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Flashcards in Parkinson 1 Deck (43):
1

4 features of Parkinson's

  • Resting Tremor - pill rolling
  • Rigidity - cogwheel
  • Bradykinesia - slow shuffling gate
  • Postural Instability - no contralateral gait

2

Pathology of Parkinson

Dopamine deficiency 

or

Acetylcholine excess

3

3 features of MS

  • Visual compromise
  • Stiffness
  • Weakness (unilateral)

4

Pathology of MS

Autoimmune disease (affects CNS)

5

  • Does Parkinson develop rapidly or slowly?
  • It develops after age ___.
  • Rarely occurs in what population?

  • Gradually/slowly
  • 50
  • Blacks

6

A sporadic or familial progressive neurodegenerative disease which affects nerve cells in brain & spinal cord, results in loss of voluntary movement & muscle control

Amyotrophic Lateral Sclerosis (ALS)

7

Nerve disorder characterized by uncontrollable shaking or "tremors" seen in especially when you do simple tasks (drinking from glass/tying shoelaces)

Essential Tremor

8

  • Flu vaccine
  • A condition where the immune system attacks the nerves w/ sxs of weakness & tingling in the fet and legs ascending to upper body. 
  • Paralysis can occur

Guillain-Barre

9

  • Inherited adult-onset neurologic disease characterized by dementia and bizarre involuntary movements

Huntington's Disease

10

Chronic autoimmune neuromuscular disorder characterized by fluctuating weakness of voluntary muscle groups

Myasthenia Gravis 

11

  • A disorder of the part of the nervous system which causes urge to move legs
  • Associated w/ iron deficiency

Restless Leg Syndrome (RLS)

12

  • Disorder w/ repetitive movements or unwanted sounds (tics) that can't be easily controlled
  • Etiology is unknown, but likely combo of inherited/genetic & environmental factors

Tourette's Syndrome

13

  • An inherited (autosomal recessive) disorder of copper accumulation in liver, brain, kidneys, eyes

Wilson's Disease

14

  • Education
  • Exercise
  • Nutrition
  • Psychosocial support

Non-pharm tx for Parkinson Disease

15

  • Levodopa
  • Levodopa-carbidopa

Dopamine precursor

(for PD)

16

  • Bromocriptine
  • Pramipexole
  • Ropinirole

Dopamine Agonists

(for PD)

17

  • Selegiline
  • Rasagiline

MAOI inhibitors

(for PD)

18

  • Entacapone
  • Tolcapone

COMT inhibitors

(for PD)

19

  • Benztropine 
  • Trihexyphenidyl

Muscarinic antagonists

20

  • Initial drug for the flu, helps PD

Amantadine

21

  • Neurosynaptic cleft
  • Enhances dopamine release
  • Blocks glutamatergic N methyl D

Amantadine

22

  • ___ can cross BBB
  • _____ cannot cross BBB

  • Levodopa can cross BBB
  • Dopamine cannot

(when levo crosses BBB it becomes dopamine)

23

  • Treatment should be initiated for PD when?

  • When the disease begins to interfere w/ activities of daily living, employment, or quality of life

24

Monotherapy for PD?

MAO-B inhibitors (Rasagiline/Selegiline)

(interferes w/ degredation of dopamine & results in prolonged dopamergic activity)

25

  • W/ tx of PD, MAO-B inhibitor along w/ addition of ______ should be considered if motor fluctuations develop to extend duration of activity of L-dopa (levodopa)
  • Alternatively consider addition of an MAO-B inhibitor or ____ _____. 

  • Catechol-O-methyltransferase (COMT) inhibitor
    • Entacapone
    • Tolcapone
  • Dopamine agonist
    • Bromocriptine
    • Pramipexole
    •  

26

For management of L-dopa induced peak dose dyskinesias, consider addition of _______. 

Amantadine (initial drug for flu)

27

MOA: Selective irreversible inhibition of MAO-B in the brain interferes w/ degredation of dopamine and results in prolonged dopamingergic activity

MOA-B inhibitors (Rasagiline/Selegiline)

28

Adverse affects of what drug?

  • Nausea
  • Orthostatic hypotension
  • Confusion
  • Insomnia
  • Hallucinations

MAO-B inhibitor 

(Rasagiline / Selegiline)

29

What does a drug interaction of MAO-B inhibitor (Rasagiline/Selegiline) w/ Meperidine and opioid analgesics result in?

Serotonin Syndrome

30

Sxs of what?

  • Change in BP
  • Rapid HR
  • N/V
  • Tremor
  • Agitation / Restlessness

Serotonin Syndrome

31

T/F

  • Concomitant use of serotonergic antidepressants w/ MAO-B inhibitors is NOT contraindicated
  • (These drugs can be used concomitantly when clinically warranted)

True

32

What is the administration route of Selegiline?

  • Oral
  • ODT formulation (oral dissolving tablet)

33

Which drug?

  • Provides "modest" improvement in motor function
  • In advanced PD, adjunctive use of selegiline can provide 1 hour of extra "on time" for pts w/ wearing off
  • (off time = can't move)
  • Inconsistent results bc of erratic bioavailability

Selegiline

34

Metabolism:

Which drug undergoes "first pass hepatic metabolism predominantly via cytochrome P450 (CYP450 2B6 and 2C19) to end products of methamphetamine and I-amphetamine?

Selegiline (MAO-B inhibitor)

35

Which drug?

  • Agitation
  • Insomnia (esp if admin at bedtime)
  • Hallucinations
  • Orthostatic hypotension
  • Increases the peak effects of  l-dopa and can worsen pre-existing dyskinesia or psych sxs (delusions)

Selegiline (MAO-B inhibitor)

36

Which drug?

  • Indicated for Parkinson "off" episodes
  • MOA: selective, reversible monoamine oxidase type B (MAO-B) inhibitor approved as adjunctive tx w/ levodopa/carbidopa (w or w/o agents)
  • Modestly increases mean daily "on" time w/o troublesome dyskinesia

Safinamide (MAO-B inhibitor)

37

Which drug?

Most common adverse events:

  • Dyskinesia
  • Falls
  • HTN
  • Hallucinations
  • Impulse control disorder
  • Serotonin Syndrome
  • *Very high tyramine containing foods*
  • $30/ tablet

Safinamide (MAO-B inhibitor)

38

  • Is found in aged cheese, meats, and beer
  • If not metabolized, will lead to HTN crisis and HA

Tyramine

39

What is the tx of Parkinson if the main PE finding is a tremor?

Anticholinergic medication

(Increased Cholinergic activity is believed to contribute to tremor of PD)

40

Which med?

  • Useful for mild tremor-predominant PD
  • Most useful as monotherapy in pts <65yrs
  • DO NOT have significant bradykinesia or gait disturbance
  • "add on" in more advanced PD
  • Caution in elderly / pre-existing cognitive difficulties

Anticholinergic med for PD

(Benztropine & Trihexyphenidyl)

41

What meds are these?

  • Benztropine
  • Trihexyphenidyl

Anticholinergic meds for PD

42

What are the 5 adverse effects of anticholinergics?

  • Hot as a hare
  • Dry as a bone
  • Blind as a bat
  • Red as a beet
  • Mad as hatter

43

Instead of anticholinergic, what would you give pt who is 65 or older?

Dopamine