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Pharm Exam 1 > PD Drugs > Flashcards

PD Drugs Flashcards

1
Q

PD Diagnosis Acronym

A

T-tremor @ rest
R-rigidity
A-Akinesia/bradykinesia
P-postural/gain instability

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2
Q

what is an early sign of PD?

A

hyposmia

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3
Q

1st line for PD

A

Levodopa + Carbidopa +/- entacopone
OR
dopamine agonist: pramixpexole, ropinirole, rotigotine

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4
Q

2nd line

A

anti-cholinergics–benztropine
Selective MAO B inhibitors–sele, ras, safin
NMDA agonist–amantadine

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5
Q

how should patients avoid hypotension with PD drugs?

A

increase water intake

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6
Q

what drug is most effective for symptomatic treatment

A

levodopa

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7
Q

how should levodopa be taken?

A

on an empty stomach

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8
Q

what should you do to levodopa if you add on entacapone?

A

decrease the dose

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9
Q

what color does entacapone turn your pee?

A

orange

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10
Q

what should the initial dose of levodopa + carbidopa look like?

A

small small dose–titrating up

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11
Q

what should you do if a pt’s dose is >1000mg/d for levodopa+ carbidopa

A

assess if PD is the correct diagnosis

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12
Q

what drugs should not be combined with levodopa + carbidopa?

A

alpha-antagonists (prazosin) (tamulozosin)

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13
Q

what is special about levodopa over time?

A

it becomes less effective–honey moon phase ends

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14
Q

who shouldn’t recieve levodopa via inhalation?

A

asthma pts

COPD pts

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15
Q

Dopamine Agonist–non-ergot:

A

ropinirole
pramipexole
rotigotine
apomorphine

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16
Q

non-ergots for RLS

A

pramixpexole
ropinirole
rotigotine

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17
Q

what dopamine agonist formulation must be taken with trimethobenzmide

A

SQ–apomorphine

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18
Q

what anti-emetic drug shouldn’t be used w/ dopamine agonist? why?

A

zofran–due to hypotensive effects

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19
Q

what is an ADR of non-ergots?

A 
impulse control disorders
edema
nausea
somnolence
hypotension
hallucinations
20
Q

what irreversible MAO-B inhibitors do we use?

A

rasagiline

21
Q

what PD drug is best used in early disease

A

rasagiline

22
Q

what drug combined with rasagiline can cause psychosis

A

dextromethrophan

23
Q

ADR of rasagiline

A

hypotension
nausea
confusion
HTN w/ tryamine rich foods

24
Q

what anticholinergic is used in PD?

A

Benztropine

25
Q

what is a benefit of using benztropine in late PD?

A

help with drooling

26
Q

what is a pearl of benztropine?

A

can help with EPS

27
Q

What is the NMDA antagonist used in PD?

A

Amantadine

28
Q

what does amatadine work on?

A

dopamine and glutamate

29
Q

What is a major skin ADR of amatadine

A

livedo reticularis

30
Q

what 2 major things prevent PD?

A

coffee

exercise–biking/dancing

31
Q

how do we manage dyskinesia w/ too much dopamine?

A 
decrease levodopa
replace part of levodopa w/ dopamine agonist
add amatadine to help
take in the middle of the night
reduce dose interval
32
Q

PDD drug

A

Pimavanserin

33
Q

what is type of drug is pimavenserin?

A

Anti psychotic

34
Q

what drugs can be used in PDD for hypotension

A

midodrine or fludrocortisone

35
Q

which MAOI-B can be used initially in early disease?

A

rasagiline

36
Q

MAOI-B + DM=?

A

psychosis

37
Q

what happens with sudden withdrawal of amantadine?

A

severe exacerbation of PD symptoms or NMS

38
Q

what do younger PD pts start tx with?

A

dopamine agonist

39
Q

what do older (>65) PD pts start tx with?

A

levodopa

40
Q

when is levadopa the obvious inital med?

A

when symptoms are serious and threatening pts lifestyle

41
Q

how do we avoid/manage the wearing “off” phenomenon

A
  1. look @ diet–if on leveo make pt take on empty stomach
  2. reduce levadopa dosing interval
  3. add doapmine agonist
  4. add COMT inhibitor (entacapone)
  5. add MAO-B inhibitor–rasagiline
42
Q

when do dyskinesia’s occur in PD pts?

A

when they have TOO MUCH DOPAMINE

43
Q

what type of dementia is PDD

A

lewy body dementia

44
Q

what type of impairment comes with PDD?

A

issues w/ attention, executive fcn, visuospatial fcn, free recall

45
Q

what drugs help w/ mood issues of PDD?

A

SSRI/SNRI + CBT

46
Q

what are clinical indications for deep brain stimulation?

A

dyskinesia, and motor fluctuations impairing QOL

Pharm Exam 1 (9 decks)

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