23 - Parkinson Disease Flashcards Preview

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Flashcards in 23 - Parkinson Disease Deck (36):
1

If > 60 yo, can start _____ as first line

levodopa

2

If < 60 yo, can start _____ ____ as first line

dopamine agonists

3

meds that provide the most benefit increase _____ levels in the brain

dopamine

4

Exclude drugs that can induce parkinsonism such as what drugs?

-FGAs, SGAs and central dopamine-blocking antiemetics (ex. metoclopramide and prochlorperazine)

5

non-pharms for PD ?

exercise, speech therapist or physical therapist may help. some benefit from surgery

6

MOA of levodopa

converted to dopamine within presynaptic dopaminergic neurons

7

Why is levodopa combined with carbidopa or benserazide?

They are DOPA decarboxylase inhibitors
-They inhibit peripheral transformation to dopamine, thus enhancing distribution to the brain, reducing amount of Levodopa required, minimizing s/e such as n/v

8

Bromocriptine, Pramipexole, Ropinirole, Pergolide, Rotigotine are all examples of ??

dopamine agonists

9

Place in therapy for dopamine agonists?

as monotherapy in early PD or as adjunct to levodopa in more severe cases

10

What dopamine agonist is not on the market anymore due to cases of serious cardiac problems but still available through SAP ?

Pergolide

11

What dopamine agonist comes as a patch?

Rotigotine

12

Advantage of using dopamine in early or young PD over levodopa?

they have less motor complications than levodopa in the first 5 years

13

Both levodopa and dopamine agonists can cause what side effect ?

daytime sleepiness or sleep attacks (occurs more frequently with dopamine agonists than levodopa)

14

What is a s/e of dopamine agonists?

-hypersexual behavior or gambling problems
-GI s/e, hypotension and psych reactions

15

List 2 MAOB inhibitors

-selegiline
-rasigiline

16

MAOB inhibitors are first line for ___ _____

mild symptoms

17

Which MAOB inhibitor is more potent and for more advanced diseases

rasagiline

18

When do you give MAOB inhibitors?

morning

19

What is amantadine and what is it's place in therapy?

-NMDA antagonist
-mild-mod improvement and improves levodopa-induced dyskinesias in the later stages of the disease
-don't use with cognitive deficits

20

Rare but notable s/e of amantadine?

levidoreticulitus - blue/skin mainly in lower extremeties

21

Trihexyphenidyl, benztropine, ethopropazine, and procyclidine are examples of _______ used in PD

anticholinergics

22

What do anticholinergics help most with?

tremor

23

s/e of anticholinergics

dry eyes/mouth, urinary retention, constipation

24

Why do you give COMT inhibitors with levodopa?

-COMT is an enzyme that helps metabolize levodopa
-give a COMT inhibitor to increase levels of levodopa and therefore can use lower doses and minimize s/e

25

List 2 examples of COMT inhibitors

-entacapone
-tolcapone

26

_____ is a COMT inhibitor that was approved by HC but bc of hepatotoxicity is now only available through SAP

tolcapone

27

_____ is a COMT inhibitor not associated with liver toxicity but can cause diarrhea and orange/brown urine

entacapone

28

Tx of Non-Motor Issues:
Options for depression?

SSRIs or TCAs (use with caution)

29

Tx of Non-Motor Issues:
Options for Psychosis and Dementia?

-withdraw anticholinergics, then selegiline, rasagiline, then everything until only levodopa remains

-Can sometimes use antipsychotics as long as PD symptoms are still managed

30

Tx of Non-Motor Issues:
Options for Psychosis and Dementia:

What SGA appears to have lowest risk of reducing control of movement disorders?

clozapine

31

Tx of Non-Motor Issues:
Options for Psychosis and Dementia:

What SGA do we try first before clozapine to avoid blood monitoring?

quetiapine has no evidence but often tried first to avoid blood monitoring

32

Tx of Non-Motor Issues:
Options for Psychosis and Dementia:

If they have deterioration in motor function from adding antipsychotics, what else can we add on?

ChEi (ex. donepezil, rivastigmine, galantamine)

33

Tx of Non-Motor Issues:

Treatment of autonomic dysfunction?

-increase salt and H20 intake and avoid alcohol to increase BP

-if that doesn't work, add domperidone, midodrine and/or fludrocortisone

34

Tx of Non-Motor Issues:

Tx of urinary incontinence?

anticholinergics

35

What can occur if PD drugs are abruptly d/c?

NMS

36

What are 2 risk factors for NMS?

-dehydration
-hyponatremia

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