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Pharm Parkinsons
Neurology Parkinsons Rx
| Question | Answer |
|---|---|
| Most common neurodegenerative dz | Alzheimers |
| 2nd most common neurodegenerative dz | Parkinsons |
| TRAP pneumonic | Tremor, rigidity, Akinesia, Postural Instability (all four signs do not have to present of dx) |
| Essential Tremor Presentation | Commonly bilateral, not present at rest, lack of response to levodopa |
| Parkinson's Disease Presentation | Often first seen on one side, present at rest, clinical response to levodopa |
| Drug induced Parkinsons agents | Dopamine receptor blockers (antipsychotics), Antiemetics (metoclopramide, prochlorperazine), Dopamine storage depletors (reserpine) |
| Synthetic form of heroine that can cause Parkinsonism | MTPT |
| Initial recommendation in patients presenting with parkinsonisms | review drug profile to rule out drug-induced parkinsonism |
| What is the pathophysiology regarding dopamine and ACH in parkinsons? | Dopamine is gradually lost and ACH gradually increases |
| What turns Levodopa into dopamine? | Dopa decarboxylase |
| What turns Levodopa into 3-OMD | COMT |
| What causes the adverse effects of levodopa? | The peripheral dopamine caused by dopa decarboxylase (in Awakenings, they had to use huge doses of levodopa b/c they did not yet have carbidopa; dopamine caused AEs) |
| ____ is a peripheral decarboxylase inhibitor | Carbidopa. |
| Carbidopa is contraindicated in patients with | Narrow-angle glaucoma |
| Common AE's of sinemet | Postural hypotension, N/V, Sedation, Vivid Dreams, Psychiatric SE |
| Sinemet Drug interactions | LOTS!! Iron, Antacids, Benzo's, Phenytoin, TCA's, MOAI's just to name a few |
| Appropriate monitoring for Sinemet | BP, Sx, Dyskinesias, Mental status |
| When should sinemet be taken? | Best on an empty stomach. Other patient education: rise carefully from sitting/lying position (hypotension) and do not crush SR product |
| When converting Sinemet IR to SR how should the dose be adjusted? | Increase total daily dose by about 30%. CR form has decreased bioavailability |
| Where do COMT inhibitors work? | Tolcapone:In the periphery and in the nigrostriatum (central); Entacopone: in ther peripheral only. (ENTACOPONE works in the EXTERIOR). Prevent peripheral conversion of levodopa to 3-OMD |
| What must be given with a COMT inhibitor? | Levodopa/carbidopa |
| What does COMT do? | It is an enzyme that metabolizees catecholamines and levodopa. |
| AEs of COMT inhibitors | N, Dyskinesia, Diarrhea, Abdominal Pain, Brown-orange urine |
| What is the fatal AE associated with Tolcapone? | Fatal liver injury; requires strict monitoring of hepatic function. Need patient to sign an informed consent. Patient can't drive a car or operate machinery. |
| What agents increase endogenous dopamine? | L-amino acid decarboxylase (L-AAD) inhibitor, Catechol-O-methyl-transferase (COMT)inhibitors, MAO-B inhibitors |
| What is the function of MAO-B | Breaks down dopamine in the brain |
| Which MOA-B I has no amphetamine metabolites | Rasagiline |
| Contraindications of MAO-B I | Use with meperidine, opioids, other MAO I's |
| Avoid administering Selegiline at what time of the day? | Late in the day due to the insomnia |
| When you add MAO-B's to Sinemet, how should Sinemet be adjusted? | Sinemet dose should be decreased |
| Name the Dopamine Agonists | Nonergot: Pramipexole, Ropinirole, Apomorphine. Ergot: Pergolide, Bromocriptine |
| Ergot AE's | May induce pleural fibrosis |
| Contraindication for Dopamine Agonists | CYP3A4 inhibitors |
| Tx of Parkinsons | Is only symptomatic, it does not change the progression of disease |
| Dopamine agonists are preferred in which pt population? | Younger pts. Orthostatic Hypotension is an AE and psychosis is more likely in older pts |
| Anticholinergics are effective for | treatment of tremor, but not for bradykinesia or other Idiopathic Parkinson Disease Sx. |
| Name the three anticholinergics | Trihexyphenidly, Benztropine, Diphenhydramine |
| Contraindications for Anticholinergics | Narrow-angle glaucoma, Pyloric or duodenal obstruction, bladder neck obstruction |
| Can't pee, can't see, can't poop, can't spit are associations with which tx? | Anticholinergics |
| Which population should anticholinergics not be prescribed for? | Elderly. Poor agents for patients with cognitive dysfunction |
| Name the N-Methyl-D-Aspartate Antagonist | Amantadine (symmetrel). Antiviral |
| Precautions for N-Methyl-D-Aspartate Antagonist | Psychosis, Renal dysfunction, Edema/CHF pts, avoid with angle closure glaucoma |
| Which drugs should be avoided in patients with angle glaucoma? | Symmetrel (N-Methyl-D-Aspartate Antagonist), Anticholinergics, and Carbidopa |
| What aspect of PD does Symmetrel help with? | Effective against Tremor |
| Livedo Reticularis can be seen with | Amantadine (symmetrel). Occurs in up to 80% of patients and persists until therapy is stopped. Edema also may be seen with livedo reticularis (livedo usually occurs in the LEs) |
| Iron interacts with | Levodopa/carbidopa |
Created by:
ltm12