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Primary Care EXAM 3 > Pharm: Drugs for PD > Flashcards

Pharm: Drugs for PD Flashcards

1
Q

Parkinson’s is primarily caused by a deficiency in ________.

A

dopamine

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2
Q

What is a common way to rule out Parkinson’s disease from other movement disorders?

A

trial of Parkinsonian drugs

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3
Q

What are the 3 signs that differentiate PD from other movement disorders?

A
  • asymmetry
  • resting tremor
  • good response to levodopa
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4
Q

By the time PD is diagnosed over ____% of dopamine is lost.

A

80%

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5
Q

Why don’t we give dopamine to patient’s with PD?

A
  • doesn’t get absorbed orally

- doesn’t cross the BBB

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6
Q

How is it that levodopa crosses the BBB but dopamine does not?

A

levodopa looks like an amino acid so gets taken up by amino acid transporters

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7
Q

What is the purpose of adding carbidopa to levodopa?

A
  • carbidopa inhibits the decarboxylase in the periphery to allow more levodopa to get into the brain
  • carbidopa = peripherally acting decarboxylase inhibitor*
  • decreases side effects
  • increases efficacy
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8
Q

What are the 2 most common peripheral side effects of levodopa?

A
  • dizziness

- nausea

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9
Q

What are the 2 most common brain side effects of levodopa?

A
  • movement (dyskinesia)

- mood disorders (hallucinations)

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10
Q

Levodopa should be avoided if a patient is already taking what medication?

A

non-selective MAO inhibitors

potential for hypertensive crisis

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11
Q

What are the 2 concerns with chronic use of levodopa?

A
  • wearing off effect requiring higher doses

- higher doses result in increased toxicity

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12
Q

What is the function of Entacapone?

A
  • inhibits COMT so levodopa does not get converted into methyldopa in the periphery
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13
Q

The COMT inhibitors or Entacapone-like drugs are very toxic to what organ?

A

liver

need to monitor liver enzymes

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14
Q

What are the most common side effects with Entacapone-like drugs?

A

ALL THE SAME THINGS

  • nausea, dizziness, hallucinations, dyskinesia
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15
Q

Neurologists like to begin with either of these 2 drug classes when treating PD.

A
  • MAO-type B inhibitors

- Dopamine receptor agonists

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16
Q

By inhibiting MAO-type ____ dopamine levels increase

A

B

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17
Q

Old dopamine receptor agonists (e.g. Bromocriptine) are commonly used for what condition?

A

prolactinomas

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18
Q

Newer dopamine receptor agonists are commonly used for what 2 conditions?

A
  • parkinson’s disease

- restless leg syndrome

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19
Q

What are the 2 new dopamine receptor agonists that was bolded in class?

A
  • Pramipexole (Mirapex)

- Ropinirole (Requip)

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20
Q

Patients who are taking non-ergot-derived agents (e.g. Pramipexole, Ropinirole) should be advised against doing what?

A

driving

because causes somnolence

21
Q

Increased in compulsive behaviors are an adverse effect of what drugs?

A

newer dopamine receptor agonists (e.g. Pramipexole, Ropinirole)

22
Q

This drug is used for intermittent treatment of hypomobility episodes and is given either SQ or sublingual.

A

Apomorphine (Dopamine agonist)

23
Q

What are the side effects of Apomorphine?

A
  • nausea/ SEVERE vomiting (requires antiemetic)
  • hypersomnia
  • orthostatsis
  • priapism (rare)
24
Q

Patients who are on Apomorphine should avoid what drugs?

A

5HT3 antagonists

25
The first type of therapy ever used for PD was what class of drugs?
anticholinergic agents (hyoscyamine) *Dr. Charcot*
26
Why did we stop treating PD with anticholinergics (Benztropine)?
- adverse effects (anti-SLUD) which are already common in the elderly population
27
What is the role of amantadine in treating PD?
adjunctive therapy for someone already on levodopa therapy
28
What are the 3 mechanism of action for anticonvulsants?
- enhance of inhibitory activity (GABA) - inhibition of excitatory activity (glutamate or aspartate) - modulation of voltage-dependent ion channels involved in propagating the action potential
29
What is the main role of anticonvulsants?
- slow down neurotransmission
30
Phenytoin and carbamazepine are what type of anticonvulsants?
sodium channel blockers
31
Most of the anticonvulsants are cleared from the body by what organ?
liver *except for levetiracetam*
32
If you are worried about a patient's liver function what anticonvulsants should you choose to give?
levetiracetam (Keppra) *is cleared by the kidneys*
33
What are the 5 anticonvulsants we should be able to identify for the exam?
- phenytoin - carbamazepine - valproic acid - lamotrigine - levetiracetam
34
What dermatologic adverse effect do you worry about with lamotrigine?
SJS *need to stop med if this happens*
35
Which of the anticonvulsants is especially contraindicated in pegnancy?
Valproic acid
36
Why is it necessary to monitor blood levels in anticonvulsants?
- there is a non-proportional change in concentration of a drug with an increased in dose * very individualized* * zero order = process of removal is saturated*
37
Anticonvulsants are primarily CYP450 _________.
inducers *decreases amount of other drugs in body*
38
What must be present for benzodiazepine to open up the chloride channel? How is this different than barbiturates?
- GABA | - barbiturates open up the chloride channels by themselves = can be lethal
39
Phenobarbital or benzodiazepines is primarily indicated for what acute condition?
status epilepticus
40
Why can't we use phenobarbital or benzodiazepines for chronic seizure control?
because of the tolerance effect
41
What drug has GABA like activity but is different from benzodiazepines?
valproic acid *because it increases glutamic acid decarboxylase (GAD) activity and decreases GABA transaminase activity*
42
What is the mechanism of action of gabapentin?
- calcium channel blocker
43
Since gabapentin is a calcium channel blocker what is a common side effect of this drug?
- peripheral edema
44
Gabapentin is primarily used for what problem?
neuropathic pain
45
Why do we use gabapentin for neuropathic pain instead of other anticonvulsants?
- less adverse effects - less drug-drug interactions - predictable pharmacokinetics
46
What is the widely used drug for seizure disorders?
Levetiracetam (Keppra)
47
What are the main difference between older and newer agents?
- older: narrow therapeutic margins, more drug interactions but good experience for numerous indications - narrow: wider therapeutic margins, less drug interactions but more narrow indications
48
Which drug is effective for almost every type of seizure?
Valproic acid because it has many mechanism of actions *similar to Amiodarone*

Primary Care EXAM 3 (5 decks)

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