Term
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Definition
| Progressive neurogenerative disease causing tremor, bradykinesia, rigidity, dementia, psychosis, and autonomic dysfunction (excessive sweating, bladder frequency/urgenct, orthostasis) |
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Term
| What are the most common drug causes? |
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Definition
| SGAs, FGAs, central dopamine-blocking antiemetics (eg. metoclopramide) |
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Term
| What is Levodopa prescribed with? why? |
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Definition
| Levodopa is prescribed with Carbidopa because it inhibits the enzyme that breaks down levodopa - dopamine decarboxylase |
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Term
| Initial Management of Parkinsons |
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Definition
Figure 1, pg 284.
If no functional impairment - watch and wait
If functional impairment with only mild symptoms: Rasagliline, amantadine, selegiline, or an anticholinergic
If moderate/severe symptoms and under 70 - Dopamine Agonists: Bromocriptine, pramipexole, ropinirole
If moderate/Severe symptoms and over 70 - Levodopa/Carbidopa |
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Term
| What symptoms of Parkinsons are poorly responsive to levodopa therapy? |
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Definition
| dysarthria, gait disorders, postural instabilty, and cognitive dysfunction |
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Term
| Which dopamine agonist is associated with pulmonary fibrosis? For this reason, which are preferred ? |
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Definition
Bromocriptine is associated with pulmonary fibrosis
Prefer Pramipexole or ropinirole |
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Term
| Side effects of Dopamine Agonists |
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Definition
| GI upset, ortho HoTN, psychiatric reactions |
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Term
MAO-B Inhibitors - What are they?
Place in therapy? |
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Definition
Selegiline, Rasagiline
Use in patients with mild symptoms, or in patients with "wearing off" |
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Term
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Definition
Amantadine
Use in mild symptoms of PD
Use in treatment of levodopa induced dyskinesia |
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Term
| Amantadine Common adverse effects? |
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Definition
| Edema, erythemam livedo reticularis reversible condition characterized by bluish, mottled appearance of skin" |
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Term
| With what agents can daytime sleepiness occur? |
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Definition
| ALL dopamine replacement medications. Worse so with newer dopamine agonists (ropinirole and pramipexole) |
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Term
Anticholinergics in PD - what are they?
Use ?
SEs? |
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Definition
Anticholinergics in PD:
Benztropine, ethopropazine, Procyclidine, trihexyphenidyl
Use - Treats tremor, no effect on bradykinesia. Monotherapy in mild symptoms, or in combination with dopamine agonists in more severe cases.
SEs - Anticholinergic effects eg. dry mouth, urinary retention, constipation.
These limit their use especially in the elderly |
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Term
COMT inhibitor -
Mechanism?
Uses?
Side effects? |
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Definition
COMT inhibitor - Entacapone
Mechanism - inhibits COMT (metabolizes levodopa in the periphery)
Uses - Use in patients with wearing off
Side effects - Diarrhea or harmless discoloration of urine |
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Term
Managing levodopa associated motor complications
If primary problem is "wearing off", with mild or no dyskinesia what should be done? |
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Definition
Managing levodopa associated motor complications
If primary problem is "wearing off", with mild or no dyskinesia what should be done:
- Increase frequency of levodopa
- add entacapone
- add dopamamine agonist
- add rasagiline
- change to slow release levodopa |
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Term
Managing levodopa associated motor complications
If primary problem is "wearing off", with moderate dyskinesia what should be done? |
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Definition
Managing levodopa associated motor complications
If primary problem is "wearing off", with moderate dyskinesia what should be done:
- add amantadine
- increase frequency, but smaller doses of levodopa
- decrease levodopa and dopamine agonist |
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Term
Managing levodopa associated motor complications
If primary problem is dyskinesia, with no wearing off what should be done? |
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Definition
Managing levodopa associated motor complications
If primary problem is dyskinesia, with no wearing off what should be done:
- add amantadine
- decrease levodopa
- d/c anticholinergic
- d/c selegiline |
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Term
| Treating Depression in PD |
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Definition
SSRIs or TCAs
be weary with TCAs of anticholinergic effects especially in elderly, or taking other anticholinergics |
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Term
| PD medications often need to be withdrawn due to the patient's worsening cognitive status. In what order are they withdrawn? |
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Definition
1) Anticholinergics
2) Selegiline
3) Rasagiline
4) Amantadine
5) Dopamine agonists & COMT inhibitors
until only Levodopa remains |
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Term
What antipsychotic has shown clear benefit to PD patients in treating dementia/psychosis?
What makes this drug difficult to use?
For this reason, another drug is often prescribed to deal with psychosis/dementia, which is it? |
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Definition
Clozapine - requires regular monitoring for agranulocytosis
Quetiapene often used instead |
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Term
| What drugs can also be used to treat parkinson's dementia? |
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Definition
| Cholinesterase inhibitors - Donepezil & rivastigmine |
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