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Naplex
Parkinson Disease
| Question | Answer |
|---|---|
| Q1. Definition of PD | • PD: brain disorder • Substantia nigra die / impaired • Substantia nigra cells produce dopamine |
| Q2. Agonist vs Antagonist | • Agonists: Drugs that occupy receptors and ACTIVATE them • Antagonists: Drugs that occupy receptors and BLOCK receptor activation by agonists. |
| Q3. Dopamin blocking dgugs that worsen PD | • Prochlorperazine (phenothiazines list): N/V, agitation • Butyrophenones: haloperidol, droperidol (PONV) • SGAs: risperidone (high dose), paliperidone • Metoclopramide: renally-cleared, accumulate in elderly pts |
| D4. What population DOSE adjustment for Metoclopramide (Reglan) | • Elderly, renal impairment, CYP2D6 inhibitors • Dopamine blockade and CNS depression |
| Q5. Classic T-R-A-P Presentation: The 4 Primary Motor Symptoms | • Tremor: during rest, worsened by anxiety • Rigidity - arms, legs, trunk and face (mask-like face) • Akinesia/bradykinesia - lack of movement or slow initiation of movement • Postural instability (fall risk) |
| Q6. PD Nonmotor symptoms | • Loss of sense of smell (anosmia) • Constipation • Sleep difficulties • Low mood/depression and orthostasis. |
| Q7. Parkinson Disease Non-Motor Disorders | • depression, sleep disorders, weight loss • orthostatic hypotension • difficulty speeking/swallowing, excessive SALIVATION • constipation, micturition disorders, impotence • Sweating |
| Q8. Treatment for related psychotic conditions: Depression, Anxiety | • NO BZD • SSRI, SNRI, 2nd TCA (Not doxepin) |
| Q9. Treatment for related psychotic conditions: Psychosis (seen in Advanced PD) | • Seroquel (orthostatic, metabolic) • ONLY clozapine if no other option (too many SEs) |
| Q10. Dopamine is broken down by | • Monoamine Oxidase • COMT (catechol-O-methyltransferase) |
| Q11. Role of carbidopa in Sinemet | • Sinemet: carbidopa/levodopa • Inhibits dopa decarboxylase enzyme • Prevent peripheral metabolism of levodopa |
| Q12. non-selective MAOi - Levodopa together | • dopamine level go UPP, risk of fatal (HTN crisis: epinephrin / adrenaline) |
| Q13. Entacapone (Comtan) | • Inhibits COMT, catechol-O-methyltransferase • Use TOGETHER with sinemet • 200mg PO w EACH dose carbidopa/levodopa (max 1,600 mg/d) |
| Q14. Dopamine agonists | • mimic dopamine • Mirapex • Requip • Neupro patch |
| Q15. MAO-B inhibitors | • preserve existing dopamine |
| Q16. Dopamine agonists and replacement agents | • Sinemet: Carbidopa/Levodopa • Comtan: entacapone • Dopamine Agonists: (Pramipexole, Ropinirole, Rotigotine-patch • Rescue (mobility) agent for advanced PD: apomorphine (Apokyn): move again in 45 mins |
| Q17. Sinemet: Carbidopa/Levodopa | • Carbidopa 70-100 mg/day • Separate from IRON, PROTEIN (decrease absorption) |
| Q18. Sinemet: Carbidopa/Levodopa dose | • IR (starting dose): 25/100 mg PO TID • CR (starting dose): 50/200 mg PO BID, can be cut in half, NOT crush or chew |
| Q19. Sinemet: Carbidopa/Levodopa DDI | • Non-selective MAOi: within 14 days, narrow angle glaucoma • Dopamine blockers (worsen symptoms): phenothiazines, metoclopramide |
| Q20. Sinemet: Carbidopa/Levodopa SEs | • Nausea, dizziness, orthostasis, dyskinesias • dry mouth, dystonias (occasional, painful) • confusion, hallucinations or psychosis • Brown, black or dark urine, saliva or sweat • Coombs test (+) • Unusual sexual urges, priapism; increased uric acid |
| Q21. Long term use Sinemet | • Fluctuations in response and dyskinesias |
| Q22. Carbidopa total dose is 150 mg | • Carbidopa 70-100 mg/day • Less: peripheral metabolism of levodopa • More: vomit (too nauses) |
| Q23. Rytary | • Carbidopa/Levodopa: SR capsules, can be opened and sprinkled on a small amount of applesauce. |
| Q24. Duopa | • Carbidopa/Levodopa • Enteral suspension • Administered by portable pump into the jejunum (đoạn hỗng tràng) |
| Q25. Tolcapone (Tasmar) | • COMT inhibitor • Hepatotoxicity (less used) |
| Q26. Entacapone (Comtan) SEs | • ONLY levodopa SEs (extending its duration) |
| Q27. Stalevo | • Carbidopa/Levodopa / Entacapone |
| Q28. Dopamine Agonists - Pramipexole (Mirapex, Mirapex ER) | • IR: start 0.125mg PO TID, titrate wkly, max of 1.5mg TID • ER: start 0.375mg PO QD, titrate wkly, max of 4.5mg QD |
| Q29. Dopamine Agonists - Pramipexole formulation which is approved for restless legs syndrome (RLS) | •IR formulation •Mirapex |
| Q30. Dopamine Agonists - Ropinirole (Requip, Requip XL) | • IR: start 0.25mg PO TID, titrate wkly, max of 8mg TID • XL: start 2mg PO QD, titrate wkly, max of 24mg QD |
| Q31. Dopamine Agonists - Ropinirole formulation which is approved for restless legs syndrome (RLS) | • IR formulation • Requip |
| Q32. Dopamine Agonists - Rotigotine (Neupro) Patch | • Indication: PD, RLS. • Start 2mg/24 hrs (early PD), Max dose: 8 mg/24 hours • Apply QD same time each day • NOT same site for at least 14d, NO heat source over the patch • Remove MRI; avoid if allergy to SULFITES • Hyperhidrosis (tiết mồ hôi) |
| Q33. Dopamine Agonists requires SLOW TITRATION (no more than weekly) | • Orthostasis, dizziness, SLEEPINESS |
| Q34. Apomorphine (Apokyn): "rescue" movement agent for "off" periods | • Lasts 45-90 mins • Medical office • CI: 5HT3 antagonists: severe hyPOtension, loss of consciousness • SEs: Severe N/V, hyPOtension, yawning, dyskinesias, somnolence, dizziness, QT prolongation |
| Q35. Apomorphine (Apokyn) monitor | • Monitor supine (nằm) and standing BP • Emesis prevention: trimethobenzamide (Tigan) 300 mg PO TID, or similar antiemetic, 3 days prior to the initial dose • NO ondansetron |
| Q36. Amantadine - DA reuptake inhibitor | Somnolence, psychosis, orthostasis/dizziness |
| Q37. MAO-B Inhibitors list | • Selegiline (Eldepryl), ODT formulation:Zelapar. Activating, QHS • Rasagiline (Azilect) |
| Q37. MAO-B Inhibitors | • DDI: foods high in tyramine, and anything that contains dopamine, tyrosine, phenylalanine, tryptophan or caffeine • 5HT syndrome |
| Q39. Centrally-acting anticholinergics | • Benztropine (Cogentin) • Trinexyphenidyl • Used in young pt w tremor • NOT use in elderly |
| Q40. Droxidopa (Northera) | • For orthostasis (neurogenic orthostatic hypotension - nOH) • Cause syncope |
| Q41. PD counsel topics | • Melanoma (check skin) • Dyskinesias • Drug Interactions • Unusual urges • Mood changes • Do not stop suddenly • Avoid alcohol |
| Q41. PD specific drugs counsel topics | • Levodopa/carbidopa: urine can darken, separate iron, protein • Dopamine agonists: sudden sleepiness, dose titration, nausea (can take with food) • Entacapone: same as levodopa • MOA-B inhibitors: |
Created by:
dao.vo11017