3- Parkinson's Disease

Question 1

What is Parkinson’s disease

Answer 1

Autoimmune affecting CNS with Dopamine deficiency (of Ach excess)

Question 2

Classing PD findings include

Answer 2

resting tremor
cog wheel rigidity
bradykinesia
postural instability

Question 3

How id PD different from MS

Answer 3

MS includes visual compromise and weakness but no tremors!

Question 4

What is Amyotropic Lateral Sclerosis (ALS)

Answer 4

Progressive neurodegenerative disease

Question 5

What is an essential tremor

Answer 5

nerve disorder with uncontrollable shaking while moving

Question 6

What is Guillain-Barre

Answer 6

Immune system attacks the nerves causing weakness and tingling in the LE and feet

Question 7

What is Huntington’s disease

Answer 7

inherited adult onset near disease with dementia and bizarre involuntary movements

Question 8

What is MG

Answer 8

chronic AI neuro disorder with fluctuating weakness

Question 9

What is RLS

Answer 9

urge to move legs, associated with Iron deficiency

Question 10

What is Tourettes

Answer 10

repetitive movements or unwanted sounds that are not easily controlled

Question 11

What is Wilson’s disease

Answer 11

autosomal recessive disorder with copper accumulation in eyes, liver, brain, and kidneys

Question 12

When should you initiate PD pharm therapy

Answer 12

When symptoms interfere with daily life

Question 13

What are Dopamine precursors

Answer 13

Levodopa

Levodopa-Carbidopa

Question 14

Why add carbidopa

Answer 14

Enzymes outside the brain (dopa decarboxylase) turn Levodopa into dopamine and epinephrine (causing arrhythmia) so not a lot gets in.
Carbidopa blocks these enzymes so more Levodopa can cross the BBB and convert into Dopamine

Question 15

When should you take L-Dopa

Answer 15

absorbed best on empty stomach, but take with food to avoid nausea

Question 16

What does L-Dopa interact with

Answer 16

COMT and MAO inhibitors- They prolong the action causing excess dopamine

Question 17

What are S/E of L-Dopa

Answer 17

Drowsiness
Nausea
Dyskinesia
Impulsive behavior

Question 18

What is Dupoa

Answer 18

enteral suspension (gel) form of carbidopa/levodopa that is pumped directly into your small intestines through a stoma

Question 19

What is Duopa used for

Answer 19

Treating motor symptoms of PD by improving absorption and reducing off-times

Question 20

What are Dopamine Agonists

Answer 20

Pramipexole

Bromocriptine

Question 21

How do Dopamine agonists work

Answer 21

They stimulate dopamine receptors in substantial nigra and stratium making the brain think there is more dopamine

Question 22

Side effects of Dopamine Agonists are

Answer 22

Postural hypotension 
Confusion
hallucinations
Sedation
Psychosis (vivid dreams)
Impulsive behavior

Question 23

What are Monoamine oxidase inhibitors

Answer 23

Rasagiline (#1- early start maintains functionality)

Selegiline

Question 24

How do MAOI’s work

Answer 24

inhibit metabolism and destruction of dopamine

Question 25

What are Side Effects of Monoamine oxidase inhibitors

Answer 25

``` Nausea Orthostatic hypotension insomnia confusion hallucinations ```

Question 26

What does Rasagiline interact with

Answer 26

Meperidine (demerol) and causes Serotonin Syndrome (n/v, tremor, agitation, BP change)

Question 27

What are Catechol-O-methyltransferase inhibitors

Answer 27

Entacapone | Tolcapone

Question 28

How do CMT inhibitors work

Answer 28

Block conversion of L-Dopa into inactive 3-O-Methyldopa (more L-dopa crosses BBB) Prevents conversion of Dopamine to 3-Methoxytyramine

Question 29

Side effects of CMT inhibitors are

Answer 29

``` related to high L-Dopa; Dyskinesia, confusion, nausea, diarrhea, orthostatic hypotension Liver toxicity (monitor LFT's!) ```

Question 30

What do CMT inhibitors react with

Answer 30

L-Dopa (reduce dose) | Anti-diarrheal's

Question 31

What are Anti-cholinergics

Answer 31

Bentropine Trihexyphenidyl (balance cholinergic and dopaminergic activity)

Question 32

What are anticholinergics used for

Answer 32

Mild Tremor predominant PD <70 w/ disturbing tremor and no bradykinesia or gait change Advanced disease with refractory persistent tremor **Caution in elderly with cognitive difficulties

Question 33

Side effects of anticholinergics

Answer 33

``` Hot as a hare dry as a bone blind as a bat red as a beat mad as a hatter ```

Question 34

What is Deep Brain Stimulation

Answer 34

long probe stuck into brain to block muscular response causing tremor and involuntary movements

Question 35

How do you treat End-Of-Dose (wearing off)

Answer 35

Increase frequency of carbidopa/L-dopa dose | can add MAO or CMT inhibitor

Question 36

How do you treat "Delayed on" (no on) response

Answer 36

Carbidopa/L-dopa on empty stomach in ODT form

Question 37

How do you treat Start Hesitation (freezing) response

Answer 37

Increase carbidopa/L-dopa dose add bromocriptine or pramipexole OR MAOI PT and assistive walking

Question 38

How do you treat Peak-dose dyskinesia

Answer 38

Give smaller carbidopa/L-dopa dose | add Amantidine

Question 39

How does Amantidine work

Answer 39

enhances dopamine release, Blocks NDMA receptor | *same S/E as anticholinergics

Question 40

What is Amantidine used for

Answer 40

young patient with early/mild PD Later in disease with problematic dyskinesia Decreases tremor, rigidity, bradykinesia