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Pharm - Parkinson's jenks228
pharm t4
60
Pharmacology
Graduate
03/20/2010

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Cards

Term
indications for neuroprotective therapy in PD:
Definition
dx w no fxnl impairment then focus becomes neuroprotective
Term
2 drugs for neuroprotective therapy in PD:
Definition
1. Selegine
2. Rasagiline
Term
therapy for tremor predominant PD pts >70yo
Definition
amantidine
Term
therapy for tremor predominant PD pts <70yo
Definition
anticholinergics
Term
therapy for non-tremor predominant PD pts <65yo:
Definition
DA agonist
Term
therapy for non-tremor predominant PD pt >65yo:
Definition
CD/LD
Term
therapy for non-tremor predominant PD in patients who are cognitively impaired:
Definition
CD/LD
Term
name 3 options for pts not responding to therapy in non-tremor dominant PD:
Definition
1. increase dose of DA agonist or CD/LD
2. add CD/LD to regimine
3. consider another dx
Term
when adding selegiline or rasagiline as an adjunct it is necessary to reduce the levodopa dose by:
Definition
10-30% possibly as much as 50% to prevent involuntary movements or hallucinations
Term
considering CD/LD therapy a DA agonist should be added when daily doses reach:
Definition
500-800mg necessary for affect
Term
when adding COMT therapy to CD/LD how should you dose adjust?
Definition
important to dose adjust levodopa downward 20-30%
Term
steps in transitioning IR CD/LD to CR CD/LD:
Definition
1. decrease frequency of administration by 50%
2. dose @ 100-120%
3. if wearing off persists but <60min then just increase the dose of the IR therapy
4. If wearing off persists >60min then increase the dose/frquency
Term
2 MAOs
Definition
selegine & rasagiline
Term
MAOi's MOA:
Definition
MonoAmine Oxidase B inhibitors - MAO-B is the enzyme in the brain responsible for the breakdown of DA
Term
max doe for MAO-B
Definition
10mg/day
Term
SE of MAO-Bi's: GI,CNS,CV
Definition
1. GI (N/V, constipation, dery mouth)
2. CNS (agitation, confusion, psychosis)
3. CV (hypotension, arrhythmias, palpitations)
Term
MAO-B role in therapy:
Definition
reduces the need for high doses of L-dopa therefore alleviating some of the SE assoc w L-dopa
Term
MOA for anti-cholinergics:
Definition
decrease the action of ACh in CNS helping to restore the ACh/DA balance
Term
what do the Anti-cholinergics help with? not help with?
Definition
mainly help with tremors and rigidity but not postural imbalance, bradykinesia, or gait problems
Term
who is the prefered pt for anti-cholinergic therapy:
Definition
pt <70yo w tremor predominant and without akinesia
Term
anticholinergic SE:5
Definition
1. dry mouth
2. constipation
3. dizziness
4. urinary retension
5. memory impairment
Term
MOA of Amantidine: 4
Definition
1. increases DA synthesis,
2. blocks DA reuptake,
3. stimulates DA receptors and
4. has peripheral anticholinergic preperties.
Term
role in therapy for amantidine:
Definition
effective in tx of akinesia and rigidity but less effective in the tx of tremors EXCEPT for those pts >70yo
Term
SE of amantidine:
Definition
1. rare at rec doses
2. N/V/D, constipation, abd cramping
3. increse tremor, seixures, hallucinations
4. worsening CHF, arrhythmias
5. Livido Reticularis (diffuse rose colored motling of the skin)
Term
LD/CD MOA:
Definition
LD is a precursor in DA syn and can be converted to DA in the CNS. CD stays in the periphery and inhibits LD conversion in the periphery, ensuring it goes where its needed
Term
SE of levodopa:
Definition
1. Vomiting, PUD
2. orthostatic hypotension, arrhythmias
3. anxiety, confusion, hallucinations, hypersexuality, dyskinetic movements
Term
Direct DA agonist's role in therapy:
Definition
monotherapy (although dosen't cover all sx) OR adjunct therapy w LD to reduce LD dosage.
Term
SE of direct DA agonist:
Definition
SE occur upon initiation of tx and tolerance develops over days-wks:
N/V, postural Hypotension, psychiatric sx, impulse control d/o (gambling, hypersexual, complusive shopping)
Term
COMT inhibitors MOA:
Definition
inhibit COMT which breaks down levodopa in the CNS
Term
COMTi role in therapy:
Definition
reduce the wearing off phases in CD/LD therapy seen in late stage PD
Term
Adverse Effects of COMTi: 5
Definition
1. diarrhea
2. discoloration of urine
3. nausea
4. HA
5. somnolence
Term
COMTi that runs a risk of severe hepatocellular injury including acute fulminant liver failure.
Definition
Tolcapone
Term
normal doses for selegine
Definition
1. eldepryl 5mg
2. zelepar 1.25

10mg/day for both
Term
normal doses for amantidine:
Definition
symmetrel 100mg (200-300mg/d)
Term
normal dosing for IR CD/LD
Definition
sinemet 300-1000mg/d
Term
normal dosing for CR CD/LD
Definition
sinemet CR 400-1000mg/d
Term
which is the desintegrating tablet of CD/LD
Definition
Parcopa 300-1000mg/d
Term
normal dosing for COMTi
Definition
entacapone 200mg (600-2000mg/d)
Term
define "delayed on response"
Definition
delay of absorption of med through the BBB. LD uses neutral AA transporters to get thru BBB not taking med on empty stomach increases competition for these xporters
Term
define "wearing off phenom"
Definition
loss of response to dose before the next is due. - from either decreased absorption/penetration (GI/BBB) OR degeneration of presynaptic DA neurons resulting in decreased DA storage (late PD)
Term
control measures for wearing off:3
Definition
1. increase the freq and/or dose of LD
2. add DA agonist
3. add COMTi
Term
define "on-off phenom"
Definition
rapid fluctuation from sx free to extreme sx; occur in 40% of pts after 5yrs
Term
control measures for on-off phenom:
Definition
1. direct DA agonist
2. extra levodopa
3. chewing an IR between CR doses
Term
define freezing:
Definition
unable to initiate a coplete movement
Term
what causes freezing:
Definition
uknown pathophys; can occur during on or off phenoms and is unrelated to dose timing and unresponsive to dose changes.
Term
control measures for freezing:
Definition
guessing game; an atempt to find a relationship to meds and recommend an increase or decrease
Term
dyskinesias: etiology
Definition
PD meds; the therapeutic window for eliciting motor responses without causing a dyskineasia decreases w the progression of PD
Term
control methods for dyskinesia:5
Definition
1. switch from CR to Ir
2 reduce or eliminate selegine or COMTi
3. reduce LD/CD
4. add amantidine
5. consider surgery
Term
define diphasic dyskinesia:
Definition
dyskinesia occuring during dose absorption or when dose is wearing off
Term
control of diphsic dyskinesias:
Definition
prolonging the on state by:
1. increasing dose/frequency
2. add DA agonist
3. consider surgery
Term
define off-dystonia:
Definition
can be the presenting sign of PD; foot posturing upon awakening
Term
control of off-dystonia:
Definition
Dopaminergic agents
Term
etiology of neuropsychiatric problems in PD:
Definition
can be a manefestation of dz or Rx
Term
control measures for cognitive impairment in PD:
Definition
1. tx any underlying probs (inf, lytes)
2. remove any unecessary Rx
3. decrease/dc PD rx
Term
in the case of controling cognitive impairment in PD, in what order do you d/c PD meds:
Definition
1. anitcholinergics
2. amantidine
3. selegine
4. DA
Term
control of hallucinations/delirium in PD:
Definition
discontinue:
1. anticholinergics
2. amantidine
3. selegine
4. DA
in that order
Term
what is the Rx for psychosis in PD?
Definition
1. clozapine
2. quetiapine
Term
in PD pts >70 amantidine increases:
Definition
chances for cognitive impairment
Term
in PD pts <70 CD/Ld therapy is generally reserved for:
Definition
when there is marked impairment of ADLs
Term
CD/LD in PD pts >70 increases risks for:
Definition
hallucinations, confusion, psychosis
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