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Flashcards in Parkinsons Disesae Deck (55):
0

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

1

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)

2

Primary s/sx of PD?

TRAP

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
movement

Postural instability - poor balance, which may lead to freq falls

3

Other signs of PD?

Small, cramped handwriting (micrographia)

Shuffling walk

Stiff facial expression, reduced eye blinking

Muffled speech, drooling, dysphagia

Depression, anxiety (psychosis in advanced dx)

Constipation, incontinence

4

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

5

What has the highest efficacy for tx in PD pts with depression?

Tricyclic antidepressants

6

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)

7

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

8

Which agent is most commonly used and most effective and is sometimes tolerated for initial tx in elderly?

Carbidopa-Levodopa (Sinemet)

9

What could be used for initial tremor in younger pts?

Anticholinergic

Amantadine

10

MOA of Carbidopa/Levodopa?

Carbidopa Inhibits dopa decarboxylase, preventing peripheral metabolism of levodopa

(Levodopa is a precursor of dopamine)

11

Brand name of Carbidopa/Levodopa

Sinemet

Sinemet CR

12

T/F? Sinemet SR tab can be cut into half?

T

But don't crush or chew

13

How much Carbidopa is required to inhibit peripheral conversion (dopa decarboxylase) and to reduce nausea?

70-100mg of Carbidopa

14

SEs of Sinemet (Carbidopa/Levodopa)?

Nausea

Dizziness

Orthostasis

Dyskinesia (abnormal movement)

Brown, black or dark urine, saliva or sweat and discolor clothing

15

Sinemet (Carbidopa/Levodopa) and unusual sexual urges?

Sinemet (Carbidopa/Levodopa) may cause unusual sexual urges, priapism

16

Effect of Long-term use of Sinemet (Carbidopa/Levodopa)?

Response may fluctuate after long-term use

17

What does Sinemet (Carbidopa/Levodopa) need to be separated from?

Iron

May be protein

18

MOA of COMT-INHIBITOR?

Inhibit enzyme COMT to prevent peripheral and central conversion of levodopa

19

Role of COMT-inhibitor in therapy?

Used only with levodopa to increase levodopa duration of action

20

COMT-inhibitor agents?

Entacapone (Comtan)

Levodopa/Carbidopa + Entacapone (Stalevo)

21

Brand name of Entacapone? (COMT-inhibitor agent)

Comtan

22

Brand name of Levodopa/Carbidopa + Entacapone? (Sinemet + COMT-inhibitor agent)

Stalevo

23

List dopamine (DA) agonists agents

Pramipexole (Mirapex, Mirapex ER)

Ropinirole (Requip, Requip XL)

Rotigotine (Neupro)

24

Brand name of Pramipexole (DA-agonist)?

Mirapex

Mirapex ER

25

Brand name of Ropinirole (DA-agonist)?

Requip

Requip XL

26

SEs of Pramipexole (Mirapex, Mirapex ER) & Ropinirole (Requip, Requip XL) - DA agonists?

NODD-H

Nausea

Orthostasis

Drowsiness, including sudden daytime sleep attacks

Dizziness

Hallucinations

Dyskinesias

27

SEs of Rotigotine (Neupro) - DA agonists?

Peripheral edema

Drowsiness

HA

Fatigue

Orthostasis

Sleep disturbances (trouble irritating/ maintaining sleep)

Hallucinations

Application site (skin) rxns

Hyperhidrosis

28

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

29

Role of DA-agonist injection (Apomorphine - Apokyn) in therapy?

For advanced dx: a "rescue" movement agent for "off" periods

30

SEs of Apomorphine (Apokyn) - DA-agonist injection?

Severe nausea and vomiting

Hypotension

31

Look at counseling points on pg 880-883

Look!

32

MOA of Amantadine?

Blocks DA reuptake into presynaptic neurons, increases DA release from presynaptic fibers

33

Role of Amantadine in PD?

Used for mild dx

Or

For Dyskinesias in advanced dx

34

SEs of Amantadine?

Dizziness

Toxic delirium (with renal impairment, reduce dose)

Cutaneous rxn called livedo reticularis (reddish skin mottling - d/c drug)

35

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

36

Selective MAO-B inhibitors agents used in PD?

Selegiline (Eldepryl)

Zelapar-ODT

Rasagiline (Azilect)

Emsam (Selegiline patch)

37

Dose of Selegiline (selective MAO-B inhibitors in PD)?

5-10 mg daily

38

Dose of Zelapar (selective MAO-B inhibitors in PD)?

1.25-5 mg daily

39

Dose of Radagiline (selective MAO-B inhibitors in PD)?

0.5-1 mg daily

40

Why is bedtime dose of Selegiline prohibited?

Selegiline is activating... Don't dose at bedtime

If dose twice, take 2nd dose at mid-day

41

When is Selegiline beneficial in PD?

Only when used with Levodopa

42

Role of Rasagiline (Azilect) in PD therapy?

Initial monotherapy

Or

Adjunctive with Levodopa

43

SEs of selective MAO-B inhibitors?

Tyramine interactions: Low risk, but possible, HTN crises can occur

44

Drug interactions with selective MAO-B inhibitors?

Meperidine (Demerol) - can be fatal

Tramadol

Methadone

Propoxyphene

Dextromethropan

St. John's wort

Mirtazapine

Cyclobenzaprine

45

List centrally acting anticholinergics used in PD?

Benztropine (Cogentin)

Trihexyphenidyl

46

Role of centrally-acting anticholinergics in therapy?

Used primarily for tremor in younger patients

47

What's the correct titration schedule for ropinirole or pramipexole?

Wait about 1 wk b4 increasing dose

48

Advantage of using Carbidopa with Levodopa?

Decrease nause

49

Common SE of Ropinirole use?

Somnolence

50

Which PD med req dose reduction in renal impairment?

Pramipexole

Amantadine

51

Howz Pramipexole (Miraplex) dosed?

Start at 0.125mg TID

Titrate weekly to 0.5-1.5mg TID

52

Howz Pramipexole (Miraplex ER) dosed?

Start at 0.375mg daily, can increase approx 5-7 d to max dose of 4.5mg/d

53

Howz Ropinirole (Requip) dosed?

Start at 0.25mg TID

Titrate weekly to 1-4mg TID

54

Howz Ropinirole (Requip XL) dosed?

Start 2mg daily

Can increase approx 1-2 wks dose of 24mg/d

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