, insomnia, hallucinations
invlountary, erratic, writing movements of the face,arms, legs or trunk
choreiform movements
dystonic movments
due to medication, levodopa
what is this effect of PD?
dyskinesia
pharmacologic treatment?
anticholinergic amantadine carbidopa/levodopa MAO-B inhibitors DA agonists COMT inhibitor
drug interactions of levodopa-carbidopa?
drug food interactions?
antipsychotics
pyridoxine
phenothiazine
protein
-decreases levodopa absorption
