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Pharm Unit 4 > Wk 10 > Flashcards

Wk 10 Flashcards

1
Q

Characteristic features of Parkinson

A

Tremor
Rigidity
Bradykinesia
Postural instability

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2
Q

What occurs from complications of Parkinson?

A

death

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3
Q

Pathophysiology of Parkinson

A

Loss of dopaminergic neurons in the substantia nigra

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4
Q

50-90% of patients on levodopa for > __ years develop _____

A

5 years; motor complications

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5
Q

Two most common motor complications of levodopa

A

wearing off

on-off effect

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6
Q

wearing off effect is initially treated by ___

A

dosing more often (shorten dose interval)

later on, add dopamine agonist

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7
Q

treat on off affect:

A

w/ rescue apomorphine, or adjust dose/frequency of levodopa

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8
Q

physical disability is _____ and ___

A

progressive & unavoidable

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9
Q

initiation of therapy for Parkinson and dosing is ____

A

highly individualized

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10
Q

Mainstay of treatment since 1960s and most effective agent for PD

A

LEvodopa

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11
Q

LD ___ cross the BBB

A

does

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12
Q

significant peripheral adverse effects of Ldopa

A 
dyskinesias
N/V/anorexia
postural hypotension
mental disturbances
cardiac arrythmias
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13
Q

Ldopa is always administered w/ peripheral _____

A

DDC inhibitor (Carbidopa)

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14
Q

L dopa competes for absorption w/ other ___

A

amino acids

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15
Q

Ldopa has ___ minimized

A

GI upset

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16
Q

Ldopa is best absorbed w/ ___ meals

A

low protein

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17
Q

peripheral dopa decarboxylase inhibitor

A

carbidopa

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18
Q

COMT inhibitors

A

entacapone

tolcapone

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19
Q

MAO-B inhibitor

A

selegiline

rasagiline

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20
Q

carbidopa is available ___ or in ___

A

alone; combo w/ levodopa

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21
Q

____ mg CD is usually needed to inhibit peripheral DDC

A

75-100mg

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22
Q

Usually start carbidopa w/ ____ of

A

IR product of 25/100 mg (CD/LD) Simemet TID

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23
Q

Most patients respond to ____ of LD

A

750-1000mg

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24
Q

after ___ of 25/100mg, switch to 1 tab of 25/250 TID

A

8 tabs

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25
Q

Carvidopa (brand) allows greater ___ for patients w/ advanced PD

A

individualized

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26
Q

COMPT is widely distributed – ____

A

peripheral and central

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27
Q

entacapone is available alone as ___

A

generic

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28
Q

generic entacapone is «< expensive than _____

A

brand tolcapone (taster)

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29
Q

levodopa/carbodopa/entacapone is called:

A

stalevo

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30
Q

Tolcapone is dosed as ____

A

single drug TID

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31
Q

tolcapone is assoc w/ _____

A

fatal cases of acute liver fialure

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32
Q

tolcapone has limited ____

A

clinical use

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33
Q

MOA of MAO-B

A

selective MAO-B inhibition prolongs DA effects

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34
Q

MAO-B inhibitor effects are usually ___

A

modest

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35
Q

MAO-B inhibitors are usually used as ____

A

adjunctive (add-on therapy) in advanced cases

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36
Q

when taking MAO-B inhibitors, minimize _____

A

tyramine intake

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37
Q

When taking MAO-B inhibitors avoid ____

A

cocontaminant use of SSRIs (potential for serotonin syndrome

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38
Q

early use of selegiline may _____

A

delay LD therapy by 9 mo

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39
Q

selegiline may improve ___

A

wearing off effect by 50-70%

40
Q

MAOB-Is are less effective in improving ____

A

on-off effects

41
Q

Dosing of eldepryl

A

BID breakfast, lunch

42
Q

least expensive MAOB inhibitor

A

eldepryl

43
Q

dosing of zelapar

A

daily – decreased 1st pass effect

44
Q

emsam is only FDA approved for ___

A

depression

45
Q

MAOB-I is more poteRasagiline is more potent inhibition of MAO-B than ___

A

selegiline

46
Q

brand and generic of Rasagiline are both ___

A

EXPENSIVE

47
Q

Safinamide are used as ___

A

adjunct (add-on) therapy for Levodopa/carbidopa

48
Q

Safinamide is useful for tx of ____

A

off episodes

49
Q

adverse effects of safinamide

A

severe HTN (at greater than recommended doses)
Hypersexual behavior
Retinal degeneration

50
Q

at what dosage of Safinamide do you see severe HTN

A

> 100mg per day

51
Q

DAg’s cross the ___ and stimulate the ___ receptor

A

BBB; dopamine (d2)

52
Q

___ improve on DAg’s

A

ADLs

53
Q

DAGs may be used as ___ (early) and ___ (late)

A

monotherapy; adjunctive

54
Q

mono therapy w/ DAg’s are more effective in ____

A

younger patients (<65)

55
Q

early use of DAg’s may ____

A

postpone use of LD

56
Q

ergot derivatives

A

bromocriptine

57
Q

removed from the market in 2007

A

pergolide

58
Q

non-ergot derivatives

A

pramipexole
ropinirole
apomorphine
rotigotine

59
Q

1st gen ergot derivative that is rarely used now

A

bromocriptine

60
Q

bromocriptine has increased risk of major adverse effects:

A

pericardial fibrosis

cardiac valve fibrosis

61
Q

2nd generation of PD DAg

A

pramipexole

62
Q

pramipexole + LD has fewer:

A

dyskinesias
“wearing off” effects
motor complications

63
Q

dosage of IR generic pramipexole

A

TID

64
Q

dosage of IR brand pramipexole

A

TID

65
Q

dosage of brand pramipexole

A

dailyq

66
Q

pramipexole is the only _____ DAg

A

really eliminated

67
Q

the nusing pramipexole, adjust for ____

A

CrCl <50

68
Q

Pramipexole has no recommended ___

A

taper if D/Cd

69
Q

Ropinirole is equally efficacious per ___

A

indirect comparisons

70
Q

dosage of generic ropinirole

A

TID

71
Q

dosage of brand ropinrole

A

once daily

72
Q

ropinirole requires a ____ if d/cd

A

taper over 7 days

73
Q

ropinirole is ___ metabolized

A

renal dysfunctionhepatically

74
Q

Ropinirole has no dose adjustment for ___

A

renal dysfunction

75
Q

Apomorphine has a potent non-ergot ____

A

injectable

76
Q

apomorphine is ___

A

expensive

77
Q

FDA approved for rescue therapy of ___ or ___

A

hypo mobility; off episodes

78
Q

apomorphine may cause severe ___

A

emesis; take w/ antiemetic

79
Q

serotonin receptor antagonists (__) are ___ w/ apomorphine

A

zofran; contraindicated

80
Q

serotonin RAs + apomorphine causes ____

A

severe hypotension & syncope

81
Q

dosage of apomorphine

A

SC

82
Q

contraindicated administration of apomoprhine

A

IV

83
Q

only dopamine agonist transdermal patch

A

rotigotine

84
Q

expensive DAg

A

Rotigotine

85
Q

mainstay of treatment for PD until late 1960s

A

anticholinergic

86
Q

anticholinergics are no longer ___

A

1st line

87
Q

anticholinergics are reserved for ___ early in disease (<65)

A

resting tremor

88
Q

side effects of anticholienrgics

A

constipation, dry mouth, blurred vision, confusion, urinary retention

89
Q

benztropin may inhibit ___

A

reuptake of dopamine

90
Q

usual dose of benztropin

A

divided BID or single dose at HS

91
Q

dosage form for benztropin

A

IV/IM injection solution

92
Q

usual dose of trihexyphenidyl

A

divided 3-4x/d

93
Q

dosage form o trihexyphenidyl

A

oral elixer

94
Q

amantadine is primarily an ___

A

antiviral agent, found to have anti-PD activity

95
Q

amantidine was previously used as ___

A

early mono therapy

96
Q

amantidine is now used as an ___

A

add on for levodopa – induced dyskinesias

Pharm Unit 4 (3 decks)

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