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PT2 Neuro 6-9 > PD therapeutics > Flashcards

PD therapeutics Flashcards

(64 cards)

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1
Q

motor symptoms of parkinson’s

A
  • resting tremor
  • bradykinesia
  • rigidity
  • postural instability
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2
Q

musculoskeletal symptoms of parkinson’s

A
  • dysarthria (speech problems)
  • dysphagia (can’t swallow)
  • hypophonia (talk quietly)
  • flexed posture
  • micrographia (small writing)
  • diminished arm swing
  • difficulty turning in bed
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3
Q

gait symptoms of parkinson’s

A
  • shuffling
  • freezing at initiation of movement
  • festinating gait (trouble starting/stopping)
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4
Q

other non-motor symptoms of parkinson’s

A
  • urinary urgency
  • ED
  • drooling
  • cognitive dysfunction
  • mood disorders
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5
Q

current therapies only treat the…

A

symptoms

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6
Q

goals of PD treatment

A
  • restore dopamine/ACh balance

- manage associated symptoms of PD

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7
Q

things to consider in drug therapy of PD

A
  • Pts. current signs and symptoms
  • age and stage of disease
  • degree of functional disability
  • level of physical activity and productivity
  • Pts. desires
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8
Q

how to start a new drug for PD

A

start low and titrate slow

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9
Q

why do we not give straight dopamine as a therapy

A

it doesn’t cross the BBB

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10
Q

L-dopa is usually given with what

A

carbidopa (and sometimes entacapone) to prevent L-dopa metabolism in the periphery

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11
Q

levodopa MoA

A

dopamine precursor

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12
Q

carbidopa MoA

A

decarboxylase inhibitor (prevents conversion of L-dopa to dopamine in the periphery)

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13
Q

kinetics problem with levodopa monotherapy

A

highly metabolized so only 1% reaches brain

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14
Q

carbidopa/levodopa is useful for…

A

treating motor symptoms associated with PD

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15
Q

carbidopa/levodopa dosing

A

individualized to the patient
carbidopa ~25 mg/dose
levodopa ~100 mg/dose

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16
Q

carbidopa/levodopa immediate release brand name

A

Sinemet

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17
Q

carbidopa/levodopa dosage forms

A
  • immediate release
  • controlled release
  • ODT
  • extended release
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18
Q

main problem with long term use of levodopa

A

patients will develop dyskinesias after 2-7 years

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19
Q

most effective treatment for symptoms of PD

A

levodopa

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20
Q

issues in levodopa use

A
  • on-off syndrome
  • wearing off
  • delayed response
  • freezing
  • peak dose dyskinesia
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21
Q

how to deal with “wearing off” of levodopa

A

use in combination with COMT inhibitor, MAO-B inhibitor, or dopamine agonist

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22
Q

how to prevent delayed response to levodopa

A

take on an empty stomach

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23
Q

adverse effects of carbidopa/levodopa

A
  • orthostatic hypotension
  • N/V
  • dyskinesias
  • anxiety, confusion, hallucinations, depression
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24
Q

neurologic side effects of carbidopa/levodopa usually occur when

A

when you first start the dose or increase the dose

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25
drug interactions with carbidopa/levodopa
- cocaine, MAO-I - antipsychotics - antihypertensives - pyridoxine or vit. B6 - protein
26
contraindications with carbidopa/levodopa
hypersensitivity | narrow-angle glaucoma
27
MAO-B inhibitors
selegiline (Eldepryl) | rasagiline (Azilect)
28
MAO-B inhibitors MoA
selective inhibit MAO-B in the CNS to block dopamine degradation
29
MAO-B monotherapy
- can work early in therapy because it can cross the BBB and works within dopamine neurons - still usually used w/ carbidopa/levodopa
30
advantages of MAO-B
- potentially reduces "on-off" phenomenon and less wearing off may also occur with lower dose * should lower levodopa dose to avoid dyskinesia/halllucinations*
31
adverse effects of selegiline
``` nausea diarrhea insomnia hallucination/vivid dreams confusion ```
32
adverse effects of rasagiline
``` arthralgia hallucinations dyspepsia depression falls ```
33
drug interactions with MAO-B inhibitors
meperidine | SSRIs
34
COMT inhibitors
tolcapone (Tasmar) | entacapone (Comtan)
35
COMT inhibitors MoA
reversible inhibition of COMT in the periphery (and CNS for tocapone)
36
COMT inhibitors monotherapy
not approved so don't do it
37
adverse effects of COMT inhibitors
- worsen levodopa side effects - hepatotoxicity - sedation - diarrhea (common reason to d/c) - urine discoloration
38
when to use COMT inhibitors
- in combination with carbidopa/levodopa | - useful for wearing off and on/off phenomenon
39
when to discontinue COMT inhibitors
if no clinical benefit is seen after 3 weeks of treatment
40
dopamine agonists
pramipexole robinirole rotigotine apomorphine
41
dopamine agonist MoA
activate dopamine receptors (D2) to stimulate the production of dopamine
42
dopamine agonist adverse effects
- nausea - orthostasis - sedation - compulsive behaviors
43
when to use dopamine agonists
- in younger patients | - avoid >65 due to increased risk of orthostasis and hallucinations
44
apomorphine use
for acute episodes of freezing
45
apomorphines adverse effects
- N/V so must premedicate with trimethobenzamide - hallucinations - orthostasis, somnolence * must give a test dose with medical supervision*
46
antichonlinergics
benztropine | trihexphenidyl
47
anticholinergics MoA in PD
-tries to restore ACh/DA balance in the basal ganglia
48
when to use anticholinergics
in younger patients earlier in the disease because of the side effects
49
adverse reactions of anticholinergics
- dry | - confusion
50
drug interactions of anticholinergics
levodopa (does not mean you cannot use it, just monitor for side effects due to increased concentration of dopamine)
51
how to stop anticholinergics
taper
52
amantadine MoA
NMDA receptor antagonist
53
when to use amantadine
- early in parkinsons for akinesia or rigidity | - may suppress levodopa-induced dyskinesia
54
amantadine dosing
according to their CrCl because it is cleared renally
55
contraindications of amantadine
seizures | CHF
56
adverse effects of amantadine
- anticholinergic - dizziness - edema - confusion - hallucinations - "livedo reticularis"
57
drug interaction of amantadine
- triamterene | - trimethoprim
58
non-pharmacologic treatments of PD
- education - physical therapy - exercise - occupational therapy - medical nutrition therapy - support groups - deep brain stimulation
59
treatment plan for those under 65 y/o
- Mild or early PD: rasagiline or amantadine, anticholinergics if tremor - moderated-advanced: DA agonists, levodopa/carbidopa and eventually COMT or MAO-B inhibitor to reduce wearing off
60
treatment plan for those over 65 y/o
- levodopa/carbidopa or MAO-Bs if early in PD - eventually add COMT or MAO-B to reduce wearing off - amatadine to reduce dyskinesia - avoid DA agonists and anticholinergics
61
when do we consider drug therapy
when disease is interfering with activities in life
62
why use anticholinergics in PD
to reduce mild tremors
63
most effective medicaiton for symptomatic treatment of PD
carbidopa/levodopa
64
how to start/stop any PD drug
always titrate/taper

PT2 Neuro 6-9 (5 decks)

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