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Primary Care EXAM 3 > Pharm: Drugs for PD > Flashcards

Pharm: Drugs for PD Flashcards

1
Q

Parkinson’s is primarily caused by a deficiency in ________.

A

dopamine

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2
Q

What is a common way to rule out Parkinson’s disease from other movement disorders?

A

trial of Parkinsonian drugs

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3
Q

What are the 3 signs that differentiate PD from other movement disorders?

A
  • asymmetry
  • resting tremor
  • good response to levodopa
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4
Q

By the time PD is diagnosed over ____% of dopamine is lost.

A

80%

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5
Q

Why don’t we give dopamine to patient’s with PD?

A
  • doesn’t get absorbed orally

- doesn’t cross the BBB

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6
Q

How is it that levodopa crosses the BBB but dopamine does not?

A

levodopa looks like an amino acid so gets taken up by amino acid transporters

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7
Q

What is the purpose of adding carbidopa to levodopa?

A
  • carbidopa inhibits the decarboxylase in the periphery to allow more levodopa to get into the brain
  • carbidopa = peripherally acting decarboxylase inhibitor*
  • decreases side effects
  • increases efficacy
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8
Q

What are the 2 most common peripheral side effects of levodopa?

A
  • dizziness

- nausea

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9
Q

What are the 2 most common brain side effects of levodopa?

A
  • movement (dyskinesia)

- mood disorders (hallucinations)

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10
Q

Levodopa should be avoided if a patient is already taking what medication?

A

non-selective MAO inhibitors

potential for hypertensive crisis

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11
Q

What are the 2 concerns with chronic use of levodopa?

A
  • wearing off effect requiring higher doses

- higher doses result in increased toxicity

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12
Q

What is the function of Entacapone?

A
  • inhibits COMT so levodopa does not get converted into methyldopa in the periphery
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13
Q

The COMT inhibitors or Entacapone-like drugs are very toxic to what organ?

A

liver

need to monitor liver enzymes

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14
Q

What are the most common side effects with Entacapone-like drugs?

A

ALL THE SAME THINGS

  • nausea, dizziness, hallucinations, dyskinesia
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15
Q

Neurologists like to begin with either of these 2 drug classes when treating PD.

A
  • MAO-type B inhibitors

- Dopamine receptor agonists

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16
Q

By inhibiting MAO-type ____ dopamine levels increase

A

B

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17
Q

Old dopamine receptor agonists (e.g. Bromocriptine) are commonly used for what condition?

A

prolactinomas

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18
Q

Newer dopamine receptor agonists are commonly used for what 2 conditions?

A
  • parkinson’s disease

- restless leg syndrome

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19
Q

What are the 2 new dopamine receptor agonists that was bolded in class?

A
  • Pramipexole (Mirapex)

- Ropinirole (Requip)

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20
Q

Patients who are taking non-ergot-derived agents (e.g. Pramipexole, Ropinirole) should be advised against doing what?

A

driving

because causes somnolence

21
Q

Increased in compulsive behaviors are an adverse effect of what drugs?

A

newer dopamine receptor agonists (e.g. Pramipexole, Ropinirole)

22
Q

This drug is used for intermittent treatment of hypomobility episodes and is given either SQ or sublingual.

A

Apomorphine (Dopamine agonist)

23
Q

What are the side effects of Apomorphine?

A
  • nausea/ SEVERE vomiting (requires antiemetic)
  • hypersomnia
  • orthostatsis
  • priapism (rare)
24
Q

Patients who are on Apomorphine should avoid what drugs?

A

5HT3 antagonists

25
Q

The first type of therapy ever used for PD was what class of drugs?

A

anticholinergic agents (hyoscyamine)

Dr. Charcot

26
Q

Why did we stop treating PD with anticholinergics (Benztropine)?

A
  • adverse effects (anti-SLUD) which are already common in the elderly population
27
Q

What is the role of amantadine in treating PD?

A

adjunctive therapy for someone already on levodopa therapy

28
Q

What are the 3 mechanism of action for anticonvulsants?

A
  • enhance of inhibitory activity (GABA)
  • inhibition of excitatory activity (glutamate or aspartate)
  • modulation of voltage-dependent ion channels involved in propagating the action potential
29
Q

What is the main role of anticonvulsants?

A
  • slow down neurotransmission
30
Q

Phenytoin and carbamazepine are what type of anticonvulsants?

A

sodium channel blockers

31
Q

Most of the anticonvulsants are cleared from the body by what organ?

A

liver

except for levetiracetam

32
Q

If you are worried about a patient’s liver function what anticonvulsants should you choose to give?

A

levetiracetam (Keppra)

is cleared by the kidneys

33
Q

What are the 5 anticonvulsants we should be able to identify for the exam?

A
  • phenytoin
  • carbamazepine
  • valproic acid
  • lamotrigine
  • levetiracetam
34
Q

What dermatologic adverse effect do you worry about with lamotrigine?

A

SJS

need to stop med if this happens

35
Q

Which of the anticonvulsants is especially contraindicated in pegnancy?

A

Valproic acid

36
Q

Why is it necessary to monitor blood levels in anticonvulsants?

A
  • there is a non-proportional change in concentration of a drug with an increased in dose
  • very individualized*
  • zero order = process of removal is saturated*
37
Q

Anticonvulsants are primarily CYP450 _________.

A

inducers

decreases amount of other drugs in body

38
Q

What must be present for benzodiazepine to open up the chloride channel?

How is this different than barbiturates?

A
  • GABA

- barbiturates open up the chloride channels by themselves = can be lethal

39
Q

Phenobarbital or benzodiazepines is primarily indicated for what acute condition?

A

status epilepticus

40
Q

Why can’t we use phenobarbital or benzodiazepines for chronic seizure control?

A

because of the tolerance effect

41
Q

What drug has GABA like activity but is different from benzodiazepines?

A

valproic acid

because it increases glutamic acid decarboxylase (GAD) activity and decreases GABA transaminase activity

42
Q

What is the mechanism of action of gabapentin?

A
  • calcium channel blocker
43
Q

Since gabapentin is a calcium channel blocker what is a common side effect of this drug?

A
  • peripheral edema
44
Q

Gabapentin is primarily used for what problem?

A

neuropathic pain

45
Q

Why do we use gabapentin for neuropathic pain instead of other anticonvulsants?

A
  • less adverse effects
  • less drug-drug interactions
  • predictable pharmacokinetics
46
Q

What is the widely used drug for seizure disorders?

A

Levetiracetam (Keppra)

47
Q

What are the main difference between older and newer agents?

A
  • older: narrow therapeutic margins, more drug interactions but good experience for numerous indications
  • narrow: wider therapeutic margins, less drug interactions but more narrow indications
48
Q

Which drug is effective for almost every type of seizure?

A

Valproic acid

because it has many mechanism of actions

similar to Amiodarone

Primary Care EXAM 3 (5 decks)

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