Flashcards in Parkinson Deck (25):
Dopamine blockers that worsen PD
Risperidone and Palperidone
Which is the preferred antipsychotic and why?
Quetiapine which has low risk of movement disorders but can also cause METABOLIC conditions like increased sugar and cholesterol
Clozapine bc of the low risk of movement but high risk of agranulocytosis and seizures
Which is the most beneficial treatment?
Levodopa which is paired with Carbidopa bc of its ability to prevent peripheral metabolism which would destroy most of the drug before it crosses the BBB
what does COMT do for PD pateints?
its an inhibitor of the enzyme so it will allow more drug to pass BBB
Which drugs prevent the breakdown of Dopamine?
Centrally acting Anti-cholinergics are most effective in these patients?
Young patients with Tremors.
Inhibits dopa decarboxylase preventing peripheral metabolism
How many mg of Carbidopa are required to inhibit dopa decarboxylate
Which Dopamine agonist can be cut and which can be sprinkled?
Cut- Sinamet CR
If a patient has PD and test positive in a cooms test, what next?
Discontinue the drugs
SE and Notes for Carbidopa/Levodopa
Nausea/Dizziness, Discolor urine, unusual sex urges, priapism
Notes- long term use can lead to fluctuations in response and dyskinesia.
COMT moa? Drugs/dose?
Increase the duration of Levodopa
Entecapone (Comtan) 200mg PO
or Sinemet+Entecapone (Stalevo)
Name some Dopamine agonist and what other indications?
Rotigotine (Neurpro) PATCH
Restless leg syndrome
Dopamine agonist SE's and Notes
Somnolence, Orthostasis, Hallucinations and Dyskinesia
Neupro- rotate every 2 weeks and avoid if allergic to Sulfites
Dopamine agonist injectable for severe patients.. and tal about CI/SE/NOTES
Dose is written in ML, last 45-90 min
CI- Dont use with 5HT3 (Zofran) can cause severe hypotension and loss of consciousness
SE: hypotension, SEVERE N/V
Notes: for emesis prevention give TIGAN (trimethobenzamide)
What are some Drug interactions with Sinemet?
separate with MAOI for 2 weeks
Iron and protein rich foods
Amatadine CI/Warning/SE and MOA
CI with CrCl<15
Warning: Somnolence and Psychosis
SE: Dizziness, Orthostatic hypotension
MOA- Blocks the reuptake of Dopamine in the synapse so it can increase more dopamine in the presynaptic fibers
Selective MAO-B CI/Warning/and MOA
MOA- Blocks the breakdown Dopamine and mostly used at adjunctive therapy
Warnings include Serotonin syndrome and hypertension
Which MAOB should not be taken at night? and which is the only indicated for monotherapy
Selegiline and Resegiline (AZILECT)
Centrally acting anticholinergic medications MOA and SE
Anticholinergic and Antihistamine effects
SE: Dry mouth, urinary retention, constipation, blurred vision, confusion, somnolence.
Droxidopa (Northera) has this MOA and SE
SE include syncope, falls and HA
What interacts with cariboda/levodopa?
Protein, Iron and High fat foods.
Counseling points for Neupro patch?
Drink lots for fluids, avoid sunlight, wait at least 14 days before reapplying it in the same place.
Xadago CI and class
CI- Severe hepatic impairment