Term
| Variations of Movement Disorders |
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Definition
Parkinson's (Idiopathic, Drugs)
Tremors
Huntington's
Tics
Restless Leg Syndrome (RLS) |
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Term
Pathophys of IPD, Reverse correlation
When are motor features detectable? |
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Definition
Degeneration of Dopaminergic neurons in the nigrostriatal pathway in combination with aging, environmental exposure, and genetics (especially if <50yo)... Imbalance in dopaminergic and cholinergic pathways
*Reversed correlation w/ smoking cigarettes and caffeine
**Motor features detectable at 70-80% loss |
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Term
IPD Clinical Presentation &
Diagnostic Testing |
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Definition
At least TWO of the following:
Limb Muscle Rigidity
Resting Tremor (gone w/ movement)
Bradykinesia
**Rule out drug-induced (antipsychotics, metoclopramide, prochlorperazine)
***NO DX TESTING |
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Term
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Definition
Tremor of UE at Rest (MC-hands)
Rigidity in UE, LE - increased to passive range of motion *cogwheel
-->may involve face (hypomimia - masking of facial expressions)
Bradykinesia - festinating gait, difficulty initiating
Postural Instability - advanced IPD |
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Term
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Definition
Preserve ADLs, Improve mobility, Maintain best QOL, Improve nonmotor features
*Increase dopamine, Decrease Ach |
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Term
Trihexyphenidyl, Benztropin
Indication
ADEs |
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Definition
Anticholinergics - most effective for tremor early in disease (rarely effective for dyskinesia)
ADEs: Blurry vision, confusion, dry mouth, constipation, urinary retention |
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Term
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Definition
Unknown MOA
Short-lived for tremor, rigid, bradykin.
Suppresses dyskinesia from levodopa
**Adjust w/ low CrCl (100mg 30-50, 100mg QOD 15-29, 200 Qwk <15)
ADRS - confusion, dizzy, hallucinations, LIVEDO RETICULARIS *reversible; diffuse skin mottling and often LE edema |
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Term
| ___ can cross the BBB, but might get metabolized before it gets to the brain. To combat this, we use ____ to prevent the metabolism. |
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Definition
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Term
Carbadopa/Levodopa
MOA
PK - avoid taking with?
Contraindications |
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Definition
MOA: direct L-dopa supp plus inhibition of conversation of L-dopa to DA by LAAD
*Don't take w/ protein meals, antacids
Contra: Narrow angle glaucoma, MAOIs |
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Term
| Carbidopa/Levodopa DDIs, ADRs |
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Definition
DDI - Dopa Antag (antiemetics, antipsychs), MAOIs (hypertensive crisis), Bupropion (^side effects), PIs (toxicitiy), PHT, iron - reduce L-dopa efficacy
ADRs: GI, post hypotens, vivid dreams, long term motor complications |
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Term
| End of Dose wearing off Options |
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Definition
Increase L Dopa frequency
Change to Long Actor
Add Short Actor to Long Actor
Add DA agonist, MAOB-i, or COMT-i |
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Term
| In rapid transition from dyskinetic "on" to bradykinetic "off" states, what are your options? |
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Definition
| Add MAOB-i, COMT-i, Dopa Agonist |
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Term
Dyskinesias often happen where?
Options to fix? |
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Definition
Happens in neck, trunk, UE, LE
Options: smaller but more frequent doses
CR formulation
ADD AMANTIDINE
If severe, go to surgery |
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Term
Selegiline, Rasagiline
MOA, Uses, ADRs |
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Definition
MAO-B inhibitors *block metabolism by MAO-B
Use: Extend l-dopa duraction of action
*Rasagiline is 1st line for managing motor fluctuations
Rasag ADR: orthost hypotension, dyskinesia, GI hemorrhage, N/V/C
Seleg ADR: N/dizzy, HA, hallucinations, a-fib |
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Term
| Selegiline, Rasagiline Contras |
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Definition
Sele: Meperidine, opioids w/patch
Rasag: Cyclobenzaprine, St. John's, opioids |
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Term
| _____ may slow the rate of disease progression in early IPD. |
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Definition
Rasagiline.
**First line** |
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Term
Entacapone, Tolcapone
MOA
Increase or decrease l-dopa? |
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Definition
COMT inhibitors
*Extend effects of l-dopa by inhibiting COMT induced metabolism
*Entacapone - peripheral
*Tolcapone - peripheral, central(minimal) **Contra w/hepatic impairment
-->May need to reduce L-dopa dose |
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Term
| Entacapone, Tolcapone ADRs, DDIs |
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Definition
Tolca - fatal hepatotoxic
-Orange-brown urine, delayed diarrhea
DI = nonselective MAOIs |
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Term
| Entacapone, Tolcapone Uses, Place in Therapy |
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Definition
Use: Wearing off, reduce "off" time
Place:
Entac - first line managing motor fluctuations
Tolca - pts not responding to other therapies |
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Term
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Definition
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Term
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Definition
| Non-ergot Dopa Agonistss (D2) |
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Term
Apomorphine - special considerations
Rotigotine |
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Definition
Apo = Parenteral Non-Ergot Dopa Agonist - pre-med w/ trimethobenz 3 days prior; rapid temporary relief of off-period
Rotig = Transdermal early IPD; approved for use in early IPD; ADRs include N/V, HA, sleep attacks |
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Term
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Definition
| post. hypo, LE edema, nausea, hallucinations, sedation, psychosis, pleuropulm fibrosis, sleep attacks, light headed |
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Term
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Definition
| Azole antifungals, PIs, erythro all INCREASE bromo concentrations |
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Term
| _____ can be used as monotherapy out of all dopamine agonists. |
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Definition
| Non-ergots (pramipexole, ropinirole, apomorphine) |
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Term
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Definition
Essential: hands, arms; beta-ad defect
Tx-propranolol
Intention: present during movement
Tx-decrease offending agent
Rest tremor: Parkinsonism |
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Term
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Definition
AutoDom inherited resulting in chorea and dementia; overactive dopaminergic paths
*Tx - Reserpine, Tetrabenzine, Haldol, |
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Term
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Definition
Gilles de la Tourette's; usually sx treatment.
Tx- Haldol, Clonidine in kids |
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Term
| Restless Leg Syndrome, Tx |
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Definition
Creeping discomfort arising deep in legs; common in pregnancy, diabetic neurop.
Tx: Dopa Agonists |
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Term
| First Line in IPD (nonpharm) |
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Definition
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Term
Additional Sx Control: Tremors
>65yo
<65yo |
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Definition
>65: amantidine
<65: Antichol, amantidine |
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Term
Additional Sx Control: Brady, rigidity, tremor
>65
<65 |
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Definition
>65: amantidine, DA agon or Carbi/L-dopa
<65: amantidine, DA ag or carbi/l-dopa |
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Term
| Switching from IR Carba/Levo to CR |
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Definition
| Reduce frequency and increase dose 10-30% |
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Term
| Carb/Levo: Drug-resistant off periods: How it happens and what are your options |
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Definition
Due to delayed gastric emptying or decreased GI absorption
Options:
Give on empty stomach
Crush tablet or take ODT formulation
Avoid CR formulation |
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