PD Med Counseling Points Flashcards
(12 cards)
Levodopa/Carbidopa
-avoid in respiratory disease
-ideally on empty stomach
-if nausea, take with food (avoid high protein)
-may experience brown, black, or dark discoloration of fluids
-CI to non-selective MAOIs
-taper
COMT inhibitors
-not for monotherapy - use only with carb/levo
-D/C if no improvement within 3 weeks
-when added, decrease levodopa dose by 25%
Tolcapone
-needs LFT, AST/ALT monitoring
-can be administered alone due to both peripheral and central brain activity
-typically avoided due to BBW hepatotoxicity and AEs
Entacapone
-1st line for motor fluctuations
-not associated with liver toxicity
-available as combo product with carb/levodopa (Stalevo)
Opicapone
-less diarrhea and body fluid discoloration
-can cause impulse control disorder and psychosis
-taken once daily
MAO-B inhibitors
-Safinamide - can cause severe hepatic impairment
-Hypertensive crisis - diastolic BP higher than 120 mmHg
-Serotonin syndrome: HARM
What does HARM stand for
they are the S/S of serotonin syndrome
Hyperthermia
Altered mental status
Rapid heartbeat
Muscle rigidity, tremor in lower extremities
Ropinirole, Pramipexole
-have more DDIs
-administer slow titrations due to orthostasis, dizziness, sleepiness
Rotigotine
-patch, once daily at same time of day
-shoulder, upper arm, side of body, stomach, hip thigh
-do not use same site for at least 14 days
-remove before MRI
-avoid in sulfa allergy
Apomorphine
-available as injection or sublingual
-must be started with a test dose in medical office
-emesis prevention - give trimethobenzamide 3 days before initial dose
Anticholinergic agents
-primarily for tremor
-avoid in elderly
Amantadine
-decrease dose with renal impairment
-may aggravate seizures
-primary for dyskinesias associated with peak-dose of levo/carb
