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Flashcards in Parkinsons Deck (38)
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1

Etiology of Parkinsons

Dopamin deficiency OR Ach excess

2

Feature of Parkinsons

1. Resting tremor
2. Rigidity
3. Bradykinesia
4. Postural instability

3

Amyotrophic Lateral Sclerosis (ALS)

Sporadic or familial progressive neurodegenerative disease

4

Essential Tremor

Nerve disorder characterized by uncontrollable shaking while moving

5

Guillan-Barre

Immune system attack the nerves with weakness and tingling in the feet and legs-->ascending paralysis

6

Huntington's Disease

Inherited adult-onset neurologic disease with dementia and bizarre involuntary movements

7

Myasthenia Gravis

Chronic autoimmune neuromuscular disorder with fluctuating weakness

8

Restless Leg Syndrome (RLS)

Urge to move the legs
Associated with iron deficiency

9

Tourettes Syndrome

Repetitive movements or unwanted sounds (tics) that can't be easily controlled
Inherited (genetic) and environmental factors

10

Wilsons disease

Inherited autosomal recessive disorder of copper accumulation in liver, brain, kidneys, and eyes

11

List a monoamine Oxidase Inhibitor (MAO-B)

Rasagline

12

Rasagline ADEs

1. Confusion
2. Insomnia
3. Hallucinations
4. Nausea
5. Orthostatic hypotension

13

Rasagline Drug interactions with Meperidine

Serotonin Syndrome
-N/V
-Tremor
-Agitation/restlessness

14

What would be the best treatment of choice in a 71-year-old PD patient?

Amantadine

15

Amantadine MOA

1. Enhances Dopamine release
2. Blocks glutamatergic NMDA receptors

16

Amantadine Benefits

Decreases:
1. Tremor
2. Rigidity
3. Bradykinesia

17

Amantadine ADEs

Anti-cholinergic effects:
1. Dry as a bone-Dry mouth, urinary retention
2. Blind as a bat-Dilated pupils/Mydriasis
3. Mad as a hatter-Confused/hallucinations
4. Red as a beet-Flushing

18

List the prototype Dopamine Agonist

Pramipexole

19

Pramipexole MOA

Stimulate dopamine activity on the nerves in the substantial nigra and striatum

20

Pramipexole ADE's

1. Postural Hypotension
2. Impulsive Behavior-Tend to gamble
3. Psychosis- Confusion, hallucinations, sedation, vivid dreams

21

Levodopa MOA

Dopamine Precursor
-Crosses the blood brain barrier
-Once crossed, converted to Dopamine

22

Carbidopa MOA

Prevents the metabolism of Levodopa in the peripheral blood via dopa decarboxylase
-->higher blood levels and good portion gets into the brain

23

Levodopa/Carbidopa drug interactions

COMT and MAO type B inhibitors diminish doses and prolongs action= Excess Dopamine

24

Levodopa/Carbidopa ADEs

1. Drowsiness
2. Nausea
3. Dyskinesias-MOTOR COMPLICATIONS

25

List the two COMT inhibitors

1. Entacapone
2. Tolcapone

26

COMT inhibitor effect on L-Dopa

1Blocks conversion of L-Dopa into the inactive form of 3-O-Methyldopa (3-OMD) = Greater % that will cross BBB

27

COMT inhibitor effect on Dopamine

Prevents conversion of Dopamine to 3-methoxytyramine (3-MT)

28

What are we going to monitor when using COMT inhibitors?

LFTs due to liver toxicity

29

What drug is the most useful as monotherapy in patients under 70 years of age with disturbing tremor who do not have significant bradykinesia or gait disturbances?

Anticholinergic/Antimuscaranic

30

List the two Anticholinergic/Antimuscaranic used in PD

1. Benztropine
2. Trihexyphenidyl

31

What is Duopa

Carbidopa/Levodopa in Gel form that goes directly to your intestine through a tube

32

Benefits of Duopa

1. Treat motor sx's
2. Improve absorption
3. Reduce off-times by delivering directly to small intestines

33

End-of-dose "wearing off" (motor fluctuation) treatment

1. Increase frequency of carbidopa/L-dopa doses
2. Add COMT or MAO-B inhibitor
3. Add Dopamine Agonist

34

"Delayed on" or "no on" response treatment

1. Give carbidopa/L-dopa on empty stomach
2. Use carbidopa/L-dopa ODT

35

Start hesitation ("freezing") treatment

1. Increase frequency of carbidopa/L-dopa doses
2. Add MAO-B inhibitor
3. Add Dopamine Agonist
4. Physical Therapy
5. Sensory cues

36

Peak-dose dyskinesia treatment

1. Provide smaller does of carbidopa/L-dopa
2. Reduce dose of adjunctive dopamine agonist
3. Add Amantadine

37

What do we want to give to your patients who are on Entcapone/Talcapone (COMT inhibitors) to help avoid one of the SE's?

Anti-diarrheal agents due to diarrhea SE

38

What are we going to monitor in Amantadine?

1. Mental status
2. Renal function