ParkinsonFC

Question 1

Parkinson Disease pathophysiology

Answer 1

Neurons in the substantia nigra die or become impairedDopamine production decreases

Question 2

symptoms of parkinsons

Answer 2

TRAP symptoms (Tremor, Rigidity, Akinesia, Postural instability)Other signs: small, cramped handwriting; shuffling walk; stiff facial expression; reduced eye blinking; muffled speech; drooling; constipation; incontinence

Question 3

Drug-Induced Parkinson Disease is based on what aspect of drug delivery?

Answer 3

Dose dependent

Question 4

which medications can cause parkinsons or be a risk factor?

Answer 4

Phenothiazines (prochlorperazine)
First generation antipsychotics (haloperidol)
Second generation antipsychotics (paliperidon, risperidone)
Metoclopramide
Cholinesterase inhibitors used for dementia (donepezil, rivastigmine) can worsen symptoms

Question 5

Initial Therapy Selection parkainsons

Answer 5

Carbidopa/levodopa (Sinemet) is most effective for elderly
Anticholinergic for tremors in younger patients
Amantadine for tremors in younger patients

Question 6

Carbidopa/Levodopa (Sinemet) MOA

Answer 6

levodopa is a precursor of Dopamine, Carbidopa inhibits breakdown of levodopa

Question 7

can you crush the sinemet tab?

Answer 7

SR tab can be cut into half (do not crush)

Question 8

what is the effective dose for sinemet

Answer 8

70-100mg of carbidopa is required to be effective

Question 9

how long does it take for sinemet to be effective?

Answer 9

May take several weeks for full effects (do not stop abruptly)

Question 10

sinemet SE?s

Answer 10

SE: Nausea, vomiting, dry mouth, dizziness, orthostasis, dyskinesias, dystonias, confusion, hallucinations, psychosis, dark urine, saliva or sweat, unusual sexual urges, priapism

Question 11

what do you need to separate sinemet from?

Answer 11

Separate from iron and protei

Question 12

Di of sinemet ?

Answer 12

DI: MOAIs, Dopamine blockers, and iron & protein can decrease absorption

Question 13

Entacapone (Comtan) moa and use

Answer 13

COMT Inhibitor: used only with levodopa to increase duration of action
levodopa/Carbidopa + entacapone (Stalevo)

Question 14

entacapone Ses

Answer 14

SE: Nausea, dizziness, orthostasis, hypotension, dyskinesia, dark urine, diarrhea

Question 15

entacapone dosing?

Answer 15

Dose: 200mg with each dose of levadopa/carbidopa

Question 16

why is tolcapone not used much?

Answer 16

Tolcapone (Tasmar) not used much due to hepatotoxicity

Question 17

Pramipexole (Mirapex) moa

Answer 17

Dopamine agonist

Question 18

pramipexole dosing

Answer 18

Titrate dose slowly: start 0.125mg TID (dose adjust if CrCl <60)

Question 19

pramipexole Ses

Answer 19

SE: drowsiness, Nausea, vomiting, dry mouth, dizziness, orthostasis, peripheral edema, hallucination, dyskinesias, falling asleep during routine activity, renal damage

Question 20

what is another indication of pramipaxole?

Answer 20

IR also approved for restless leg syndrome

Question 21

Ropinirole (Requip)

Answer 21

Dopamine agonist

Question 22

se of ropinirole

Answer 22

SE: drowsiness, Nausea, vomiting, dry mouth, dizziness, orthostasis, peripheral edema, hallucination, dyskinesias, falling asleep during routine activity, renal damage

Question 23

dosing of ropinirole

Answer 23

Titrate dose slowly: start 0.25mg TID

Question 24

another indicaiton of ropinirole

Answer 24

IR also approved for restless leg syndrome

Question 25

Rotigotine (Neupro) MOA

Answer 25

Dopamine agonist (patch)

Question 26

se of rotigotine

Answer 26

SE: peripheral edema, drowsiness, headache, fatigue, orthostasis, sleep distubance, hallucinations, hyperhidrosis, dyskinesias, arthralgias

Question 27

how to apply rotigotine patch

Answer 27

Apply once daily, at same time (stomach, thigh, hip, side of body, shoulder, or upper arm)
Do not apply to same site for at least 14 days
do not Apply heat source over patch
Remove patch prior to MRI

Question 28

another indication for rotigotine

Answer 28

approved for restless leg syndrome

Question 29

Apomorphine (Apokyn) MAO

Answer 29

-Dopamine agonist (SQ injection): used as a “rescue” movement agent during “off” periods

Question 30

how frequent and when to use the apomorphine med?

Answer 30

-Used during “off periods” up to 5 times/day

Question 31

apomorphine CI

Answer 31

-CI: use with 5HT-receptor antagonist (ondansetron, granisetron, etc.)

Question 32

apomorphine Se

Answer 32

SE: severe Nausea and vomiting, hypotension, yawning, dyskinesias, somnolence, dizziness, QT-prolongation

Question 33

which med must you use before using apomorphine

Answer 33

start using trimethobenzamide (Tigan) before using this drug

Question 34

dose of apomorphine

Answer 34

Dose: start 0.2mL SQ injected up to 5x/day

Question 35

Amantadine (Symmetrel) MOA

Answer 35

Dopamine reuptake Inhibitor

Question 36

when to use amantadine

Answer 36

used for mild disease, or dyskinesias

Question 37

side effects of amantidine

Answer 37

SE: Nausea, dizziness, insomnia, toxic delirium, cutaneous reaction called livedo reticularis

Question 38

dosing of amantadine

Answer 38

-Dose: 100mg BID-TIDdecrease Dose in renal impairment

Question 39

MOA-B Inhibitors names

Answer 39

-Selegiline (Eldepryl, Zelapar-ODT, Emsam), Rasagiline (Azilect)

Question 40

when to use rasagiline for therapy?

Answer 40

Rasagiline can be used as initial monotherapy or adjunctive

Question 41

DI of MAOIs

Answer 41

DI: meperidine, tramadol, methadone, dextromethorphan, St. John’s wort, mirtazapine, cyclobenzaprine

Question 42

Centrally-Acting Anticholinergics names

Answer 42

Benztropine (Cogentin), trihexyphenidyl

Question 43

use of centrally acting anticholinergis

Answer 43

-Used primarly for tremor in young; aviod in elderly

Question 44

SE of centrally acting anticholinergis

Answer 44

SE: dry mouth, constipation, urinary retention, blurred vision, drowsiness, confusion, tachycardia