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MJ- Pharm Exam 3 > Parkinson 2- SG > Flashcards

Parkinson 2- SG Flashcards

(38 cards)

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1
Q

What is the precursor of Dopamine?

A

Levodopa/Carbidopa/L-dopa

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2
Q
  • What is the best tx of a pt who is 65 yrs or older?
  • Is useful if tremor is not controlled by an anticholinergic
  • Most effective drug for symptomatic tx of PD
A

Levodopa / Carbidopa

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3
Q

Ultimately all pts w/ PD will require what med?

A

Levodopa / Carbidopa / l-dopa

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4
Q

Why is Carbidopa added to Levodopa?

A

It prevents the breakdown of Levodopa

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5
Q

Carbidopa inhibits peripheral metabolism of Levodopa via ___ ______.

A

Dopa decarboxylase

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6
Q

Ultimately leads to an increase in the fraction of the dose that reaches the brain.

A

Role of adding Carbidopa to Levodopa (prevents breakdown of Levodopa)

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7
Q

What 2 drugs interact w/ Levodopa/Carbidopa resulting in:

  • diminished doses
  • prolonged action

What would pt experience w/ this interaction?

A

COMT (peripheral & brain, prevent dopamine degredation)

MAO B inhibitors

Excess dopamine (hallucinations/schizophrenia) and EPS - extra priamital ability

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8
Q

Adverse effects of what drug?

  • Drowsiness
  • Dyskinesias
  • **Motor Complications**
A

Levodopa / Carbidopa

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9
Q

MOA of what drug?

  • Blocks the conversion of L-dopa into the inactive form of 3-O-Methyldopa (3-OMD)
  • Prevents conversion of Dopamine to 3-methoxtyramine (3-MT)
  • Provides greater % of l-dopa to cross BBB & Dopamine in brain
A

COMT inhibitor

(Entacapone & Tolcapone)

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10
Q

Which drug?

  • Attenuate motor fluctuations in carbidopa/l-dopa treated pts
  • Modest symptomatic benefit as monotherapy
  • Benefit may be from neuroprotective effect
  • NO benefit as a monotherapy as it may not get more levodopa into the brain
A

COMT inhibitors (catechol-O-methyl-transferase)

(Entacapone & Tolcapone)

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11
Q

Adverse effects of which drug?

  • Relates to increased levels of L-dopa
  • Dyskinesias
  • Confusion
  • Liver toxicity *
  • Orthostatic hypotension
A

COMT inhibitors

(Entacapone & Tolcapone)

Tolcapone specifically toxic to liver**

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12
Q

Which drug has these drug interactions?

  • L-dopa reduces dose
  • Antidiarrheals reduce dose
A

COMT inhibitors

(Entacapone & Tolcapone)

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13
Q

What should you monitor in a patient taking COMT inhibitors (Entacapone & Tolcapone)?

A

LFTs

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14
Q

Which drug?

  • MOA: stimulates dopamine activity on the nerves in the subtantia nigra and striatum
  • Pramipexole is the “prototype”
  • Causes doing things in excess like spending money / gambling
A

Dopamine Agonists

(Amantadine)

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15
Q

Adverse Effects of which drug?

  • **Postural hypotension**
  • Pulmonary fibrosis
  • Confusion
  • Hallucinations
  • Sedation
  • Vivid dreaming
  • **Impulsive Behaviors**

(Underlined = Psychosis)

A

Dopamine Agonists

(Amantadine)

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16
Q

When should you consider giving pt Amantadine?

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A

If pt is older and doesn’t want to go on l-dopa

17
Q

Which drug?

  • Enhances dopamine release
  • Blocks glutamatergic N-methyl-D-aspartate (NMDA) receptors
Study These Flashcards
A

Amantadine (Dopamine Agonist)

18
Q

What 3 things does Amantadine (Dopamine Agonist) improve in PD pts?

Study These Flashcards
A
  • Tremors
  • Rigidity
  • Bradykinesia
19
Q

Adverse effects of which drug?

  • Dizziness
  • Dry mouth
  • Hallucinations
  • Livedo reticularis
Study These Flashcards
A

Amantadine (dopamine agonist)

20
Q
  • Which drug has adverse reactions similar to anticholinergics?
  • What are the 5 effects?
Study These Flashcards
A

Amantadine (dopamine agonist)

  • Mad as a hatter
  • Blind as a bat
  • Dry as a bone
  • Red as a beet
  • Hot as a hair
21
Q
  • What drug provides “symptomatic benefit,”
  • but less than that of dopamine agonists or carbidopa/l-dopa
  • Useful add-on agent to attenuate dyskinesias
22
Q
  • An aporphine alkaloid originally derived from morphine, but lacks narcotic properties
  • Bc of poor oral bioavailability due to extensive hepatic 1st pass metabolism
  • Is administered subcutaneously
  • Indicated for pts w/ advanced PD who are experiencing intermittent off episodes despite optimized therapy
23
Q
  • Upon subcutaneous administration, apomorphine produces an “on” response within ___ minutes.
  • Sites of injection (abd, UE, upper thigh) should be rotated to avoid development of ____ ____.
  • Apomorphine elimination half life is approximately ___ minutes and duration of benefit can be up to ____ minutes.
Study These Flashcards
A
  • 20 mins
  • Subcutaneous nodules
  • 40 minutes
  • 100 minutes
24
Q

What should patients be “premedicated” w/ before receiving Apomorphine?

Study These Flashcards
A

Trimethobenzamide

(antiemetic)

25
If drug overdose, give what med? Which causes nausea and vomiting.
Apomorphine
26
**Tx of what effect?** * Increase frequency of carbidopa/L-dopa doses * Add either COMT inhibitor or MAO-B inhibitor or dopamine agonist
End-of-dose "wearing off" | (motor fluctuation)
27
**Tx of what effect?** * Give carbidopa / L-dopa on empty stomach * Use carbidopa/L-dopa ODT * Avoid carbidopa/L-dopa CR (long acting) * Use apomorphine subcutaneous
"Delayed on" "no on" response
28
**Tx of what effect?** * Increase carbidopa/L-dopa dose * Add a dopamine agonist or MAO-B inhibitor * Utilize physical therapy along w/ assistive walking devices or sensory cues * (rhythmic commands, stepping over objects)
Start hesistation (freezing)
29
**Tx of what effect?** * Provide smaller doses of carbidopa/L-dopa * Add amantadine
Peak-dose dyskinesia
30
A form of carbidopa / levodopa delivered in gel form, called enteral suspension
Duopa
31
* Used to treat the motor sxs of PD * Surgical placement of enteral tube in stomach wall to place a tube in your intestine * Pump then delivers ____ directly to the intestine
Duopa
32
Duopa uses the same active ingredients as orally administered ____ \_\_\_\_\_, but is designed to improve absorption and reduce off times by delivering the drug directly to the small intestine.
Carbidopa / Levodopa
33
What drug do you give on empty stomach?
L-lopa/Carbidopa
34
Surgery should be considered an adjunct to pharmacotherapy when pts are experiencing _____ or ______ or ______ despite an optimized medical regimen.
* frequent motor fluctuations * disabling dyskinesia * tremor
35
\_\_\_\_ DBS (Deep Brain Stimulation) is very effective for suppressing tremor specifically ___ tremor, but it does not significantly improve the other parkinsonian features (bradykinesia, rigidity, motor functions, or dyskinesias)
* Thalamic * arm
36
Both ____ and ____ are associated w/ improvements in tremor, rigidity, bradykinesia, motor fluctuations, dyskinesia, and activities of daily living, however, _____ allows for greater reduction in medications.
* STN and GPi DBS * STN DBS
37
As with pharmacotherapy, DBS uncommonly improves ____ or \_\_\_\_\_.
Gait or postural instability
38
* Excess dopamine results in ______ sxs * When we tx \_\_\_\_\_, it looks like Parkinsons
* schizophrenia

MJ- Pharm Exam 3 (17 decks)

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