PD Drugs Flashcards
PD Diagnosis Acronym
T-tremor @ rest
R-rigidity
A-Akinesia/bradykinesia
P-postural/gain instability
what is an early sign of PD?
hyposmia
1st line for PD
Levodopa + Carbidopa +/- entacopone
OR
dopamine agonist: pramixpexole, ropinirole, rotigotine
2nd line
anti-cholinergics–benztropine
Selective MAO B inhibitors–sele, ras, safin
NMDA agonist–amantadine
how should patients avoid hypotension with PD drugs?
increase water intake
what drug is most effective for symptomatic treatment
levodopa
how should levodopa be taken?
on an empty stomach
what should you do to levodopa if you add on entacapone?
decrease the dose
what color does entacapone turn your pee?
orange
what should the initial dose of levodopa + carbidopa look like?
small small dose–titrating up
what should you do if a pt’s dose is >1000mg/d for levodopa+ carbidopa
assess if PD is the correct diagnosis
what drugs should not be combined with levodopa + carbidopa?
alpha-antagonists (prazosin) (tamulozosin)
what is special about levodopa over time?
it becomes less effective–honey moon phase ends
who shouldn’t recieve levodopa via inhalation?
asthma pts
COPD pts
Dopamine Agonist–non-ergot:
ropinirole
pramipexole
rotigotine
apomorphine
non-ergots for RLS
pramixpexole
ropinirole
rotigotine
what dopamine agonist formulation must be taken with trimethobenzmide
SQ–apomorphine
what anti-emetic drug shouldn’t be used w/ dopamine agonist? why?
zofran–due to hypotensive effects
what is an ADR of non-ergots?
impulse control disorders edema nausea somnolence hypotension hallucinations
what irreversible MAO-B inhibitors do we use?
rasagiline
what PD drug is best used in early disease
rasagiline
what drug combined with rasagiline can cause psychosis
dextromethrophan
ADR of rasagiline
hypotension
nausea
confusion
HTN w/ tryamine rich foods
what anticholinergic is used in PD?
Benztropine
what is a benefit of using benztropine in late PD?
help with drooling
what is a pearl of benztropine?
can help with EPS
What is the NMDA antagonist used in PD?
Amantadine
what does amatadine work on?
dopamine and glutamate
What is a major skin ADR of amatadine
livedo reticularis
what 2 major things prevent PD?
coffee
exercise–biking/dancing
how do we manage dyskinesia w/ too much dopamine?
decrease levodopa replace part of levodopa w/ dopamine agonist add amatadine to help take in the middle of the night reduce dose interval
PDD drug
Pimavanserin
what is type of drug is pimavenserin?
Anti psychotic
what drugs can be used in PDD for hypotension
midodrine or fludrocortisone
which MAOI-B can be used initially in early disease?
rasagiline
MAOI-B + DM=?
psychosis
what happens with sudden withdrawal of amantadine?
severe exacerbation of PD symptoms or NMS
what do younger PD pts start tx with?
dopamine agonist
what do older (>65) PD pts start tx with?
levodopa
when is levadopa the obvious inital med?
when symptoms are serious and threatening pts lifestyle
how do we avoid/manage the wearing “off” phenomenon
- look @ diet–if on leveo make pt take on empty stomach
- reduce levadopa dosing interval
- add doapmine agonist
- add COMT inhibitor (entacapone)
- add MAO-B inhibitor–rasagiline
when do dyskinesia’s occur in PD pts?
when they have TOO MUCH DOPAMINE
what type of dementia is PDD
lewy body dementia
what type of impairment comes with PDD?
issues w/ attention, executive fcn, visuospatial fcn, free recall
what drugs help w/ mood issues of PDD?
SSRI/SNRI + CBT
what are clinical indications for deep brain stimulation?
dyskinesia, and motor fluctuations impairing QOL
