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Flashcards in Anti-Parkinson Deck (34):
1

concept: Why does increasing DOPA make sense

@ normal physiological context DOPA levels are negligilbe. since rate limiting step is tyrosine OHase above DOPA production, if you load up on substrate you can increased DA = good to go for parkinson hurrah.

2

Goal of therapy for Parkinson

want to decrease GABA -- normally DA stimulates GABA neurons and Ach decreased GABA -- so goal is to get more DA and less Ach so that GABA activity is increased

3

What happens when levidopa is decarboxylated in the periphery ie symptoms

nausea
vomiting
cardiac arrhtymias
hypotension

4

Why does food slow the appearance of levidopa in the plasma?

amino acids compete with absorption from gut and transport from blood to brain

5

Wearing Off Phenomenon VRS On-Off Phenomenon

wearing off - fluctuations due to timing of levodopa administration
On-off phenomenon - fluctautions not due to timing of levodopa administration

6

How to treat the Offs of the ON Off phenomenon

give apomorphine

7

What vitamin is contraindicated with levodopa and why

vitamin B6 because is a cofactor for DOPA decarboxylase and increases peripheral metabolism of levodopa

8

Why cant you use levodopa with a nonspecific MAO inhibitor

hypertensive crisis

9

What type of meds and patients shouldnt be given levodopa

healthy people and ppl on antipsychotics or with mental disturbances

10

What eye probelms contraindicated levodopa

angle closure glaucoma

11

What heart problems are significinat?

can cause arrhtymias in cardiac patients

12

Name the ergot D2 agonist

Bromocriptine

13

Name the nonergot D2 agonists

Pramipexole
Ropinirole (pin role = parkinson side effect ;))
Rotigotine

14

Which nonergo D2 agonist is available only transdermal

Rotigotine`

15

Ergot side effects please :) only the bolded ones

Bromocriptine: pulmonary infiltrates
plueral and retroperitoneal fibrosis
erythromelalgia (bouts of pain cuased by temperature, turns red, usually hands and feet)

16

Nonergot side effects bolded please

Pramipexole
Ropinirole (Ro-pin roll)
Rotigotine

SOMNOLENCE

17

~*~Contraindications and be careful pateints for DA agonists

psychotic illness
recent mi (causes arrhythmias)
periperal vascular disease (erytrmelalgia and vasospasm @ periphery)
puptic ulceration (makes em bleed)

18

Who cares about Apomorphine and why

rescue for OFF episodes of akinesia

emetogenic so give an antiemtic first

other effects i dont have time for- not bolded

19

Which MAO i are used as adjuncts for levodopa treatment?

selegiline - deprenyl
and
(new one, not listed in antidepressant lec) =
Rasagiline


GILINES

20

What is a concern about the metabolism of selegilin

metabolized to metamphetamine and amphetamine so can cause insomnia if take late in the day

21

Justify the use of Tolcapone (gangster) and Entacapone

Tolcapone and Entacapone inhibit COMT --> thus levodopa is not metabolized to 3-o-methyl dopa so there is no compeition for uptake of levodopa to the BBB or the intestine; when you use carbidopa it causes increase shunting of levodopa to its metabolite

22

Describe site of action of tolcapone and entacapone

tolcapone - in bbb and intestine

entacapone - periphery (enterocytes ie enta @ gut)

23

~*~A/se of tolcapone

fulminating hepatic necrosis; entacapone doesnt cause this so preferred.

24

~*~Antiviral with antiparkinsonism effects?

Amantadine

25

MOA Amantadine

a) increases synthesis, release or reuptake of DA from **surviving neurons

26

Bolded side effect of Amantadine

Levido reticularis - clears spontaneously after 1 month of cessationg of tx

27

What good are antimuscarinics for Parkinson?

improve tremor and rigidity but not relaly bradykinesia (more central and due to DA... maybe)

28

When should you not use antimuscarins

glaucoma
prostatic hyeprtrophy
pyloric stenosis

29

Describe the first line regimen for Parkinson.

levodopa + carbidopa

30

Decribe what you'd give for second line treatment of Parkinson

dopamin agonist
ergot - bromocriptine
nonergot - pramipexole, ropinirole, rotigotine

31

Why would you add a COMT inhibitor or an MAOB inhibitor to levodopa?

to reduced motor fluctations for peopel with advanced disease

COMT inhibitors are teh CAPTONES
MAo-b are the GILINES

32

Why would you add an antimuscarinic to the treatment regimen @ parkinson?

control of tremor and drooling.

33

If I say CAPTONE you say?

COMT inhibitors
control of adcanced disease
fulminating hepatic necrosis

34

If I say GILINE you say?

MAO-B inhibitor
control of advanced disease
dont take late in the day because of the meth metabolism ;)