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Ph Neuro Parkinson

Pharma Neuro

QuestionAnswer
Drug induced parkinsonism Neuroleptics/Antipsychotics; Prochlorperazine; Metoclopramide; Valproate; Amiodarone; Phenytoin; Lithium
Levodopa does not improve: postural instability, dementia, autonomic dysfunction or freezing
Begin levodopa tx when: pt experiences functional impairment
Levodopa CI Hypersensitivity, narrow angle glaucoma, melanoma or undiagnosed skin lesions
Levodopa biggest AE N&V; give 30 min before/60 min after meal, but can give w/meal, decrease GI sx; avoid high pro diet (competes w/pro to cross BBB)
Levodopa AE (all) N/V; postural hypotension; cardiac arrhythmia; mental disturbance; dyskinesias (TD; on-off fx or wearing-off fx: shorten interval); psychomotor excitation (agitation, hypomanic)
Levodopa DI MAOI (hypertensive rxn); Antipsychotics (decrease L-dopa fx); Fe salts (dec absorpn of L-dopa); Metoclopramide, phenytoin (dec fx of L-dopa)
Levodopa CR no difference in off-time
DA agonists: MOA Act directly on dopamine receptors in the corpus striatum (Mirapex: renal elim/dose adj; Requip: C450)
DA agonists: ergot derivatives: AE retroperitoneal, pleural & pericardial fibrosis; Cardiac valve fibrosis
DA agonists: AE Dizziness; HA; insomnia; somnolence; confusion; hallucinations; Dry mouth, nausea; constipation; ortho hypoTN; syncope; Dyskinesias; impulse control disorders (compulsive gambling/binge eating)
DA: DI CYP3A4 inhib (protease inhibs, antifungal, macrolides); antipsychotic (dec fx of DA); Efavirenz (ischemia); Metoclopramide (dec DA fx); Serotonin modulators (serotonin syndrome)
Rescue therapy for Off episodes: Apomorphine; titration & test dose under medical supervision (risk of ortho hypoTN)
Apomorphine AE Yawning; Dyskinesia; N/V; Dizziness; Angina; Rhinorrhea; Hallucinations, impulse control disorders, melanoma, orthostasis
Apomorphine DI Cipro (QT prolong); Serotonin antagonists (enhance hypoTN); Antipyschotics, Prochlorperazine, Metoclopramide (diminish fx)
COMT inhib MOA Increase amount of levodopa available to cross BBB (allows prolonged On periods; often add on when levodopa efficacy begins to diminish)
COMT inhib DI MAOI; EtOH
Tolcapone monitoring LFTs baseline, then every 2-4 weeks for 6 months, then periodically
COMT inhib AE Liver failure (tolcapone); inc levodopa exposure; Dyskinesias; N/V; Dizziness; Hallucinations; Urine discoloration; Abd pain; Diarrhea; Orthostasis; Somnolence; HA
Comtan AE urine brownish-orange
Selegiline MOA Acts centrally to prevent DA destruction (MAO-B: metab of DA); fx diminish over time
MAO-B DI Sympathomimetics (HTN fx; avoid); Meperidine, Dextromethorphan, SSRI (serotonin syn); MAOI orthostasis; Ciprofloxacin (sd inc rasagiline conc)
MAO-B CI mirtazapine
MAO-B AE Not hypertensive (MAOI) rxn; insomnia; N/V
Rasagiline AE HA; dizziness; N/V; Dyskinesias & orthostasis (combo w/ levodopa)
Anticholinergics: indication in Parkinsons Reserved for resting tremor early in the dz in younger pts
Antiviral agent that may be used alone or in combo w/ levodopa = Amantadine (Symmetrel)
Amantadine fx tachyphylaxis dev w/in 3 mos (req higher & higher doses) (withdraw, d/c & reintroduce); reduces dyskinesias (used late in dz)
Amantadine MOA augment DA presynaptic release; block reuptake; block glutamate transmission; renal metab (dose adj)
Amantadine AE convulsion (at higher doses); ankle edema; livedo reticularis; plus the usual sx
Amantadine DI antipsychotics; EtOH
Parkinson: other poss tx antioxidants (vit E Not Recommended); Coenzyme Q10 (no proven fx); creatine/minocycline (?)
Created by: Abarnard
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