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DU PA Park Pharm

Duke PA Parkinson's Pharmacology

non-pharmocologic therapies for Parkinson's disease exercise, mental therapy
surgical treatment for parkinson's disease thalamotomy, pallidotomy, deep brain stimulation
pharmocologic therapies for parkinson's disease increase endogenous dopamine, dopamine agonists, anticholinergics, NMDA antagonists
therapies to increase endogenous dopamine levodopa, peripheral decarboxylase inhibitors (PDI), catechol-O-methyl-transferase (COMT) inhibitors, monoamine oxidase B (MAO-B) inhibitors
dopamine agonists classes nonergot, ergot
precursor of dopamine levodopa
most effective drug for Parkinson's levodopa
levodopa is converted to dopamin by dopa decarboxylase enzyme
why not just give dopamine peripheral dopamine results in adverse effects, and it will not cross the blood brain barrier
peripheral decarboxylase inhibitor carbidopa
carbidopa is given with levodopa to __ block peripheral conversion of levodopa to dopamine
contraindication for levodopa+carbidopa (sinemet) narrow angle glaucoma
overdose of levodopa+carbidopa (sinemet) can lead to palpitations, arrhythmias, spasms, hypo/hypertension
when a patient is on levodopa+carbidopa (sinemet) monitor blood pressure, symptoms, dyskinesias, mental status
levodopa+carbidopa (sinemet) is best absorbed on an empty stomach
COMT Inhibitors tolcapone (Tasmar), entacapone (Comtan)
COMT inhibitors must be given with __ to have an effect levodopa+carbidopa (Sinemet
what is COMT enzyme that metabolizes catecholamines and levodopa
what do COMT inhibitors do prevent peripheral conversion of levodopa, increase levodopa half life, and increase levodopa bioavalability
there have been reporst of __ with Tolcapone fatal liver injury
d/c tolcapone if there is elevation in LFT's or signs and symptoms of hepatic failure
strict __ monitoring with tolcapone LFT
MAO-B inhibitors selegiline (Eldepryl), Rasagiline (Azilect)
MAO breaks down dopamine, norepinephrine, epinephrine, serotonin, tyramines
MAO-B inhibitor contraindications meperidine, opioids, other MAO inhibitors
when giving MOA-B inhibitors monitor blood pressure, and parkinson's symptoms
Nonergot dopamine agonists pramipexole (Mirapex), ropinirole (ReQuip), rotigotine (Neupro), apomorphin (Apokyn)
Ergot dopamine agonists pergolide (Permax), Bromocriptine (Parlodel)
dopamine agonist MOA stimulate postsynaptic dopamine receptors within the corpus striatum
when patients are on dopamine agonists monitor for signs and symptoms of orthostatic hypotension
anticholinergics trihecyphenidyl (Artane), benztropine (cogentin), diphenhydramine (Benadryl)
diphenhydramine (Benadryl) is effective against tremor but not __ bradykinesia or other IPD symptoms
MOA of anticholinergics blocks the excitatory neurotransmitter acetylcholine
anticholinergic contraindications narrow-able glaucoma, pyloric or duodenal obstruction, stenosing peptic ulcers, bladder neck obstructions, achalasia, myasthenia gravis
anticholinergics are poor agents for patients with cognitive dysfunction
NMDA antagonists amantadine (symmetrel)
NMDA antagonists MOA exact mechanism unkown, inhibits dopamine reuptake
NMDA antagonists may decrease mental altertness
NMDA antagonists precautions liver disease, eczematoid dermatitis, psychosis, h/o seizures, renal dysfunction, edema/CHF patients, avoid with angle closure glaucoma
the TRAP symptoms are Tremor, Rigidity, Akinesia/bradykinesia, postural disturbacnes
absence of movement akinesia
drugs induced parkinsonism can be caused by __ dopamine receptor blockers (antipsychotics), antiemetics (metoclopramide, prochlorperazine), dopamine storage depletors (reserpine)
secondary causes of parkinsonism drug induced, toxins, strokes, traumatic lesions, normal pressure hydrocephalus
parkinson's disease is a disorder of the __ system extrapyramidal
in parkinson's disease dopamine is outweighed by __ acetylcholine
dopamine inhibits release of __ acetylcholine
when there is less dopamine there is a relative increase in __ acetylcholine
__ has multiple drug interactions levodopa + Carbidopa
too much dopamine stimulation can cause dyskinesias
advise patients on Levodopa+Carbidopa to __ rise carefully from lying/sitting position
when converting IR to SR levodopa-carbidopa increase total daily dose by __% 30
COMT inhibitor that works both peripherally and centrally Tolcapone (Tasmar)
COMT inhibitor that works only peripherally Entacapone (Comtan)
enzyme that metabolizes catecholamines and levodopa COMT
Drug that prevents peripheral conversion of levodopa to 3-OMD COMT inhibitors (entacapone, tolcapone)
MAO-B inhibitors adverse drug effects insomnia (selegiline only), dizziness, n/v, xerostomia, dyskinesias, mood changes, headache, hypotension
Insomnia is an AE of which MAO-B inhibitor only selegiline (Eldepryl)
MAO-B inhibitor that does not cause insomnia rasagiline (Azilect)
avoid administering __ late in the day selegiline (Eldypryl)
Dopamine agonist common AE's nausea, sedation, light headedness, dizziness, vivid dreams, postural hypotension, dyskinesia
dose limiting AE's of dopamine agonists confusion, hallucinations, daytime sedation
peripheral AE's for anticholinergics blurred vision, urinary retention, xerostomia, constipation
central AE's for anticholinergics confusion, impairment of memory, hallucinations, delusions
Anticholinergics are not recommended for the __ elderly
NMDA AE's Sedation, vivid dreams, xerostomia, livedo reticularis, edema, depression, hallucinations, anxiety, dizziness, confusion
NMDA's that will go away with time sedation, vivid dreams
rose colored lacelike discoloration of lower extremities seen with amantadine therapy. this is not a harmful AE. livedo reticularis
Created by: bwyche