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PHRM 845 > L43 PD pharmacotherapy > Flashcards

L43 PD pharmacotherapy Flashcards

(67 cards)

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1
Q

clinical presentation of PD (4 things)

A

tremor
bradykinesia
rigidity
parkinson gait

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2
Q

non-motor sxs of PD (7 but idk how important they are)

A

anxiety/depression
constipation
dementia
insomnia
orthostatic htn
psychosis/delirium
sexual dysfxn

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3
Q

what does a high UPDRS score mean?

A

worse PD sxs

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4
Q

Non-pharm therapy and when is it important?

A

exercise/PT
Nutritional counseling
Occupational therapy
psycotherapy/support groups
speech therapy

its important early after diagnosis

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5
Q

what is recommended before pharmacologic options?

A

physical therapy

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6
Q

1st line pharm therapy- initial tx

A

rule out drug induced PD *
dopamine precursor
dopamine agonist
MAO-B i

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7
Q

2nd line pharm therapy-initial tx

A

COMT i
Amantadine

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8
Q

what drug class has a risk of potentiating PD?

A

dopamine precursors (L-DOPA)

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9
Q

meds that can induce PD

A

antipsychotics/antiemetics and promethazine (which is an antiemetic)

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10
Q

what is the typical first medication

A

L-DOPA, a dopamine precursor

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11
Q

if someone is younger than 60 what could you consider giving first?

A

dopamine agonist

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12
Q

when should you avoid dopamine agonists as initial tx? (6 things)

A

age >70
history of ICD
cognitive impairment
excessive daytime sleepiness
Hallucinations

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13
Q

T or F: in general you start with CR opposed to IR

A

False, start immediate release

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14
Q

order of efficacy for motor symptoms between drug classes **

A

levodopa/carbidopa > DA> MAOB-i

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15
Q

what is the starting dose for CD/LD?

A

25/100 mg po bid-tid with meals

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16
Q

side effects of LD/CD

A

LD motor fluctuations/dyskinesias **

N/V

hallucinations

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17
Q

LD motor fluctuations:
wearing off, what it means and what do you do

A

sxs come back because meds are wearing off, shorten intervals or give a higher dose *

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18
Q

LD motor fluctuations:
Freezing

A

inability to move bc fluctuating or inefficient dopamine levels

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19
Q

LD motor fluctuations: delayed onset, what is it and what do you do?

A

therapeutic benefits are delayed, typically a morning problem, controlled release if pt doesnt have an IR

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20
Q

LD motor fluctuations:
Peak dose dyskinesias, what is it and how is it caused

A

involuntary body movement. caused by high DA levels (duh)

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21
Q

non-ergot Dopamine Agonists (4)

A

Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neuropro)
Apomorphine (Apokyn)

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22
Q

ergot dopamine agonists (2)

A

Bromocriptine (Parlodel)
Cabergoline (Dostinex)

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23
Q

T or F: You typically use non-ergot

A

True

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24
Q

T or F: DA are first line for initial PD therapy

A

true

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25
why are ergots rarely used?
toxicity
26
advantages of dopamine agonists (2) **
- fewer motor fluctuations. - long-acting formulations
27
3 MAO-B inhibitors
Rasagiline (Azilect) Selegiline (Eldepryl) Safinamide (Xadago)
28
T or F: MAO-Bi's are more effective than DA at controlling motor sxs
false
29
starting dose rasagiline
0.5mg po qd
30
starting dose selegiline
5 mg po bid
31
starting dose safinamide
50 mg po qd
32
MAO-Bi's have a dietary restriction, what is it?
tyramine-rich foods
33
Which of the following MAO-B's has insomnia as a side effect? A. Rasagiline (Azilect) B. Selegiline (Eldepryl) C. Safinamide (Xadago)
B. Selegiline (Eldepryl)
34
MAO-Bi's are first line for what and second line for what
first line-> mild sxs second line-> adjunct therapy
35
T or F: MAO-Bi's have a risk of serotonin syndrome
True
36
what drug class minimizes the breakdown of dopamine?
COMT inhibitors
37
what drug causes orange/brown urine discoloration? what class is it in?
Entacapone, COMT-i
38
3 COMT inhibitors
Entacapone (Comtan) Opicapone (Ongentys) Tolcapone (Tasmar)
39
starting dose entacapone
200 mg po with each CD/LD dose
40
starting dose tolcapone
100 mg po tid
41
starting dose opicapone
50 mg po qhs
42
amantadine (symmertrel) place in therapy
management of LD motor fluctuations
43
side effects of amantadine (symmetrel) (3 things)
insomnia confusion/hallucinations livedo reticularis ?
44
starting dose amantadine (symmetrel)
100 mg po bid
45
T or F: Amantadine (symmetrel) is hepatically excreted
False, renally
46
2 anticholinergics
benztropine (cogentin) Trihexyphenidyl (artane)
47
place in therapy of anticholinergics
management of tremor-dominant symptom pts that are UNDER 65 yo *
48
starting dose of benztropine (cogentin)
0.5 mg po qhs
48
Starting dose trihexyphenidyl
1 mg po qd
48
why is use of anticholinergics limited?
confusion and antimuscarinic effects
49
when should you avoid anticholinergics
>65 yo
50
5 side effects of anticholinergics
confusion/dementia blurry vision urinary retention dry mouth constipation
51
monitoring for drug tx of PD (3 things)
evaluate motor sxs assess for side effects related to drugs identify meds that can worsen PD
52
what meds can worsen PD?
DA, antipsychotics, metoclopramide
53
effect of taking dopamine precursor without food
increased absorption
54
effect of taking dopamine precursor with food
decrease in nausea
55
Management of LD Motor Fluctuations: wearing off (3 things)
- increase CD/LD dose or frequency - add DA agonist, MAOi, or COMTi - XR CD/LD
56
Management of LD Motor Fluctuations: Freezing (3 things)
- increase CD/LD dose or frequency - add DA agonist, (apomorphine) - Add ODT CD/LD
57
Management of LD Motor Fluctuations: Delayed onset (3 things)
- take CD/LD on empty stomach (increases absorption) - ODT CD/LD - Avoid CR/XR CD/LD *
58
Management of LD Motor Fluctuations: Peak-dose dyskinesias (2 things)
- add amantadine * - decrease dose of DA or CD/LD
59
what is deep brain stimulation?
elective surgical procedure offered after maximizing drug tx
60
risks of deep brain stimulation
- infections - device malfunction - headache - tingling of face or limbs - cost
61
what drug class do you want to avoid with insomnia
benzos (diazepam, lorazepam, oxazepam) **
62
what drug class do you avoid with anxiety?
benzos (diazepam, lorazepam, oxazepam) ** and caution with tricyclic antidepressants
63
what drug classes do you avoid in dementia (4)
anticholinergics, benzos, antihistamines, sedatives *
64
what drugs do you avoid in psychosis/delirium? (4)
haloperidol olanzapine paliperidone risperidone
65

PHRM 845 (34 decks)

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