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Parkinson - Flashcards

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1
Q

What is a progressive DZ with the following cardinal sx: Bradykinesia, Postural instability, gait disturb, resting tremor, and rigidity?

A

Parkinson’s- MEN 1mil USA, >65yo. Genetics, Pesticides, Age

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2
Q

What location of brain is depleted of this chemical in PD?

A

Substania Nigra depleted of Dopamine. DEC movement issues. INC DOPAMINE- psychosis

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3
Q

Is Dopamine inhibitory or excretory on the ACH receptor to stimulate GABA?

A

Inhibits Cholinergic. Thus if depleted in PD, Cholinergic SNS will INC.

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4
Q

What is TRAP and SOAP in PD?

A

Tremor, Rigidity, Akinesia, Postural Instability

Sleep Disturbances, Other Autonomic, Psychological

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5
Q

What is req to DX PD?

A

Bradykinesia +1. R/o Antipsychotics, Anti-emetic

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6
Q

What antipsychotics cause extrapyramidal symptoms?

A 
Methyldopa 
Valproate 
Reserpine 
Verapamil 
Risperidone
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7
Q

What are the Goals with PD meds?

A
  1. Restore Dopamine in CNS. 2. DEC ACH levels. MIN symptoms, medication SE. MAX QOL, safety and reduce fall
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8
Q

what are pitfalls of PD?

A

Currently no approach to alter Dz progression

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9
Q

This Drug is initiated 1st and will have less motor benefit w/ INC in hallucinations?

A

Levodopa or DA agonist

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10
Q

Which med is req with LEVODOPA to allow Dopamin not to be degraded in the periphery?

A

Carbidopa- inhibit LAAD enzyme, so LEVO can cross BBB to convert to Dopamine. INC DOPAMINE in brain

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11
Q

What affects Carbidopa-Levodopa PK?

A

NO PROTEIN

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12
Q

This eye condition is contraindicated in C-L?

A

Narrow angle glaucoma

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13
Q

Avoid these drugs w/ C-L

A

Antiemetics, Antipsychotics, MAOIs, Phenytoin, iron-DEC efficacy

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14
Q

What are the ADR of C-L

A
  1. GI,
  2. Postural HTN
  3. Dreams
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15
Q

What can MC occur with C-L and what is management of this ADR?

A
  1. Wearing off- loss of DA storage, depends on LEVO 2. INC Frequency, short to long acting…ADD DA agonist, MAO, COMT inhibitors
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16
Q

What is cause if Pt experience delayed or no response?

A

GI Absorption. Give on empty stomach, crush tablet

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17
Q

What meds selective activate dopamine receptors?

A

DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine

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18
Q

Which med is req. to take Trimethbenzamind 3 day prior for N/V ADE?

A

Apomorthoine- INJ

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19
Q

Rotigotine is DA that can be used for RLS, PD add on. How is it RX?

Study These Flashcards
A

Transdermal Patch- slow and low.

20
Q

Where do Tolcapone and Entacapone inhibit cateholometh transferase, which will INC Dopamine?

Study These Flashcards
A
  1. Tol (2)-Peripheral and CNS- 2. Enta-( enter body) COMT is another enxyme that breaks done DOPA
21
Q

Are COMT inhibitor ever given mono-therapy?

Study These Flashcards
A

NO. OFten give with other DA, thus may need to lower other doses

22
Q

What does Monoamine oxidase B inhibitory do?

Study These Flashcards
A

Selegline, Rasagline, block MOA-B enzymes that break down DOPA in the CNS. 1. MIN on ff phenomena 2. Prolongs LEVO

23
Q

What is drug that has rare ADR of A.fib, and should avoid, meperidine, methadone, tramadol, Dextrmethrphan, and MAOIs?

24
Q

What is drug that has rare ADR of GIBs, HTN, MDD and should be avoid, St. John wart, methadone and Dextromethorphan?

25
What is drug that has rare ADR of HTN, dreams, insomnia, falls ONLY?
Safinamide
26
What is life threatening risk with LEVO and other MOAB?
Hypertensive crisis
27
What are other caution with MAOB?
NO OTC RX. Risk of Serotonin Syndrome
28
What antiviral INC Dopamine by synthesis release of Dopamine?
Amantadine
29
What skin and LE edema reaction is R/T amantadine?
Livedo Reticularis- RENAL Dose Adjust
30
What RX for PD controls TREMORS only?
Anticholinergics- Benztrophine, Trihexyphenidyl (BENZ car tremor). DEC ACH excess
31
If PD pt present with confusion, dry mouth, red, urinary retention, what is management?
Titrate low and slowly or D/c Anitcholingeric response or Add artificial saliva add docusate stool softness
32
What RX is used for PD psychosis condition if pt has hallucination and delusions?
pimavanserin- ADR- prolong QT, Avoid CYP3A
33
Which PD RX had more improvement in motor symptoms?
LEVOdopa- use if motor sx affect QOL
34
Which PD RX had more improvement in ADLs?
LEVOdopa
35
Which PD RX has less motor complication for PD?
DA-Ropinirole, Apomorphine, Rotigotine, MOABI-Resilgine, Segeline- Use early stages where motor doesn't impact QOL
36
Which have the most ADR for PD?
DA- Bromocriptine-ergot, Pramipexal, Ropinirole, Apomorphine, Rotigotine
37
What should never be used for 1st line PD due to ADE?
DA- Bromocriptine-ergot
38
What are adds on for PD when the develop dyskinesia or motor fluctuations even if on LEVODOPA?
DA agonist, MAOBI-geline or COMT- capone
39
What is preferred PD initially?
**Rasalgiline
40
John is 66yo w/PD he is on Rasagiline, but needs conrol for tremors, what is considered?
Amantadine
41
John is 56yo w/PD he is on Rasagiline, but needs control for tremors, what is considered?
Benztrophine, Trihexyphenidyl (Anit ACH) or Amantadine
42
If further control is need for both for tremor, bradykinesia, rigidity, what is used?
Amantadine, DA agonist, Carb/ldopa
43
Mr. Hyde c/o slow movement often at beginning of dose?
Delayed on response fluctuations.
44
Mr. Jekyll c/o slow movement 4hrs later post taking meds? How is managed?
Wearing off. MAINTAIN Adjust interval of carbibdop/levo (*opa, met, ary)ADD MAOB, or COMT or DA. OR
45
What is profound unpredictable return of PD sx unrelated to dosing intervals?
ON-OFF phenomenon- random movement oscillations. keep extra dose while away or longer acting meds or schedule activities or space meds 2hr post meal or consider protein intake. LAST ADD entacapone-COMT, rasalgilne-MOA, pramipexole-DA, ropinirole-DA or segline-MAOB
46
Which has the most ADE?
COMT-capones
47
Which PD has the most hallucinations and OFF time reduction?
DA-pramipexole, ropinirole

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