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PHM701 > Exam 2 - Parkinson's Disease > Flashcards

Exam 2 - Parkinson's Disease Flashcards

(81 cards)

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1
Q

Characteristics of Parkinson’s Disease epidemiology? (4)

A

male predominant, average age of onset 62, rural life increases risk, cigarette smoking inversely correlated

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2
Q

Characteristics of Parkinson’s Disease pathophysiology? (4)

A

dopamine deficiency, loss of dopaminergic cells, formation of Lewy Bodies, nigral cell death (30-80%) before clinical manifestation

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3
Q

Diagnosis criteria for Parkinson’s Disease? (3)

A

bradykinesia and rigidity/resting tremor/postural instability

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4
Q

“On” vs “Off” meaning?

A

“On” = good movements, “Off” = poor movements

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5
Q

What class of medications for PD are on the Beer’s list?

A

anticholinergics

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6
Q

What is the MOA for anticholinergics?

A

antimuscarinic

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7
Q

What are examples of anticholinergics available for PD? (2)

A

benztropine (Cogentin) and trihexyphenidyl (Artane)

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8
Q

What are AEs of anticholinergics? (2)

A

dementia/cognitive decline risk, anti-SLUDGE

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9
Q

What is the MOA for levodopa?

A

precursor to dopamine

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10
Q

What are contraindications for levodopa? (3)

A

breastfeeding, closed-angle glaucoma, melanoma(?)

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11
Q

What are AEs of levodopa? (3)

A

dyskinesias, psychiatric, GI

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12
Q

What are important counseling points for levodopa? (2)

A

effectiveness may decrease over time, take without food (or with food consistently)

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13
Q

What is the dosing for levodopa?

A

200-300 mg/d in divided doses, no max

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14
Q

What is the MOA for carbidopa?

A

noncompetitive dopa decarboxylase inhibitor

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15
Q

Does carbidopa or levodopa cross the BBB?

A

levodopa only

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16
Q

What are contraindications for carbidopa? (2)

A

pregnancy, breastfeeding

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17
Q

What is the dosing for carbidopa/levodopa (Sinemet) to avoid N/V?

A

carbidopa amount of at least 70-100 mg/d

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18
Q

What are important counseling points for carbidopa/levodopa CR (Sinemet CR)? (2)

A

bioavailability is decreased by 25%, delayed onset of effect

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19
Q

What is the dosing for carbidopa/levodopa intestinal gel (Duopa)?

A

max 2000 mg of levodopa

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20
Q

What are AEs for carbidopa/levodopa intestinal gel (Duopa)? (2)

A

same as levodopa, PEG-J tube infection

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21
Q

What is the indication for levodopa powder for inhalation (Inbrija)?

A

two 42 mg capsules inhaled, max five times daily

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22
Q

What are contraindications for levodopa powder for inhalation (Inbrija)? (2)

A

nonselective MAOI use within 2 weeks, respiratory disorders (asthma, COPD)

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23
Q

What is the MOA for COMT inhibitors?

A

prevent the breakdown of L-dopa

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24
Q

What is the dosing of entacapone (Comtan)?

A

200 mg with each dose of levodopa/carbidopa, max eight times daily

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25
What are contraindications for entacapone (Comtan)?
none
26
What are AEs for entacapone? (2)
same as levodopa, discolored urine
27
What is the dosing for the combination entacapone/carbidopa/levodopa (Stalevo)?
1:4 200 mg
28
What is the dosing for tolcapone (Tasmar)?
100 mg tid
29
What are contraindications for tolcapone (Tasmar)?
hepatic disease
30
What are AEs for tolcapone (Tasmar)?
hepatocellular disease/liver problems/increase in LFTs
31
What is the dosing for opicapone (Ongentys)?
50 mg qhs
32
What is an important counseling point for opicapone (Ongentys)?
do not eat for 1 hr before and after dose
33
What are contraindications for opicapone (Ongentys)? (2)
nonselective MAOI use, catecholamine-secreting neoplasms
34
What are AEs for opicapone (Ongentys)?
same as levodopa
35
What is the MOA for MAOIs?
noncompetitive, selective antagonists of monoamine oxidase type B (prevent dopamine breakdown)
36
What is important regarding the PKPD of selegiline (Eldepryl, Zelapar)?
many active metabolites with long half-lives
37
What is the dosing for selegiline (Eldepryl)? For transbuccal selegiline (Zelapar)?
5 mg qd-bid, 1.25 mg qd
38
What are contraindications for selegiline (Eldepryl, Zelapar)?
none
39
What are AEs for selegiline (Eldepryl, Zelapar)? (3)
insomnia, jitteriness, serotonin syndrome
40
What is the dosing for rasagiline (Azilect)?
0.5 mg qd with levodopa, 1 mg as monotherapy
41
What are contraindications for rasagiline (Azilect)? (2)
many meds, vasoconstrictors
42
What are AEs for rasagiline (Azilect)? (2)
orthostasis, arthralgia
43
What is the MOA for safinamide (Xadago)?
Na and K channel blocker (decreases glutamate release)
44
What is the dosing for safinamide (Xadago)?
50 mg qd
45
What are contraindications for safinamide (Xadago)?
renal impairment (Child-Pugh Class C)
46
What are AEs for safinamide (Xadago)? (3)
dopaminergic (dyskinesias, psychosis), hypersomnolence, retinal pathology
47
What is the MOA of amantadine (Symmetrel, Gocovri, Osmolex)?
unknown
48
Which version of amantadine is immediate release?
Symmetrel
49
What is important regarding the PKPD of amantadine (Symmetrel, Gocovri, Osmolex)?
adjust dose with renal impairment
50
What are contraindications for amantadine (Symmetrel, Gocovri, Osmolex)? (3)
CHF, orthostatic HTN, peripheral edema
51
What are AEs for amantadine (Symmetrel, Gocovri, Osmolex)?
livedo reticularis
52
Which class of medications has a reduced risk of developing motor complications?
dopamine agonists
53
What are the four dopamine agonists?
apomorphine, pramipexole (Mirapex), ropinirole (Requip), rotigotine (Neupro)
54
What is the dosing for pramipexole IR (Mirapex)? For pramipexole ER (Mirapex)?
0.125 mg tid, 0.375 mg qd
55
What is the dosing for ropinirole IR (Requip)? For ropinirole ER (Requip)?
0.25 mg tid, 2 mg qd
56
What are contraindications for ropinirole (Requip)? (2)
hepatic disease, abrupt discontinuation
57
What are drug interactions with ropinirole (Requip)?
inhibitors of CYP1A2
58
What is the dosing for rotigotine (Neupro)?
2 mg qd
59
What are contraindications for rotigotine (Neupro)?
sulfite sensitivity
60
What are AEs for rotigotine? (4)
application site reaction, CNS, GI, peripheral edema
61
What is the indication for apomorphine (Apokyn)?
off episodes
62
What is the dosing for apomorphine (Apokyn)?
2 mg SQ
63
What is important regarding the PKPD of apomorphine (Apokyn)?
t1/2 = 40 min
64
What are contraindications for apomorphine (Apokyn)?
5HT3 antagonists
65
What is the MOA of istradefylline (Nourianz)?
adenosine A2A receptor antagonist
66
What is the dosing for istradefylline (Nourianz)?
20 mg qam
67
What conditions require dose adjustment for istradefylline (Nourianz)? (2)
tobacco smoking, hepatic impairment
68
What are AEs for istradefylline (Nourianz)? (2)
dyskinesias, psychiatric
69
What are non-pharm treatments for PD? (4)
surgery, PT/exercise, nutrition, OT and fall precautions
70
What has been proven useful for depression in PD? (2)
pramipexole, venlafaxine
71
What has been proven useful for dementia/cognitive impairment in PD?
rivastigmine
72
What has been FDA-approved for orthostatic HTN in PD?
droxidopa
73
What has been proven useful for sexual dysfunction in PD?
sildenafil
74
What has been proven useful for constipation in PD? (2)
probiotics and fiber
75
What has been proven useful for drooling in PD?
Botox
76
What is the first step in managing psychosis in PD?
evaluate hypoxemia, infection, and electrolyte disturbances
77
What is the second step in managing psychosis in PD?
simplify regimen
78
What is the third step in managing psychosis in PD?
consider atypical antipsychotic drugs
79
What is the MOA of pimavanserin (Nuplazid)?
atypical antipsychotic, 5HT inverse agonist
80
What is a BBW for pimavanserin (Nuplazid)?
death in elderly with dementia being treated with APDs
81
What are AEs for pimavanserin (Nuplazid)? (2)
QTc prolongation, peripheral edema

PHM701 (14 decks)

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