Parkinson Disease Flashcards
(21 cards)
What is the main cause of PD
Neurons in Nigra-striatal pathway degenerate
Decrease dopamine
Symptoms of PD
Tremor (when resting)
Rigidity (legs, arms, trunk & face)
Akinesia/Bradykinesia (lack of or slow movement)
Postural instability (Imbalance or falls)
Micrographic (small or cramped handwriting)
Anosmia (sense of smell)
What is off-time symptoms
When symptoms of disease worsen before next dose of medication due
What agent is used to treat a patient with PD & Depression
SSRIs or SNRI
Preferred agent for a patient with psychosis & PD
Quetiapine
Diagnosis of PD
Abnormal Involuntary Movement Scale (AIMS)
First line treatment for PD
Dopamine precursor
1. Carbidopa-Levodopa (Sinemet)
Dopamine Agonist
1. Pramipexole (Mirapex)
2. Ropinirole (Requip XL)
3. Rotigotine (Neuptro) Patch
4. Apomorphine (Apokyn) SC
Agents used to reduce “OFF” periods & limit dyskinesias?
COMT Inhibitor
1. Entacapone (Comtan)
2. Comtan + Sinemet (Stalevo)
MAO-B inhibitors
1. Slegiline (Zelapar)
2. Rasagiline (Azilect)
3. Safinamide (Xadago)
Dopamine Re-uptake Blocker
1. Amantadine
Agent preferred for Tremor
Centrally acting anticholinergic
1. Benztropine (Cogentin)
2. Trihexyphenidyl
Orthostatic Hypotension
Alpha & Beta agonist
1. Droxidopa (Northera)
Sinemet dose
25/100 mg PO TID
How much of carbidopa is required to inhibit dopa decarboxylase
70-100 mg/day
When adding COMT-I what should be done to levodopa dose
Decrease dose by 10-30%
How much Comtan is required with each dose of sinemet?
200 mg (Max: 8 tablets/day)
COMT inhibitor increase duration of ____?
Levodopa
Rotigotine (Neuptro) is contraindicated in____ Allergy?
Sulfite
Apomorphine (Apokyn) should not be used concurrently with _____ due to risk of ______?
5-HT3 Antagonist
Hypotension
Centrally Acting Anticholinergics should be taken
QHS
MAO-B inhibitors are activating and should be taken in the ____
Morning (AM)
Selegiline metabolizes to?
Amphetamine
Methamphetamine
Levodopa to dopamine is catalyzed by?
Dopa decarboxylase
