Parkinson 1- SG Flashcards
(43 cards)
1
Q
4 features of Parkinson’s
A
- Resting Tremor - pill rolling
- Rigidity - cogwheel
- Bradykinesia - slow shuffling gate
- Postural Instability - no contralateral gait
2
Q
Pathology of Parkinson
A
Dopamine deficiency
or
Acetylcholine excess
3
Q
3 features of MS
A
- Visual compromise
- Stiffness
- Weakness (unilateral)
4
Q
Pathology of MS
A
Autoimmune disease (affects CNS)
5
Q
- Does Parkinson develop rapidly or slowly?
- It develops after age ___.
- Rarely occurs in what population?
A
- Gradually/slowly
- 50
- Blacks
6
Q
A sporadic or familial progressive neurodegenerative disease which affects nerve cells in brain & spinal cord, results in loss of voluntary movement & muscle control
A
Amyotrophic Lateral Sclerosis (ALS)
7
Q
Nerve disorder characterized by uncontrollable shaking or “tremors” seen in especially when you do simple tasks (drinking from glass/tying shoelaces)
A
Essential Tremor
8
Q
- 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
A
Guillain-Barre
9
Q
- Inherited adult-onset neurologic disease characterized by dementia and bizarre involuntary movements
A
Huntington’s Disease
10
Q
Chronic autoimmune neuromuscular disorder characterized by fluctuating weakness of voluntary muscle groups
A
Myasthenia Gravis
11
Q
- A disorder of the part of the nervous system which causes urge to move legs
- Associated w/ iron deficiency
A
Restless Leg Syndrome (RLS)
12
Q
- 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
A
Tourette’s Syndrome
13
Q
- An inherited (autosomal recessive) disorder of copper accumulation in liver, brain, kidneys, eyes
A
Wilson’s Disease
14
Q
- Education
- Exercise
- Nutrition
- Psychosocial support
A
Non-pharm tx for Parkinson Disease
15
Q
- Levodopa
- Levodopa-carbidopa
A
Dopamine precursor
(for PD)
16
Q
- Bromocriptine
- Pramipexole
- Ropinirole
A
Dopamine Agonists
(for PD)
17
Q
- Selegiline
- Rasagiline
A
MAOI inhibitors
(for PD)
18
Q
- Entacapone
- Tolcapone
A
COMT inhibitors
(for PD)
19
Q
- Benztropine
- Trihexyphenidyl
A
Muscarinic antagonists
20
Q
- Initial drug for the flu, helps PD
A
Amantadine
21
Q
- Neurosynaptic cleft
- Enhances dopamine release
- Blocks glutamatergic N methyl D
A
Amantadine
22
Q
- ___ can cross BBB
- _____ cannot cross BBB
A
- Levodopa can cross BBB
- Dopamine cannot
(when levo crosses BBB it becomes dopamine)
23
Q
- Treatment should be initiated for PD when?
A
- When the disease begins to interfere w/ activities of daily living, employment, or quality of life
24
Q
Monotherapy for PD?
A
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
