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A - NAPLEX > Chapter 69: Parkinson's Disease > Flashcards

Chapter 69: Parkinson's Disease Flashcards

1
Q

Parkinson’s Disease occurs when

A

neurons in the substantia nigra die or become impaired

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2
Q

The cells in the substantia nigra produce which NT?

A

Dopamine - which allows smooth, coordinated function of body muscles and movement

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3
Q

What are the TRAP major symptoms of PD (due to less dopamine)

A

Tremor - when resting
Rigidity - in legs, arms, trunk and face (mask-like face)
Akinesia/bradykinesia - lack of/slow start in movement
Postural instability - imbalance, falls

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4
Q

What can be used to measure involuntary movements (i.e., tardive dyskinesias) from medications

A

The Abnormal Involuntary Movement Scale (AIMS)

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5
Q

Which drugs can worsen PD

A

Any drugs that block DA such as:

  • Phenothiazines (e.g., prochlorperazine) used for psychosis, nausea, agitation
  • Butyrophenones (e.g., haloperidol, droperidol) used for psychosis and behavior disorders or nausea
  • FGA and SGA (e.g., risperidone at higher doses, paliperidone); lowest risk with quetiapine
  • Metoclopramine, a renally-cleared drug that can accumulate in elderly patients
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6
Q

Even with high doses of PD drugs and various combinations, the disease will progress, including extended periods of “off time.” What does this mean

A

When symptoms of the disease worsen before the next dose of medication is due

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7
Q

Patients with PD have a high incidence of ___

A

depression. SSRIs or SNRIs are commonly used for treatment

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8
Q

Besides SSRIs and SNRIs, what other treatments can be used for depression in PD

A

TCAs (preferably secondary amines like desipramine and nortiptyline) and the DA agonist pramipexole

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9
Q

What is the preferred antipsychotic drug for PD psychosis & why

A

Quetiapine; low risk of movement disorders, but it can cause metabolic complications, including increased cholesterol and BG

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10
Q

What is the most effective treatment for PD

A

Levodopa (a prodrug of DA)

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11
Q

What medication is given with Levodopa & what is the combination called (brand name)

A

Carbidopa

Sinemet

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12
Q

Why is carbidopa given with levodopa

A

To prevent the peripheral metabolism of levodopa, which would destroy much of the drug before it crosses the BBB

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13
Q

Which drug class is used commonly for initial treatment in younger patients

A

DA agonists

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14
Q

Tremor-predominant disease in younger patients can be treated with a ______

A

Centrally-acting anticholinergic

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15
Q

Which drug is a precursor of dopamine

A

levodopa

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16
Q

What is the MOA of carbidopa

A

Inhibits dopa decarboxylate enzyme, preventing peripheral metabolism of levodopa

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17
Q

What is the starting dose for Sinemet IR

A

25/100 mg PO TID

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18
Q

T/F: Sinemet CR tablet CAN be cut in half

A

True

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19
Q

T/F: Rytary (carbidopa/levodopa ER capsule) can be sprinkled on a small amount of applesauce

A

True

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20
Q

What is a CI for Sinemet

A

Non-selective MAO inhibitors within 14 days, narrow angle glaucoma

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21
Q

Side effects of Sinemet

A

Nausea, dizziness, orthostasis, dyskinesias, hallucinations, psychosis

Can cause brown, black, or dark discoloring of urine, saliva or sweat and can discolor clothing; positive Coombs test: discontinue drug (hemolysis risk); unusual sexual urges, priapism

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22
Q

How many mg/day of carbidopa is required to inhibit dopa decarboxylate

A

70-100

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23
Q

Long-term use of Sinemet can lead to

A

fluctuations in response and dyskinesias

24
Q

MOA of COMT inhibitors

A

increase the duration of action of levodopa; inhibit the enzyme COMT to prevent peripheral conversion of levodopa

25
Q

Which drug is a COMT inhibitor

A

Entacapone

26
Q

COMT inhibitors should only be used with ____

A

levodopa

27
Q

Dosing for entacapone

A

200 mg PO with each dose of carbidopa/levodopa

28
Q

Dopamine agonist MOA

A

act similar to DA at the DA receptor

29
Q

Which medications are dopamine agonists

A

Pramipexole, Ropinerole, Rotigotine

30
Q

Brand name for pramipexole

A

Mirapex, Mirapex ER

31
Q

Brand name for ropinerole

A

Requip

32
Q

Brand name for rotigotine

A

Neupro

33
Q

Dopamine agonist warnings

A

Somnolence (including sudden daytime sleep attacks), orthostasis, hallucinations, dyskinesias

34
Q

Which Dopamine Agonist comes as a patch

A

Rotigotine (Neupro)

35
Q

How should Neupro be used

A

Apply once daily at the same time each day to the stomach, thigh, hip, side of body, shoulder or upper arm; do not use the same site for at least 14 days

36
Q

Rotigotine should be avoided if a patient has a sensitivity/allergy to ____

A

sulfites

37
Q

T/F: Rotigotine patch does not need to be removed before an MRI

A

False

38
Q

Which drug is a dopamine agonist injection for advanced disease (a “rescue” movement drug for “off” periods)

A

Apomorphine (Apokyn)

39
Q

What units is apomorphine written in

A

mL

40
Q

Where must the first dose of apomorphine be administered in?

A

Medical office

41
Q

Contraindication for apomorphine

A

Do not use with 5HT3 antagonists (e.g., ondansetron) due to severe hypotension and loss of consciousness

42
Q

Side effects of apomorphine

A

Severe nausea/vomiting, hypotension

43
Q

For emesis prevention, what can be given with apomorphine 3 days prior to initial dose

A

trimethobenzamide (Tigan)

44
Q

MOA of amantadine

A

blocks DA reuptake into presynaptic neurons and increases DA release from presynaptic fibers. Primarily used to treat dyskinesias associated with peak-dose of Sinemet

45
Q

Amantadine warnings

A

Somnolence, psychosis

46
Q

Amantadine side effects

A

dizziness, orthostatic hypotension, livedo reticularis (reddish skin mottling - can require drug d/c)

47
Q

Which medications are selective MAO-B inhibitors used in PD

A

Selegiline, rasagiline, safinamide

48
Q

Which MAO-B should not be taken at bedtime due to activating effects

A

Selegiline

49
Q

MOA of MAO-B inhibitors

A

block the breakdown of DA which increases dopaminergic activity

50
Q

CI of MAO-B inhibitors

A

Use in combination with other MAOi (including linezolid), opioids, SNRIs, TCAs

51
Q

Warnings of MAO-B inhibitors

A

Serotonin syndrome, hypertension

52
Q

Which centrally acting anticholinergic medications are used in PD

A

Benztropine and trihexyphenidyl

53
Q

Brand name for benztropine

A

Cogentin

54
Q

Side effects of benztropine

A

dry mouth, constipation, urinary retention, blurred vision, somnolence, confusion

55
Q

Droxidopa is used for neurogenic orthostatic hypotension. What are the side effects

A

Syncope, falls, HA

56
Q

MOA-B inhibitors should not be used with foods high in tryamine such as

A

aged or mature cheese, air-dried or cured meats, including sausages and salamis, saurkraut, fava or broad bean pods, tap/draft beers, soy sauce

A - NAPLEX (83 decks)

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