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From Flashcardlet > Neuro 63: Pharmacologic Tx of Parkinson's > Flashcards

Neuro 63: Pharmacologic Tx of Parkinson's Flashcards

1
Q

2 most common neuro degenerative disorders

A
  1. Alzheimer’s

2. Parkinson’s

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2
Q

Incidence and risks for Parkingson’s

A
  • incidence increases with age
    risks:
  • higher in males & hispanics
  • lower risks w/ smoking and caffeine use
  • several genetic mutations
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3
Q

4 Motor Sx of Parkinson’s

A
  1. resting tremor
  2. bradykinesia = slowness of mvmnt
  3. rigidity w/ cogwheeling
  4. postural instability
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4
Q

Non-motor sx of PD

A
  • olfactory disturbances - usually 10-15yrs before motor sx
  • sensory sx
  • GI disturbances - constipation
  • urinary sx - nocturia, frequency, urgency
  • orthostatic intolerance - prone to falling
  • sleep disorders - REM sleep behavior disorder
  • dementia
  • depression
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5
Q

Px of PD

A

-loss of dopaminergic neurons in the substantia nigra pars compacta

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6
Q

Dopamine is broken down via?

A
  1. MAO

2. COMT

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7
Q

Levadopa

A
  • dopamine precursor

- majority is metabolized in the gut and will not make it the brain

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8
Q

Carbidopa

A
  • peripheral dopa decarboxylase (in the gut) inhibitor

- given with levadopa to prevent its metabolism in the gut so the levadopa can get to the brain

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9
Q

4 Effects of prolonged use of levadopa/carbidopa

A
  1. wearing off = get rigidity and tremor worsening btwn doses
  2. motor fluctuations = periods of time where the pt feels good and then off
  3. freezing
  4. dyskinesias = unwanted mvmnts that are greater than tremors
    * *why this is usually not the drug of choice for young pts (<65 yrs)
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10
Q

Apomorphine

A
  • injectable dopamine agonist

- used as a rescue med for freezing experienced by PD pts with prolonged levadopa/carbidopa use

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11
Q

What should be given to a pt that is suspected to have Parkinson’s disease?

A
  • give them a trial of levadopa/carbidopa
  • if their sx get better = probably PD
  • if they do not get better = prob NOT PD
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12
Q

8 Adverse effects of levadopa/carbidopa

A
  1. Dyskinesias
  2. impulse colntrol disorders*
  3. orthostatic hypotension
  4. nausea
  5. somnolence = excessive sleepiness*
  6. Psychosis
  7. Exacerbations of glaucoma
  8. neuroleptic malignant syndrome w/ abrupt w/drawl *
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13
Q

entacapone

A
  • COMT inhibitor

- inhibit catechol-O-methyl transferase = prolongs the action of levadopa

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14
Q

2 Unique Adverse effects of entacapone

A
  1. orange-brown discoloration of urine and other bodily fluids
  2. hepatic failure w/ tolcapone
    * *others similar to levadopa/carbidopa
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15
Q

Pramipexole/ropinirole MOA

A
  • dopamine agonist = bind to the D2 receptors and activate the dopaminergic circuits
  • non-ergors
  • *ergot derivatives not used anymore b/c of cardiac valvular fibrosis risk
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16
Q

2 Unique adverse effects of Dopamine Agonists

A
  1. peripheral edema
  2. hyperhydrosis = excessive sweating
    * *other side effects similar to L/C
17
Q

Non-selective MAO inhibitors

A
  • inhibits both MAO-A & MAO-B

- risks of HTN crisis w/ tyramine containing foods (ex. wine, cheese, chocolate)

18
Q

Selective MAO-B inhibitors

A
  1. selegiline

- possibly neuro-protective –> so usually given to young pts

19
Q

Unique MAO-B inhibitor adverse effects

A
  1. serotonin syndrome - if taken in conjunction w/ tricyclic antidepressions (rare)
    * *other side effects similar to L/C
20
Q

Amantadine MOA

A
  • possible dopamine agonist and/or reuptake inhibitor
  • possible NMDA receptor antagonist
  • useful for tx of dyskinesias and tremor in tremor predom forms of PD
21
Q

Amantadines 2 side effects

A
  1. peripheral edema

2. livedo reticularis = nasty skin condition

22
Q

Anticholinergics MOA, use, and ex.s

A
  • restore natural balance of dopamine and Ach in the BG
  • useful in tx tremor in younger pts
  • benztropine, trihexylphenidyl, diphenhydramine (benadryl)
23
Q

Anticholinergics side effects

A
  1. encephalopathy = confusion, esp in older pts
  2. tachycardia
  3. constipation
  4. urinary retention
24
Q

Basic principle for levadopa/carbidopa

A
  • drug of choice

- usually used for older pts (65+)

25
Q

Basic principle for Entacapone

A

-use to prevent the “wearing off” experienced with levadopa/carbidopa use

26
Q

Basic principle pramipexole/ropinirole

A
  • almost as effective as levadopa/carbidopa in younger pts

- NO neur-protective effects found

27
Q

Basic principle for selegiline

A
  • MAO-inhibitor

- possibly neuroprotective –> so used in younger pts

28
Q

Basic principle for amantadine

A

-used for dyskinesias

29
Q

Basic principle for anticholinergics

A

-used in tremor-predom disease in YOUNGER pts

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