Neurology Parkinsons Rx
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| Most common neurodegenerative dz | Alzheimers
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| 2nd most common neurodegenerative dz | Parkinsons
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| TRAP pneumonic | Tremor, rigidity, Akinesia, Postural Instability (all four signs do not have to present of dx)
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| Essential Tremor Presentation | Commonly bilateral, not present at rest, lack of response to levodopa
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| Parkinson's Disease Presentation | Often first seen on one side, present at rest, clinical response to levodopa
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| Drug induced Parkinsons agents | Dopamine receptor blockers (antipsychotics), Antiemetics (metoclopramide, prochlorperazine), Dopamine storage depletors (reserpine)
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| Synthetic form of heroine that can cause Parkinsonism | MTPT
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| Initial recommendation in patients presenting with parkinsonisms | review drug profile to rule out drug-induced parkinsonism
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| What is the pathophysiology regarding dopamine and ACH in parkinsons? | Dopamine is gradually lost and ACH gradually increases
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| What turns Levodopa into dopamine? | Dopa decarboxylase
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| What turns Levodopa into 3-OMD | COMT
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| 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)
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| ____ is a peripheral decarboxylase inhibitor | Carbidopa.
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| Carbidopa is contraindicated in patients with | Narrow-angle glaucoma
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| Common AE's of sinemet | Postural hypotension, N/V, Sedation, Vivid Dreams, Psychiatric SE
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| Sinemet Drug interactions | LOTS!! Iron, Antacids, Benzo's, Phenytoin, TCA's, MOAI's just to name a few
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| Appropriate monitoring for Sinemet | BP, Sx, Dyskinesias, Mental status
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| 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
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| When converting Sinemet IR to SR how should the dose be adjusted? | Increase total daily dose by about 30%. CR form has decreased bioavailability
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| 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
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| What must be given with a COMT inhibitor? | Levodopa/carbidopa
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| What does COMT do? | It is an enzyme that metabolizees catecholamines and levodopa.
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| AEs of COMT inhibitors | N, Dyskinesia, Diarrhea, Abdominal Pain, Brown-orange urine
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| 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.
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| What agents increase endogenous dopamine? | L-amino acid decarboxylase (L-AAD) inhibitor, Catechol-O-methyl-transferase (COMT)inhibitors, MAO-B inhibitors
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| What is the function of MAO-B | Breaks down dopamine in the brain
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| Which MOA-B I has no amphetamine metabolites | Rasagiline
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| Contraindications of MAO-B I | Use with meperidine, opioids, other MAO I's
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| Avoid administering Selegiline at what time of the day? | Late in the day due to the insomnia
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| When you add MAO-B's to Sinemet, how should Sinemet be adjusted? | Sinemet dose should be decreased
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| Name the Dopamine Agonists | Nonergot: Pramipexole, Ropinirole, Apomorphine. Ergot: Pergolide, Bromocriptine
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| Ergot AE's | May induce pleural fibrosis
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| Contraindication for Dopamine Agonists | CYP3A4 inhibitors
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| Tx of Parkinsons | Is only symptomatic, it does not change the progression of disease
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| Dopamine agonists are preferred in which pt population? | Younger pts. Orthostatic Hypotension is an AE and psychosis is more likely in older pts
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| Anticholinergics are effective for | treatment of tremor, but not for bradykinesia or other Idiopathic Parkinson Disease Sx.
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| Name the three anticholinergics | Trihexyphenidly, Benztropine, Diphenhydramine
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| Contraindications for Anticholinergics | Narrow-angle glaucoma, Pyloric or duodenal obstruction, bladder neck obstruction
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| Can't pee, can't see, can't poop, can't spit are associations with which tx? | Anticholinergics
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| Which population should anticholinergics not be prescribed for? | Elderly. Poor agents for patients with cognitive dysfunction
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| Name the N-Methyl-D-Aspartate Antagonist | Amantadine (symmetrel). Antiviral
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| Precautions for N-Methyl-D-Aspartate Antagonist | Psychosis, Renal dysfunction, Edema/CHF pts, avoid with angle closure glaucoma
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| Which drugs should be avoided in patients with angle glaucoma? | Symmetrel (N-Methyl-D-Aspartate Antagonist), Anticholinergics, and Carbidopa
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| What aspect of PD does Symmetrel help with? | Effective against Tremor
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| 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)
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| Iron interacts with | Levodopa/carbidopa
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