Parkinsons Flashcards

1
Q

What balances with dopamine in the CNS?

A

Acetylcholine

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2
Q

What is the triad of Parkinson’s?

A

Bradykinesia, rigidity, tremor

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3
Q

Explain the on-off phenomenon

A

Periods of dyskinesia (on) and hypokinesia (off)

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4
Q

List six methods of Parkinson’s therapy

A

Replenish dopamine, agonize dopaminergic stimulation, inhibit dopamine metabolism, release stored dopamine, inhibit dopamine reuptake, reduce cholinergic overplay

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5
Q

Explain the pathophysiology behind Parkinson’s

A

Degeneration of substantia nigra causes loss of dopamine producing neurons (in back of brain)

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6
Q

What is levodopa?

A

Naturally occurring amino acid precursor of dopamine

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7
Q

Why can’t dopamine be pharmacologically administered?

A

ASIDE FROM INABILITY TO CROSS BBB, IT IS RAPIDLY METABOLIZED IN THE GUT/BLOOD/LIVER BY COMT AND MAO

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8
Q

What effect does IV dopamine have on the body?

A

RBA (renal artery dilation, beta-1 agonist, alpha-1 agonist)

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9
Q

How is l-dopa converted to dopamine?

A

Central dopa decarboxylase in the CNS

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10
Q

What is the cofactor and peripheral conversion of l-dopa?

A

Vitamin B6 (pyridoxine)

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11
Q

What happens when l-dopa alone is administered?

A

90% is metabolized by peripheral dopa decarboxylase

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12
Q

What is commonly administered with l-dopa to prevent peripheral metabolic conversion?

A

Decarboxylase inhibitors

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13
Q

What is carbidopa?

A

Decarboxylase inhibitor commonly co-administered with l-dopa

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14
Q

Name a drug interaction of levodopa

A

Interacts with nonselective MAO inhibitory – can cause hypertension emergency

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15
Q

What is Bromocriptine?

A

D2 agonist dosed in combination with l-dopa, rapidly absorbed PO

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16
Q

List adverse effects of bromocriptine

A

Nausea, vomiting, hallucinations, confusion

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17
Q

Name an alternative use for bromocriptine

A

Treats hyperprolactinemia (dopamine opposes prolactin)

18
Q

Who is most likely to suffer from hyperprolactinemia?

A

Postpartum mothers and pituitary adenoma patients

19
Q

What emergent condition is bromocriptine partly used to treat?

A

NMS neuroleptic malignant syndrome (an antipsychotic induced hyperthermia)

20
Q

List signs of neuroleptic malignant syndrome

A

rhabdo (lead pipe), temperature of 105°

21
Q

Name the QD form of bromocriptine only used to treat hyperprolactinemia

A

Cabergoline (Dostinex)

22
Q

What is pramipexole (Mirapex)?

A

D2 agonist indicated for restless leg syndrome

23
Q

Just an adverse effect of pramipexole

A

Reward seeking behavior like gambling, binge eating, sexual urges

24
Q

Which 3 drugs are indicated for RLS?

A

Pramipexole, Rotigotine and ropinirole

25
Q

What is Rotigotine?

A

Dopamine agonist indicated for Parkinson’s and RLS

26
Q

What form does Rotigotine come in?

A

QD transdermal patch

27
Q

List adverse affects of Rotigotine

A

Psychosis, compulsive behavior

28
Q

What is Entacapone?

A

COMT inhibitor that prolongs activity of l-dopa when dosed together

29
Q

Which patients require entacapone with l-dopa dose?

A

Patients with end of dose phenomenon

30
Q

Name an adverse effect of entacapone

A

Increased incidence of dyskinesias

31
Q

What is the drug similar to Entacapone with greater lipophilicity? Is it used often?

A

Tolcapone – rarely used due to risk of hepatic necrosis

32
Q

What is amantadine?

A

Drug that increases synthesis and release of dopamine, blocks dopamine reuptake

33
Q

What is the primary use of amantadine?

A

Antiviral agent (neuroamindase inhibitor) against influenza A

34
Q

Name two adverse effects of amantadine

A

Insomnia, hallucinations

35
Q

Name the hydrophilic analog of amantadine

A

Rimantidine

36
Q

Which drug is Tamiflu most similar to?

A

Amantadine

37
Q

Which strains of flu are covered by Tamiflu?

A

A and B

38
Q

List three anticholinergics

A

Diphenhydramine (Benadryl), benztropine (Cogentin), trihexyphenidyl (Artane)

39
Q

How are anti-Cholinergics used to treat Parkinson’s?

A

Help address issue of dopamine/acetylcholine imbalance

40
Q

What drug is used to treat benign essential tremor

A

Propanolol (nonspecific BB)

41
Q

Which two drugs are used to treat movement disorders associated with MS?

A

Corticosteroids, interferon-B

42
Q

List potential adverse effects of anti-cholinergics

A

Sedation, dry mouth, urinary retention, tachycardia