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Naplex 2025 > Parkinsons > Flashcards

Parkinsons Flashcards

(35 cards)

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1
Q

What is parkinsons disease?

A
  • denegerative neurological disorder where neurons die in the basal ganglia (including the substantia nigra, striatum and thalamus)
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2
Q

What does the basal ganglia (substantia nigra, striatum, thalamus) help produce?

A
  • Help produces dopamine which helps with coordinated muscle functions and movements
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3
Q

What are some of the major symptoms of Parkinsons?

TRAP

A
  • Tremor: when resting
  • Rigidity: in legs, arms, trunk, and face
  • Akinesia/Bradykinesia: Lack of/slow start in movement
  • Postural Instabilty: imbalance, falls
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4
Q

What are some dopamine blocking drugs that can worsen parkinsons/

A
  • Phenothiazines (prochloperazine - used for psychosis, nausea, agitation)
  • Butyrophenons (Haloperidol , Droperidol - used for psychosis, behavior, nausea)
  • 1st or 2nd gen Antipsychotics (Risperidone [High doses], Paliperidone)
  • Metoclopramide
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5
Q

For patietns with parkinsons & depression, what are some treatment options?

A
  • SSRIs & SNRIs are commonly used (but increased risk of Serotonin syndrome)
  • TCAs (nortriptyline) & dopamine agonists (pramipexole) are other options
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6
Q

For patients with parkinsons & psychosis, what are some treatment options?

A
  • Quetiapine is preferred (due to low movement disorders BUT has metabolic complications)
  • Clozapine has low movement disorder but HIGH risk of seizures & agranulocytosis
  • Pimavanserin helps with hallucinations/delusions
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7
Q

What are some medications/classes that can help with parkinsons disease

A
  • Carbidopa/Levodopa (Sinemet)
  • COMT Inhibitors
  • Dopamine Agonists
  • Amantadine, Selective MAO-B Inhibitors, Centrally-acting anticholinergics, Adenosine Antagonists, Alpha/Beta Agonist (other agents)
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8
Q

What are the treatment pricniples for parkinsons disease?

A
  • REPLACE DOPAMINE…
  • 1: Give drug that mimics dopamine (i.e.; Dopamines Agonist)
  • 2: Give drug that increases dopamine (i.e.; Levodopa +/- COMT inhibitors)
  • 3: Give other drugs to help with symptoms (i.e.; anticholinergics…)
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9
Q

What is the MOA for Carbidopa/Levodopa?

A
  • Levodopa is a prodrug for dopamine and Carbidopa helps inhibit the dopa decarboxylase enzyme (basically preventing the breakdown of Levodopa outside the CNS)
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10
Q

What are some contraindications for Carbidopa/Levodopa used in parkinsons?

A
  • Used Non-selctive MAO inhibitors within 14 days
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11
Q

What are some side effects for Carbidopa/Levodopa used in parkinsons?

A
  • Nausea, Dizziness, Orthostatsis, Hallucinations, Psychosis
  • Can cause Brown, Black or Dark urine
  • Positive Coombs test = DC the drug
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12
Q

What are some additional notes for carbidopa/levodopa used in parkinsons?

A
  • 70 - 10 carbidopa is required for inhibition
  • Long term use can causes fluctuation in response & dyskinesias
  • DO NOT STOP ABRUPTLY
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13
Q

What are some dosing information for carbidopa/levodopa used in parkinsons?

A
  • Titrate carefully
  • IR dose: 25/100 mg PO TID
  • ER tabs can be cut in half
  • Rytary (ER Capsule) can be taken whole or sprinkled on applesauce
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14
Q

What is the MOA for the COMT inhibitors?

A
  • Increase the duration of action of levodopa
  • Also inhibits catechol-O-methyltransferase (COMT) to prevent levodopa conversion
  • SHOULD ONLY be used with levodopa
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15
Q

What are the COMT inhibitors used for parkinsons?

A
  • Entacapone (Comtan) + Carbidopa/Levodopa (Stalevo)
  • Opicapone (Ongentys)
  • Tolcapone (Tasmar)
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16
Q

What are some side effects for COMT inhibitors used in parkinsons?

Study These Flashcards
A
  • Nausea, Dizziness, Orthostatsis, Hallucinations, Psychosis
  • Can cause Brown, Black or Dark urine
  • Positive Coombs test = DC the drug
17
Q

What is the MOA for the dopamine agonist?

Study These Flashcards
A
  • Acts like dopamine at the receptor
18
Q

What are the dopamine agonists that are used for parkinsons?

Study These Flashcards
A
  • Pramipexole (Mirapex)
  • Ropinirole
  • Rotigotine
19
Q

What are some warnings for dopamine agonist used in parkinsons?

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A
  • Somnolence (like sudden daytime sleep attacks), orthostasis, hallucinations, dyskinesias
  • Rotigotine patch: application site reactions
20
Q

What are some side effects for dopamine agonist used in parkinsons?

Study These Flashcards
A
  • Dizziness, Nausea, Vomiting, Dry Mouth, Constipation
21
Q

What are some additional notes for dopamine agonist used in parkinsons?

Study These Flashcards
A
  • DO NOT STOP ABRUPTLY
  • Patch: Apply once daily at the same time; DO NOT use the same site for at least 14 day (remove beofre MRIs
22
Q

What are the dopamine agonists (used for rescue movement) used in parkinsons?

Study These Flashcards
A
  • Apomorphine (SubQ)
23
Q

What are some contraindications for Apomorphine used in parkinsons?

Study These Flashcards
A
  • DO NOT use with serotonin antagonist (zofran) = severe HYPOtension and loss of consciousness
24
Q

What are some side effects for Apomorphine used in parkinsons?

Study These Flashcards
A
  • Severe Nausea/Vomiting
  • Hypotension
25
What are some **additional notes** for **Apomorphine** used in **parkinsons**?
- for vomiting/nausea: give **trimethobenzamide (tigan)** 300 mg PO TID 3 days before initial dose
26
What is the **MOA** for **amantadine**?
- Blocks dopamine reuptake (helps with dykinesias from peak Carb/Levo doses)
27
What are some **warnings** for **amantadine** used in **parkinsons**?
- Somnolence - Psychosis
28
What are some **side effects** for **amantadine** used in **parkinsons**?
- Dizziness - Othostatic Hypotension - Fainting, Insomnia, Abnormal dreams, Dry mouth, Constipation
29
What is the **MOA** for the **Selective MAO-B Inhibitors** used for **Parkinsons**?
- Blocks the **breakdown** of **dopamine** which ill increase dopaminergic activity - Normally + to Carb/Levo but Rasadline is mono
30
What are the **MAO-B Inhibitors** that are used for **Parkinsons**/
- Selegiline (Zelapar - ODT, Emsam - patch) - Rasagline (Azilect - Safinamide (Xadago)
31
What are some **contraindications** for **Selective MAO-B Inhibitors** used in **parkinsons**?
- When used in combo with **other MAO inhibitors, opioids, SNRIs** - Xadago: **Severe Hepatic Impairment**
32
What are some **warnings** for **Selective MAO-B Inhibitors** used in **parkinsons**?
- Serotonin Syndrome - Hypertension
33
What is the **MOA** for the **centrally acting anticholinergics** used for **parkinsons**?`
- Have the **anticholinergic** and antihistamine effects (mainly used for tremors))
34
What are the **Centrally-acting anticholinergics** that are used for **parkinsons**?
- Benztropine (Cogentin)
35
What are some **side effects** for **centrally acting anticholinergics** used in **parkinsons**?
- Dry mouth - Constipation - Urinary Retention - Blurred Vision - Mydriasis - Somnolence - Confusion

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