NMD Pharm Flashcards
When does symptoms occur with Parkinson’s disease? What occurs?
(About) 80% of the dopamine stored in the substania nigra of the basal ganglia is depleted
What is the “on-off phenomenon”?
Parkison’s worsens when what is present?
What occurs when too much dopamine is present?
The rapid swings in response to levodopa
When there is TOO little dopamine present
Dyskinesia occurs when too much dopamine is present
What is the “Wearing-off phenomenon”?
What other cognitive disease occurs as a result of PD?
On a various medication regimen and the patients are on the medications so long that they start to “wear-off”
PD-associated dementia
What is the goal of Antiparkisonian drugs?
Does drug therapy slow down the progression of disease or slow progression of symptoms?
increasing the levels of dopamine or antagonizing the effects of Ach.
Only slows down progression of symptoms
How can the nurse best explain the “off-on phenomenon” that some patients with PD experience?
A: The need to take a drug holiday to improve response to medications
B: The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms
C: The alternating schedule of medications needed to control PD
D: The fluctuation of emotions that often occurs with PD
B: The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms
What is drug class does Carbidopa-levodopa belong to? Main example?
Is this med 1st-line treatment?
When is it best to take med?
What are the contraindications?
What are the adverse effects?
Dopamine Replacement (ex: Sinement)
Main drug/1st line treatment (used early in the disease)
Best to take on an empty stomach
Contraindicated in angle-closure glaucoma
A/Es: Cardiac dysrhythmias, hypotension, chorea, muscle cramps, and GI distress; Early side effect is N/V
Why is Carbidopa given with levodopa? What is the result when given together?
Carbidopa does not cross the blood-brain barrier and prevents levodopa breakdown in the periphery.
As a result, more levodopa crosses the blood-brain barrier, where it can be converted to dopamine
What is levodopa converted into?
Dopamine
What is drug class does Selegiline (Eldepryl) and rasagiline (Azilect) belong to?
Is this med 1st-line treatment?
What are the contraindications?
What are the adverse effects?
Monoamine oxidase inhibitors (MAOIs)
Not lst line but used as monotherapy or adjuncts w/ levodopa
Contraindications (known drug allergy and concurrent use with meperidine-Demerol)
A/Es: hypotension. confusion, dyskinesia, somnolence
MANY DRUG INTERACTIONS
What does monoamine oxidase (enzyme) break down?
Why are MAOIs used for PD?
What food does this med interact with and what can occur?
Breakdown of catecholamines (like dopamine)
MAOIs are used to improve the therapeutic effect of levodopa by preventing its breakdown
MAOI non-selective interact with tyramine-containing foods (cheese, dairy and red wine) can cause a hypertensive crisis
What is an example of a dopamine modulator?
What were they originally used for?
What is the MOA? What is the result?
Antiviral drug used for treatment of influenza
Causes release of dopamine and other catecholamines from their storage sites in the presynaptic fibers of nerve cells within the basal ganglia that have not yet been destroyed by the disease process
Blocks the reuptake of dopamine into the nerve fibers
When are the dopamine modulator used?
What are the contraindications?
What are the adverse effects?
Used early in the course of disease
Usually effective for only 6 to 12 months
Know Drug Allergy
Mild and include dizziness, insomnia, and nausea.
What does COMT inhibitors purpose? (Examples?)
What do they prolong and reduce?
Block COMT, the enzyme that catalyzes the breakdown of the body’s catecholamines
Examples: Tolcapone (Tasmar), entacapone (Comtan)
Prolong the duration of action of levodopa; reduce wearing-off phenomenon so Sinemet could theoretically be taken until the end.
What are the contraindications of COMT Inhibitors? HINT: cause certain toxicity
What med cannot be take?
What are the adverse effects?
Know drug allergy. Tolcapone is contraindicated in liver failure (which is why it is not a first line treatment).
Cannot be taken w/ non-select MAOIs b/c of CV risk
A/Es: GI upset, urine discoloration, dyskensia
What does NDDRAs stand for? What class do they belong to?
What is the MOA?
How many subclass are there?
Nondopamine dopamine receptor agonists (NDDRAs) (drug class–> Direct-Acting Dopamine Receptor Agonists)
All of the NDDRAs work by direct stimulation of presynaptic and/or postsynaptic dopamine receptors in the brain.
Two subclasses: Ergot and non-ergot
