Parkinsons Flashcards
(22 cards)
End of Dose or “wearing off” medication recommendation
increase C/L frequency : add second agent
Wearing off “agents”
COMT // MAO-B // dopamine agonists // apomorphine
Suggestions if having delayed or no response to PD drugs
- give C/L on empty stomach
- use C/L ODT
- avoid C/L controlled release
Suggestions for hesitation (“freezing”) in PD
increase C/L dose or
add dopamine agonist or add apomorphine
Suggestion for Peak-dose dyskinesia in PD
smaller doses C/L add apomorphine
Key common side effect with C/L
postural hypotension
amount of carbidopa per required to inhibit peripheral conversion to dopamine
75 mg
bromocriptine
ergot-derived dopamine agonist
non-ergot dopamine agonists (3)
pramipexole, ropinerole, rotigotine (Neupro)
Type of PD agent preferred in younger patients
dopamine agonists
PEARLS for apomorphine (4)
- use for intermittent off periods
- severe n/v so use antiemetic
- renally adjusted
- avoid with 5HT3 antagonists due to severe postural hypotension
often overlooked SE of Dopamine agonists
orthostatic hypotension
two PD drugs not used as monotherapies
apopmorphine and amantadine
MAO-B inhibitors used in PD
rasigiline and selegiline
DOC for advanced PD to extend “on” time
MAO-B inhibitors
preferred MAO-B it pt has neuropsych issues
rasigiline
anticholinergics used in PD
benztropine and trihexyphenidyl
amantadine age contraindication
> 75 y.o
drug to add for tremor in PD
anticholinergic agent
COM-T inhibitors
entacapone and toclapone (not really used due to hepatotoxicity)
drugs used to aid othostatic hpotension in PD
midiorone and fludricortisone
newer agent for hallucination/delusion in PD
Nuplazid (pimavanserin) - 5HT2-a agonist
