Parkinsons

Question 1

Etiology of Parkinsons

Answer 1

Dopamin deficiency OR Ach excess

Question 2

Feature of Parkinsons

Answer 2

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

Question 3

Amyotrophic Lateral Sclerosis (ALS)

Answer 3

Sporadic or familial progressive neurodegenerative disease

Question 4

Essential Tremor

Answer 4

Nerve disorder characterized by uncontrollable shaking while moving

Question 5

Guillan-Barre

Answer 5

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

Question 6

Huntington’s Disease

Answer 6

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

Question 7

Myasthenia Gravis

Answer 7

Chronic autoimmune neuromuscular disorder with fluctuating weakness

Question 8

Restless Leg Syndrome (RLS)

Answer 8

Urge to move the legs

Associated with iron deficiency

Question 9

Tourettes Syndrome

Answer 9

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

Question 10

Wilsons disease

Answer 10

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

Question 11

List a monoamine Oxidase Inhibitor (MAO-B)

Answer 11

Rasagline

Question 12

Rasagline ADEs

Answer 12

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

Question 13

Rasagline Drug interactions with Meperidine

Answer 13

Serotonin Syndrome

• N/V
• Tremor
• Agitation/restlessness

Question 14

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

Answer 14

Amantadine

Question 15

Amantadine MOA

Answer 15

1. Enhances Dopamine release

2. Blocks glutamatergic NMDA receptors

Question 16

Amantadine Benefits

Answer 16

Decreases:

1. Tremor
2. Rigidity
3. Bradykinesia

Question 17

Amantadine ADEs

Answer 17

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

Question 18

List the prototype Dopamine Agonist

Answer 18

Pramipexole

Question 19

Pramipexole MOA

Answer 19

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

Question 20

Pramipexole ADE’s

Answer 20

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

Question 21

Levodopa MOA

Answer 21

Dopamine Precursor

• Crosses the blood brain barrier
• Once crossed, converted to Dopamine

Question 22

Carbidopa MOA

Answer 22

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

Question 23

Levodopa/Carbidopa drug interactions

Answer 23

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

Question 24

Levodopa/Carbidopa ADEs

Answer 24

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

Question 25

List the two COMT inhibitors

Answer 25

1. Entacapone | 2. Tolcapone

Question 26

COMT inhibitor effect on L-Dopa

Answer 26

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

Question 27

COMT inhibitor effect on Dopamine

Answer 27

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

Question 28

What are we going to monitor when using COMT inhibitors?

Answer 28

LFTs due to liver toxicity

Question 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?

Answer 29

Anticholinergic/Antimuscaranic

Question 30

List the two Anticholinergic/Antimuscaranic used in PD

Answer 30

1. Benztropine | 2. Trihexyphenidyl

Question 31

What is Duopa

Answer 31

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

Question 32

Benefits of Duopa

Answer 32

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

Question 33

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

Answer 33

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

Question 34

"Delayed on" or "no on" response treatment

Answer 34

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

Question 35

Start hesitation ("freezing") treatment

Answer 35

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

Question 36

Peak-dose dyskinesia treatment

Answer 36

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

Question 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?

Answer 37

Anti-diarrheal agents due to diarrhea SE

Question 38

What are we going to monitor in Amantadine?

Answer 38

1. Mental status | 2. Renal function