PD- Dopamine Agonists DI Flashcards
Dopamine agonists purpose in PD
Used as adjunctive agents in case of deterioration of response to L-Dopa, but can be used as monotherapy in younger patients
Dopamine agonists used in PD
Pramipexole, ropinirole, bromocriptine, rotigotine (Neupro) TD patch, apomorphine
Pramiprexole needs renal dose adjustment with what CrCl?
<60ml/min
Pramiprexole DDI
Cimetidine (inhibitor of renal tubular secretion)
Ropinirole CIs
Abrupt D/C, hepatic disease
Ropinirole is metabolized by what enzyme?
1A2
Ropinirole DDIs
CYP1A2 substrates and inducers
Substrates: cimetidine, cipro, clarithromycin, diltiazem, enoxacin, erythromycin, fluvoxamine, mexiletine, norfloxacin, omeprazole, ritonavir, troleandomycin
Inducers: CBZ, PB, phenytoin, rifampin, cigarette smoking
Bromocriptine is an ergot: true or false
True
Bromocriptine being an ergot means it’s what?
A potent vasoconstrictor
Bromocriptine ADEs
CNS, GI effects, pulmonary fibrosis
Bromocriptine DDIs
Antihypertensive agents, erythromycin, 3A4 inhibitors
Rotiogine precautions
Heat, MRI
Rotiogine ADEs
CNS, GI, peripheral edema, application site reactions
Rotiogine DDIs
Dopamine antagonists (APS and metoclopromide)
(The “ro” and “do” in the pronunciation of rotiogine and and dopamine rhyme)
Apomorphine route of administration
SQ injection that has to be done under medical supervision
When is apomorphine used?
Advanced PD PRN for OFF symptoms
Before taking apomorphine, what should you be pretreated with?
An antiemetic 3 days before
What type of antiemetic should you be pretreated with?
Tigan (but literally anything that’s not a 5-HT3 antagonist or antidopaminergic)
Apomorphine ADEs
N/V (that’s why you need to pretreat with Tigan), somnolence, chest pain/pressure, dyskinesia, falls, yawning, rhinorrhea
Apomorphine DDIs
CI’ed with 5-HT3 antagonists!
DDIs with QTc prolongating agents, dopamine antagonists (APS!) may decrease its effectiveness
