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PD IOS 8-4
Parkinson's Meds
| Question | Answer |
|---|---|
| Parkinsons disease symptoms | Bradykinesia, Rigidity, resting tremor, poor balance,orthostatic hypotension, Dementia |
| Parkinsons disease etiology | Alpha-synuclin,parkin, ubiquitin-C-terminal hydroxylase, rural-pesticides, age |
| PD areas of neuronal death | substantia niagra par compacta |
| Supstantia niagra par compacta produces | Dopamine and stimulates striatum |
| cerebral cortex stimulates | Striatum, SNpr/MGP, STN |
| IF SNpc is lost what pathways are no longer regulated | SNpr (direct), LGP (indirect) decreasing inhibition |
| DIrect pathway | Striatum to (GABA) SNpr/MGP to (GABA) VA/VL to stimulate (GLU) cerebral cortex |
| Indirect Pathway | Striatum to LGP to STN to SNpr/MGP to VA/VL to cerebral cortex |
| Deep brain stimulation to which are | Subthalamic nucleus |
| Paladotimity is | Removal of Lateral Globus Pallidus (GABA ergic) |
| MPTP MOA | MOAb metabolizes, utilizes DA transporter and shuts down complex I in e transporter- ROS kills neurons |
| Synthesis of DA | Tyrosine is converted via tyrosine hydroxylase to DOPA then aromatic amino acid decarboxylase converts to dopamine |
| Dopamine precursor | Levodopa-prodrug able to cross BBB, competes with other gut proteins for abs (t 1/2 1-3 hrs) |
| Sinamet or altamet | Levodopa and Carbidopa=Less GI and Cardio SE |
| Carbidopa | Used to decrease degradation of levodopa by dopa decarboxylase. It does not cross the BBB, just reduces extracerebral decarboxylation to increase levopoda in CNS and decrease SE. |
| Levodopa most effective against | Bradykinesia |
| Levodopa SE | N/V (tolerance),orthostatic Hypotension, Dyskinesia, Flucutations, depression |
| Dopamine agonist-class | ergot and non-ergot |
| Ergot of PD | Bromocriptine pergolide |
| Non-ergots for PD | Pramipexole -D3, ropinrole |
| Dopamine precursor contraindication | psychotic, glaucoma |
| Dopamine agonist SE | orthostatic hypotension, fatique, insomnia, somnolence, confusion, dyskinesia |
| MAOb inhibitor | Selegiline |
| COMT inhibitors | entacapone,tolcaptone |
| COMT indication | Decrease wearing off must be used with Sinamet |
| Antiviral for PD | amatadine |
| Ach blocking drug | Beztropine mesylate |
| Beztropine mesylate MOA | balance NT, and Ach to match the decreased DA |
| Benztropine mesylate caution | Elderly patients -confusion and hallucinations |
| PD wearing off | Fluctuations occur due to timing of Levodopa. Ridigity return at end of dose. |
| PD On, off | Fluctuations are unrelated to timing of doses. Periods are characterized by marked akinesia altering with periods of improved mobility. |
| Managing flucutations | Decrease interval, give with sinamet, reduce dietary protein, take drug holiday |
| Newer approaches for PF treatment | Transplantation, Pallidotomy, Deep Brain stimulation, antioxidants |
| Pathophysiology | Defective ROS, e-transport, GABA defect, Ischemia, low tyrosine hydroxylase,dopa-decarboxylase, low NE, 5HT |
| Drug induced PD | MTPT, metoclopramide, antiemetic, antipsychotic |
| PD diagnosis | Bradykinesia and 2 of three (rigid,resting tremor, postural instability |
| Non-pharm PD treatment | Support groups, education,exercise,nutrition, (increase CA +Vit D) |
| Sinamet dose | 200-800 levodopa, 75-100 carbidopa |
| Sinamet DI | Increase with PPI, H2, metoclopramide-- Decrease with protein |
| Levopdopa cause | Generation of ROS which believed to damage neurons over time |
| Selegline dosing | 5 mg BID morning, afternoon |
| Anticholinergics in PD | Effective for treating tremor in patients younger than 60, inhibit M1 and M2, and NMDA to alleviate akinesia |
| Apomorphine indication | D4 agonist treats "freeze" to reverse levopdopa freezing episodes |
| Coemzyme Q 10 | Neuroprotective effects |
| NMDA receptor antagonist | Memantine, Neuramaxane,Remacemide,Amantadine -studies for neuroprotective effects |
| PD hallucinations | Reduce dose then can give clozapine |
| Orthostatic hypotension PD | Change antihypertensive meds, compression stockings, salt |
| Falls PD | Check for orthostatic hypotension |
| Wearing Off PD | Increase frequency of dosing |
| PD steps | 1. Sinamet 2. Pramipexole 3. COMT-Entacapone 4. Selegiline |
Created by:
liza001
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