Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHA 550 > Parkinson Disease > Flashcards

Parkinson Disease Flashcards

1
Q

Parkinson Disease: features

A

resting tremor
rigidity
bradykinesia
postural instability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Parkinson Disease: pathology

A

dopamine deficiency

acetylcholine excess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Parkinson Disease: non-pharmacologic treatment

A

education
exercise
nutrition
psychosocial support

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Parkinson Disease: pharmacologic treatment

A 
dopamine precursor
dopamine agonist
MAOB inhibitor
COMT inhibitor
muscarinic antagonist
amantadine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

SLUDGE

A 
S: salivation
L: lacrimation
U: urination
D: defecation
G: GI
E: emesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Dopamine and the brain

A

dopamine cannot cross the blood brain barrier

levodopa is a dopamine precursor that can cross the BBB

BUT levodopa is rapidly metabolized in the periphery - need medications to prevent this

once levodopa is in the brain it is converted to dopamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

MAO-B Inhibitor: Rasagiline, Selegiline: MOA

A

irreversible inhibition of monoamine oxidase type B in the brain
–>
interferes with the degradation of dopamine
–>
prolonged dopaminergic activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

MAO-B Inhibitor: Rasagiline, Selegiline: ADEs

A 
nausea
orthostatic hypotension
confusion
insomnia
hallucinations
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

MAO-B Inhibitor: Rasagiline, Selegiline: drug interactions

A

serotonin syndrome with meperidine, opioids

SSRI’s are not contraindicated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Serotonin Syndrome: signs and symptoms

A 
change in BP
rapid HR
N/V
tremor
agitation/restlessness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Selegiline

A

oral or ODT

improves motor function
inc on time

metabolizes down to amphetamines

ADEs:

  • agitation
  • insomnia
  • hallucinations
  • orthostatic hypotension
  • can make sx worse when given with levodopa
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

MAO-B Inhibitor: Safinamide

A

selective, reversible adjunct tx with levodopa/carbidpoa

inc on time w/out dyskinesia
improves motor function, clinical status, QOL

ADEs:

  • dyskinesia
  • nausea
  • insomnia
  • halls
  • HTN
  • hallucinations
  • impulse control disorder
  • serotonin syndrome
  • LFT elevation
  • very high tyramine containing foods
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the treatment if the main physical exam finding is tremor?

A

anticholinergic medication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Anticholinergic Medication

A

mild tremor predominant PD

<65 years of age: monotherapy

65+: adjunct

used with caution:

  • elderly
  • cognitive difficuties

decreases acetylcholine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anticholinergic Medications: medications, ADEs

A

benztropine
trihexyphenidyl

ADEs:

  • inc body temp
  • dry mouth, dry eyes, dec sweat
  • dilated pupils
  • flushing
  • delirium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Levodopa/Carbidopa

A

dopamine precursor

65+ years of age

most effective drug for symptomatic treatment of PD

17
Q

Carbidopa

A

reduces side effects

inhibits peripheral metabolism of levodopa –> inc the fraction that reaches the brain

18
Q

Levodopa/Carbidopa: drug interaction

A

COMT and MAOB inhibitors

  • diminish doses
  • prolong action

patient would exhibit excess dopamine

19
Q

Levodopa/Carbidopa: ADEs

A

drowsiness
dyskinesias
-motor complications

20
Q

COMT Inhibitor: MOA

A

blocks the conversion of levodopa to 3-OMD
–>
provides greater percentage of levodopa to cross BBB

21
Q

COMT Inhibitor

A

entacapone
tolcapone

attenuate motor fluctuations in carbidopa/levodopa treated patients

neuroprotective effect

not used as monotherapy

22
Q

COMT Inhibitor: ADEs

A 
dyskinesia
confusion
nausea
diarrhea
liver toxicity (tolcapone)
orthostatic hypotension
23
Q

COMT Inhibitor: drug interaction

A

reduce dose

  • levodopa
  • antidiarrheals
24
Q

Dopamine Agonist

A

pramipexole

stimulates dopamine activity in the substantia nigra and striatum

25
Q

Dopamine Agonist: ADEs

A 
postural hypotension
pulmonary fibrosis
confusion
hallucinations
sedation
vivid dreaming
impulsive behavior
26
Q

Amantadine

A

enhances dopamine release

blocks glutamatergic NMDA receptors

benefits:

  • tremor
  • rigidity
  • bradykinesia

add on agent to attenuate dyskinesias

27
Q

Amantadine: ADEs

A 
confusion
dizziness
dry mouth
hallucinations
livedo reticularis (lacey pattern appearance)
28
Q

Apomorphine

A

derived from morphine - lacks narcotic properties

premedicated w/ trimethobenzamide (antiemetic) –> SQ –> on response w/in 20 minutes

indication: advanced PD w/ intermittent off episodes

ADEs:
N/V

29
Q

End of dose “wearing off”

A

inc frequency

add COMT inhibitor or MAOB inhibitor or dopamine agonist

30
Q

“Delayed on” or “no on” response

A

give on an empty stomach

use ODT form

avoid CR (long acting) form

use apomorphine

31
Q

Start hesitation

A

inc C/L dose

add dopamine agonist or MAOB inhibitor

PT w/ assistive walking devices or sensory cues

32
Q

Peak dose dyskinesia

A

smaller doses of C/L

add amantadine

33
Q

Duopa

A

gel form C/L (enteral suspension)

treats motor symptoms

tube placed in the intestine - duopa delivered directly to intestine

improved absorption
reduced off times

34
Q

Deep Brain Stimulation (DBS)

A

adjunct to pharmacotherapy

bilateral, chronic, high frequency electrical stimulation

does NOT improve gait or postural instability

35
Q

Thalamic DBS

A

suppresses tremor (sp arm tremor)

does NOT improve 
bradykinesia
rigidity
motor fluctuations
dyskinesia
36
Q

STN and GPi DBS

A 
improves
tremor
rigidity
bradykinesia
motor fluctuation
dyskinesia
activities of daily living

STN DBS: allows for greater reduction in meds

PHA 550 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions