Parkinson's Pharm

Question 1

what is the treatment goal with Parkinson’s?

Answer 1

help individual maintain motor function as long as possible

Question 2

how does pharm work for Parkinson’s?

Answer 2

by correcting the imbalance between dopamine and ACh

Question 3

how do drugs work to treat Parkinson’s?

Answer 3

drugs either enhance dopamine or block the effects of ACh

Question 4

MOA of levodopa/carbidopa (Sinemet)

Answer 4

–levodopa: converts to dopamine in the brain and activates dopamine receptors
–carbidopa: blocks destruction of levodopa

Question 5

advantage of levodopa/carbidopa

Answer 5

most effective drug for PD

Question 6

disadvantages of levodopa/carbidopa

Answer 6

–takes several months to see improvement
–does not work long-term
–adverse effects

Question 7

gradual loss of effect with sinemet

Answer 7

–dose wears off
–may need shorter dose intervals

Question 8

abrupt loss of effect with sinemet

Answer 8

–called the “on-off” phenomenon
–can occur anytime during dosing interval
–“off” periods increase over time
–can be reduced with drugs and avoiding high protein meals

Question 9

adverse effects of sinemet

Answer 9

–due to levodopa
–N/V
–dyskinesias
–CV
–psychosis
–dark sweat and urine
–activate malignant melanoma

Question 10

N/V side effect tips for sinemet

Answer 10

–give low doses with food
–BUT that reduces drug absorption

Question 11

CV side effect tips for sinemet

Answer 11

–postural hypotension
–dysrhythmias

Question 12

psychosis side effects for sinemet

Answer 12

–hallucinations
–nightmares
–paranoia

Question 13

sinemet interactions

Answer 13

decrease effects of levodopa:
–vitamin B6
–antipsychotics
–protein

increase effects of levodopa:
–carbidopa
–anticholinergics
–MAO inhibitors (can cause toxicity)

Question 14

duopa

Answer 14

–carbidopa-levodopa infusion
–instilled via feeding tube into small intestine
–gel form
–continuous infusion for continuous blood level (up to 16 hours a day)

Question 15

who usually uses duopa?

Answer 15

patients who respond to drug but response fluctuates

Question 16

important information about duopa for patients

Answer 16

–do not take within 2 weeks of nonselective MAOI for depression
–talk about all medications currently taking

Question 17

what drugs interact with duopa?

Answer 17

–antihypertensives
–MAOIs
–antipsychotics
–metoclopramide
–isoniazid
–iron
–vitamins

Question 18

what food interacts with duopa?

Answer 18

high protein

Question 19

side effects of duopa

Answer 19

–falling asleep without warning
–orthostatic hypotension
–hallucinations
–unusual urges
–depression
–dyskinesia
–side effects related to placement of tube

Question 20

classification of pramipexole

Answer 20

dopamine receptor agonist

Question 21

MOA of pramipexole

Answer 21

binds with D2 receptors

Question 22

indications for pramipexole

Answer 22

–monotherapy in early PD
–combined with Sinemet in advanced PD
–restless leg syndrome

Question 23

adverse effects of pramipexole alone

Answer 23

–nausea
–sleep attacks
–pathologic gambling and other compulsive behaviors

Question 24

adverse effects of pramipexole combined with levodopa

Answer 24

–orthostatic hypotension
–dyskinesias
–hallucination risk doubles

Question 25

classification of ropinirole

Answer 25

dopamine receptor agonist

Question 26

who is ropinirole used for?

Answer 26

those with idiopathic PD

Question 27

MOA for ropinirole

Answer 27

exact MOA is unknown; animal studies = increase in nerve impulses within the substantia nigra

Question 28

adverse effects of ropinirole

Answer 28

–similar to other PD drugs
–with long term use, there may be an increased risk of DM and acromegaly

Question 29

examples of other dopamine agonists

Answer 29

–rotigotine
–apomorphine

Question 30

route of rotigotine

Answer 30

once daily patch

Question 31

route for apomorphine

Answer 31

short-acting SQ injection

Question 32

when is apomorphine used?

Answer 32

fast relief of symptoms (used in the ‘off’ phases of PD)