Flashcards in Parkinsons Disesae Deck (55):
What's Parkinson's Dx (PD)?
Brain disorder that occurs when neurons in a part of the brain called the substantia nigra die or become impaired
What's the role of substantia nigra that dies or becomes impair in PD?
Dopamine (that's why there's a dopamine shortage in PD)
Primary s/sx of PD?
Tremor - seen during rest, usually worsened by anxiety
Rigidity - arms, legs, trunk and face (mask-like face)
Akinesia/bradykinesia - lack of movement or slow initiation of
Postural instability - poor balance, which may lead to freq falls
Other signs of PD?
Small, cramped handwriting (micrographia)
Stiff facial expression, reduced eye blinking
Muffled speech, drooling, dysphagia
Depression, anxiety (psychosis in advanced dx)
What's frustrating and challenging about PD complications?
Eventually, even with high doses of the 2 most effective classes of drugs (Carbidopa/Levodopa and dopamine agonists) the "off" periods will increase
What has the highest efficacy for tx in PD pts with depression?
Whats preferred antipsychotic in PD pts (psychosis can present with advanced dx)?
Quetiapine (low risk of movement disorders, but will require monitoring due to metabolic complications, including blood glucose & cholesterol)
List drugs that may induce PD (drug-induced PD)?
Phenothiazines (Prochlorperazine, etc)
FGAs (esp, haloperidol)
SGAs (Risperidone (Risperdal) at higher doses)
Metoclopramide (Reglan) - dopamine blocking agent
Which agent is most commonly used and most effective and is sometimes tolerated for initial tx in elderly?
What could be used for initial tremor in younger pts?
MOA of Carbidopa/Levodopa?
Carbidopa Inhibits dopa decarboxylase, preventing peripheral metabolism of levodopa
(Levodopa is a precursor of dopamine)
Brand name of Carbidopa/Levodopa
T/F? Sinemet SR tab can be cut into half?
But don't crush or chew
How much Carbidopa is required to inhibit peripheral conversion (dopa decarboxylase) and to reduce nausea?
70-100mg of Carbidopa
SEs of Sinemet (Carbidopa/Levodopa)?
Dyskinesia (abnormal movement)
Brown, black or dark urine, saliva or sweat and discolor clothing
Sinemet (Carbidopa/Levodopa) and unusual sexual urges?
Sinemet (Carbidopa/Levodopa) may cause unusual sexual urges, priapism
Effect of Long-term use of Sinemet (Carbidopa/Levodopa)?
Response may fluctuate after long-term use
What does Sinemet (Carbidopa/Levodopa) need to be separated from?
May be protein
MOA of COMT-INHIBITOR?
Inhibit enzyme COMT to prevent peripheral and central conversion of levodopa
Role of COMT-inhibitor in therapy?
Used only with levodopa to increase levodopa duration of action
Levodopa/Carbidopa + Entacapone (Stalevo)
Brand name of Entacapone? (COMT-inhibitor agent)
Brand name of Levodopa/Carbidopa + Entacapone? (Sinemet + COMT-inhibitor agent)
List dopamine (DA) agonists agents
Pramipexole (Mirapex, Mirapex ER)
Ropinirole (Requip, Requip XL)
Brand name of Pramipexole (DA-agonist)?
Brand name of Ropinirole (DA-agonist)?
SEs of Pramipexole (Mirapex, Mirapex ER) & Ropinirole (Requip, Requip XL) - DA agonists?
Drowsiness, including sudden daytime sleep attacks
SEs of Rotigotine (Neupro) - DA agonists?
Sleep disturbances (trouble irritating/ maintaining sleep)
Application site (skin) rxns
How should Rotigotine (Neupro) be applied?
Same time each day (don't apply to same site for at least 14 days)
Don't apply heat source over patch
Remove patch in MRI
Avoid if sensitive to sulfites
Role of DA-agonist injection (Apomorphine - Apokyn) in therapy?
For advanced dx: a "rescue" movement agent for "off" periods
SEs of Apomorphine (Apokyn) - DA-agonist injection?
Severe nausea and vomiting
Look at counseling points on pg 880-883
MOA of Amantadine?
Blocks DA reuptake into presynaptic neurons, increases DA release from presynaptic fibers
Role of Amantadine in PD?
Used for mild dx
For Dyskinesias in advanced dx
SEs of Amantadine?
Toxic delirium (with renal impairment, reduce dose)
Cutaneous rxn called livedo reticularis (reddish skin mottling - d/c drug)
Role of selective MAO-B inhibitors?
Used with levodopa (or Azilect) with levodopa or as initial monotherapy
Note: may need to reduce levodopa dose when beginning therapy with selective MAO-B inh
Selective MAO-B inhibitors agents used in PD?
Emsam (Selegiline patch)
Dose of Selegiline (selective MAO-B inhibitors in PD)?
5-10 mg daily
Dose of Zelapar (selective MAO-B inhibitors in PD)?
1.25-5 mg daily
Dose of Radagiline (selective MAO-B inhibitors in PD)?
0.5-1 mg daily
Why is bedtime dose of Selegiline prohibited?
Selegiline is activating... Don't dose at bedtime
If dose twice, take 2nd dose at mid-day
When is Selegiline beneficial in PD?
Only when used with Levodopa
Role of Rasagiline (Azilect) in PD therapy?
Adjunctive with Levodopa
SEs of selective MAO-B inhibitors?
Tyramine interactions: Low risk, but possible, HTN crises can occur
Drug interactions with selective MAO-B inhibitors?
Meperidine (Demerol) - can be fatal
St. John's wort
List centrally acting anticholinergics used in PD?
Role of centrally-acting anticholinergics in therapy?
Used primarily for tremor in younger patients
What's the correct titration schedule for ropinirole or pramipexole?
Wait about 1 wk b4 increasing dose
Advantage of using Carbidopa with Levodopa?
Common SE of Ropinirole use?
Which PD med req dose reduction in renal impairment?
Howz Pramipexole (Miraplex) dosed?
Start at 0.125mg TID
Titrate weekly to 0.5-1.5mg TID
Howz Pramipexole (Miraplex ER) dosed?
Start at 0.375mg daily, can increase approx 5-7 d to max dose of 4.5mg/d
Howz Ropinirole (Requip) dosed?
Start at 0.25mg TID
Titrate weekly to 1-4mg TID