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Flashcards in Parkinson's Generic/Brand Deck (21):
1

Parkinson's Disease
- Cause

- Due to depletion of dopamine => tx is to restore dopamine/Ach balance

2

Eldepryl

- MOA
- Indication
- dose
- SEs
- C/I

Selegiline

- MOA: MAOI-B => inhibit the reuptake of DA.
Reduces "on-off" of levodopa
- Indication: adjunct to levo/carbidopa
- Dose: 5mg QAM n QNOON. Max 10mg qd.
Do not exceed max rec dose.
- SEs: N/V, vivid dreams, hallucination, confusion, insomnia, orthostatic hypoTN
- C/I: meperidine

3

Azilect

- MOA
- Indication
- Dose
- Do not use with
- Precaution
- SEs

Rasagiline

- MOA: MOAI-B => inhibit the reuptake of DA. Reduces "on-off" of levodopa
- Indication: monothrapy or adjunct w/ levodopa
- Dose: 0.5-1 mg QD

Do not use with:
- Liver disease
- Adrenal gland tumor (pheochromocytoma)
- 14 days b/4 surgery
- Meperidine
- Tramadol
- Propoxyphene
- Methadone
- Dextromethorphan, pseudoephedrine, or phenylephrine
- St. John Wort
- Mirtazapine
- Cyclobenzapine
- Amphetamines
- MAOI
- TCAs, SSRIs, SNRIs, MOAIs

Precaution
- Avoid tyramine rich foods
- Mild hepatic impairment

SEs
- Postural hypoTN
- Flu sx
- Depression
- GI upset

4

Symmetrel

- MOA
- Indication
- SEs

Amantadine

- MOA: Dopamine re-uptake inhibitor and anticholinergic
- Dose: 100 QD to 100 BID

SEs
- Insomnia
- Depression
- Irritablity
- Anticholinergic effects
- Hallucinations
- vasoconstriction

5

Artane

- MOA
- Indication
- Dose

Trihexyphenidyl

- MOA: Anticholinergics
- Indication: adjust tx for all forms of parkinsonism.
DOC for pseudoPK
- Dose: 1mg QD. Max 15mg/day

6

COGentin

- MOA
- Dose

BENZtropine Mesylate

- MOA: Anticholinergics
- Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK

7

Akineton

- MOA
- Indication

Biperiden

- MOA: Anticholinergics
- Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK

8

Larodopa

- MOA

Levodopa

- MOA: Dopamine Precursors.

9

Sinemet

- MOA
- Need how much carbidopa/day
- Dose
- SEs
- C/I
- DDI

Carbidopa/Levodopa

- MOA: Carbidopa inhibits peripheral dopa decarboxylation to levodopa to dopamines (which doesn't cross BBB) => increase levodopa level gets into brain.
- Need 75mg of carbidopa to block enzyme

- Dose: start 1 tab 25/100 (carbi/levo) PO TID, increase to max 8 tabs (200 crab/800 levo)

- SEs:
Psychosis
Akinesia: DA
Dyskinesia: DA
HypoTN
Aphrodisias: hypersexuality

- Caution
Cardiac abnormalities
Dietary proteins: take at different time than Sinemet)

- C/I:
Lactation: incre DA = decrease prolactin
Narrow angle glaucoma

DDI
- anticholinergic: decrease gastric emptying
- Antipsychotics: decrease DA
- Reglan: blocks DA
- Phenothiazine: block DA
- Pyridoxine (Vit B6): increase SEs
- Food: reduce abs
- Tacrine: inc LFTs
- Iron: chelates to levodopa
- MAOI: HTN crisis
- St. John Wort

10

COMpazine

PROchlorperazine

11

Parlodel

- MOA
- Indication
- Dose
- Dose adjust:
- SEs

- Cautions for all dopamine agonist
- Other agents

Bromociptine

- MOA: dopamine agonist stimulate DA receptor and alpha blocking activity
- Indication: PK mono therapy or adjunct , hyperprolactinemia
- Dose: 1.25mg BID up to 100mg/d
- Dose adj: ok to use in renal failure
- SEs: H/V, HA, hallucination, hypoTN

Cautions:
- Dose depending on peripheral edema
- Increase change of HF
- Falling asleep during activity
- Compulsive behaviors

Other agents:
- Pramipexole (mirapex)
- Rotigotine (Neupro): patch
- Ropinirole (Requip)
- Apomorphine (Apokyn) => SC injection

12

MiraPEX

- MOA

PramiPEXole

- Dopamine agonists

13

Neupro

- MOA
- Indication
- Form
- Frequency

ROTigotine

- MOA: Dopamine agonists
- Indication: PK, restless legs syndrome
- Dose: patch Q24H
PK: 2mg/24H to 8mg/24H
RLS: 1mg/24H to 3mg/24H

14

Requip

- MOA
- Dose
- Avd

ROPinirole

- MOA: Dopamine agonists
- Dose: 0.25mg TID. Max 24mg/d
- Adv: good for pts with hypoTN or falls

15

Apokyn

- MOA
- Indication
- Dose
Instruction
- SEs

APOmorphine => SC injection

- MOA: Dopamine agonists
- Indication: treat "wearing-off" episodes in ppl w/ adv PK
- Dose: Start 0.2mL. Max 0.6mL
1st dose supervise: monitor BP
- Due to severe N/V, initiate antiemetic Tigan (trimethobenamide) 3 days b/4 initiating APOKYN. Then continue Tigan for at least 2mo on therapy.
** Use with 5HT2 (ondansetron, etc) are C/I
- SEs: QT prolongation, falling asleep during activity

16

Comtan

- MOA
- Indication
- Dose
- SEs

Entacapone

- MOA: COMT Inhibitor => must be on Sinemet. COMT allows more levodopa to cross the BBB which incr DA
- Indication: adjunct to Sinemet in pots with wearing off effect.
- Dose: Start 200 mg with each Sinemet. Max 8x (1600mg)
- SEs:
Hepatotoxicity, anticholinergic, GI, hallucination
Urine discoloration: brownish orange

17

Tasmar

- MOA
- Indication
- Dose
- Avoid
- SEs

TOLcapone

- MOA: COMT Inhibitor => same as above
- Indication: adjunct to Sinemet in pots with wearing off effect and can't use other alternative therapy
- Dose: 100-200 TID. Max 200 TID
- Avoid: EtOH and hepatitis => fatal hepatic failure
- SEs: same as above

18

Stalevo

- Disadvantage

Carbidopa + Levodeopa + Entacapone

=> Dopa-Decarboxylase inhibitor + Dopamine Precursor + COMT inhibitor

=> May increase risk of prostate cancer

19

Zelapar

Selegiline

- Form: ODT

20

Emsam

- Indication

Selegiline

- Indication: Major depression disorder

21

Tigan

- Indication

Trimethobenzamide

- I: tx N/V of Apomorphine