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Module 4 > UNIT 2 PD DRUGS > Flashcards

UNIT 2 PD DRUGS Flashcards

1
Q

What are the two major categories of PD drugs?

A
  1. Dopamine agents
  2. Anticholinergic agents
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2
Q

What is the MOA for dopamine agents?

A
  1. Promote activation of dopamine receptors
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3
Q

What is the MOA of anticholinergic agents?

A
  1. Prevent activation of cholinergic rectors
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4
Q

How is Levodopa absorbed?

A

Orally administered and rapidly absorbed from small intestine

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5
Q

What is the most important patient teaching for a patient taking levodopa?

A
  1. Food delays absorption esp. protein
  2. High-protein foods reduce therapeutic effects
  3. Teach patients not to eat protein at the same time as medication
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6
Q

What is important to know about neutral amino acids and levodopa?

A
  1. Neutral amino acids compete w/levodopa for intestinal absorption and for transport across the blood brain barrier
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7
Q

What is the MOA of Levodopa/carbidopa (Sinemet)?

A
  1. Levodopa is converted into dopamine in the CNS. Carbidopa prevents peripheral destruction of levodopa.
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8
Q

What are adverse effects of Levodopa/Carbidopa?

A
  1. N/V
  2. Dyskinesias
  3. Postural hypotension
  4. Dysrhythmias
  5. Psychosis
  6. Impulse control
  7. darkened sweat and urine loss
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9
Q

Due to the “on and off” effect of PD drugs what is important to monitor?

A

Blood levels

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10
Q

What do we need to know about dopamine agonists?

A
  1. 1st drug of choice for mild to moderate symptoms
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11
Q

What is the MOA of dopamine agonists?

A
  1. direct activation of dopamine receptors
  2. Not dependent on enzymatic conversion to be active
  3. Does not compete w/dietary proteins
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12
Q

Are dopamine agonists more or less effective than levodopa?

A

Less

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13
Q

What should we know about the Dopamine agonists Pramipexole (Mirapex)?

A
  1. Used alone in EARLY PD and w/levodopa in advanced PD
  2. Max benefits take several weeks
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14
Q

What are adverse effects of the Dopamine agonist Pramipexole (mirapex)

A

Monotherapy:
1. Sleep attacks***
2. Nausea
3. Dizziness
4. Daytime somnolence
5. Insomnia
6. constipation
7. Weakness
8. Hallucinations

Combined Therapy:
1. orthostatic hypotension
2. Dyskinesia
3. Increased hullucinations

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15
Q

What is a rare side effect of the dopamine agonist pramipexole (mirapex)

A

If pathologic gambling and other compulsive self-rewarding behaviors

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16
Q

What are some anticholinergic drugs?

A
  1. Trinexlphendyl
  2. Benziropine
17
Q

What is the MOA of anticholinergic drugs?

A
  1. Blocks muscarinic receptors in stratum. Decreases ach. activity
18
Q

What are some adverse effects of anticholinergic drugs?

A
  1. Dry mouth
  2. Urinary retention
  3. Tachycardia
  4. Blurred vision
  5. Constipation
  6. Photophobia
  7. Confusion
  8. Hallucinations
19
Q

Never do what with PD drugs?

A

Stop taking abruptly

20
Q

What is the MOA of COMT inhibitors?

A

Inhibit metabolism of levodopa in the periphery. NO direct theraputic effects on their own.

21
Q

What are two examples of COMT inhibitors?

A

Entracapone (comtan)
Tolcapone (tasmar)

22
Q

What should we know about COMT inhibitor Entacapone (comtan)

A

Indicated for use with levodopa

23
Q

What is the MOA of Entacapone (comtan)? COMT inhibitors

A
  1. Inhibits breakdown of levadopa in the periphery
24
Q

What are some adverse effects of entacapone (comtan)? COMT inhibitors

A
  1. Dyskinesia
  2. Orthostatic hypotension
  3. N/V/D
  4. hallucinations
  5. Sleep disturbances
  6. impulse control disorders
  7. Yellow and orange discoloration of urine
25
Q

What should we know about tolcapone (tasmar) COMT inhibitor?

A
  1. Used only in conjunction with levodopa
  2. Only used if safer agents are ineffective or inappropriate
26
Q

What are some adverse effects of tolcapone (tasmar) COMT inhibitors?

A
  1. Liver failure
  2. Dyskinesia
  3. Orthostatic hypotension
  4. Nausea
  5. Hallucination
  6. sleep disturbance
  7. Yellow and orange discoloration of urine
27
Q

What should we know about MOA-B inhibitors?

A
  1. Considered 1st line drugs for PD
  2. Benefits are modest
  3. Combination w/levodopa can reduce the wearing off effect
28
Q

What are the two MOA-b inhibitors?

A
  1. Selegline
  2. Rasagline
29
Q

What is the MOA of selegline (eldepryl) a MOA-b inhibitor?

A
  1. inhibits breakdown of dopamine
30
Q

What are adverse effects of the MOA-b inhibitor Selegline (eldpryl)?

A
  1. Insomnia
  2. Dry mouth
  3. Orthostatic hypotension
  4. Dizziness
  5. Hypertension crisis
  6. GI symptoms
31
Q

What should we know about Rasagline (azilect)? MOA-b inhibitors

A
  1. Approved for initial therapy and for combined use with levodopa
  2. Benefits derived from preserving dopamine in the brain
  3. Avoid tyramine
32
Q

What are some adverse effects of rasagline (azilect) MOA-b inhibitor?

A
  1. orthostatic hypotension
  2. insomnia
  3. irritation of buccal muscosa
  4. hypertensive crisis
33
Q

What are other agents used to treat PD?

A
  1. Antihistamine w/anticholinergic or b-adrenergic blockers are used to manage tremors
  2. Antiviral agent- amantadine
  3. Apomorphine for hypomobility
34
Q
A

Module 4 (29 decks)

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