Term
| Essential tremor treatments |
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Definition
| Propranolol: Crosses BBB; Primidone: anticonvulsant |
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Term
| ranks among the most common late life neurodegenerative disease; affects slightly more men than women |
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Definition
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Term
| Parkinson's Cardinal Signs |
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Definition
| Tremor; Rigidity; Akinesia; Postural Instability |
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Term
| Secondary Parkinsons Symptoms |
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Definition
| Short-stepped; reduced facial expressions; muffled speech (dysarthria); reduced arm swing; reduced eye blinking and frequency of swallowing; depression/anxiety; sleep disorders; constipation; orthostatic intolerance; micrographia |
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Term
| Disruption of this production affects neurotransmission |
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Definition
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Term
| decrease in number in parkinsons |
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Definition
| cells in substantia nigra which produce dopamine |
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Term
| most patients are diagnosed with this type of Parkinson's Disease |
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Definition
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Term
| Late stage complications include |
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Definition
| choking, pneumonia, falls |
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Term
| Parkinson's co-morbidities |
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Definition
| hallucinations, depression/anxiety, Parkinson's disease with dementia, insomnia, orthostatic hypotension, constipation, excessive salivation, dermatitis, excessive perspiration, urinary incontinence |
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Term
| Dementia in Parkinson's Disease |
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Definition
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Term
| Most symptoms result from lack of dopamine |
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Definition
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Term
| majority of anti-Parkinson's medications |
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Definition
| temporarily replenish, mimic, or enhance dopamine |
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Term
| Drugs that alter dopamine = dopaminergic drugs |
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Definition
| muscle rigidity, improve speed and coordination of movement, lessen tremor |
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Term
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Definition
| Ropinirole (Requip), Pramipexole (Mirapex) |
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Term
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Definition
| Entacapone (Comtan), Tolcapone (Tasmar) |
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Term
|
Definition
| Selegiline (Zelapar), Rasagiline (Azilect) |
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Term
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Definition
| Trihexyphenidyl (Artane), Benztropine (Cogentin) |
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Term
| txt: no/minimal motor impairment |
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Definition
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Term
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Definition
| MAO-B inhibitor (Selegilin, Rasagiline) |
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Term
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Definition
| Dopamine agonist, levodopa/carbidopa |
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Term
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Definition
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Term
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Definition
| L-dopa interval; COMT inhibitor, dopamine agonist, MAO-B inhibitor, apomorphine, surgery |
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Term
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Definition
| Amantadine: L-dopa reduction, surgery |
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Term
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Definition
| multidisciplinary; symptomatic |
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Term
| Possible dopamine related side effects |
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Definition
| nausea/vomiting, somnolence/fatigue, dizziness/postural hypotension, headache, dyskinesias, constipation, impulse control disorders, confusion, vivid dreams, hallucinations |
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Term
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Definition
| crosses BBB, converted to dopamine, binds dopamine receptors; effect: decreased motor symptoms; action terminated by breakdown or recycling of dopamine |
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Term
| carbidopa/levodopa (Sinemet) Symptoms that respond: |
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Definition
| tremor, rigidity, slowed movements, gait disturbances, micrographia |
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Term
| Nausea Medications: Dopamine blockers are a problem |
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Definition
| metoclopramide, prochlorperazine, several others |
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Term
| Nausea Medications: non-dopamine blockers acceptable |
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Definition
| ondansetron/other 5HT3 antagonists, anticholinergics |
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Term
| prevents conversion of levodopa to dopamine in periphery |
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Definition
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Term
| needs 70-100 mg of carbidopa/day |
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Definition
| to prevent nausea from dopamine |
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Term
| Carbidopa/Levodopa (Sinemet) |
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Definition
| initially 25/100 mg TID; CR formulations may be dose BID, taking with food may decrease N/V |
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Term
| Sinemet: taking with protein |
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Definition
| may decrease effectiveness and worsen "On" and "off" fluctuations |
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Term
| Sinemet: taking with high fat meals |
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Definition
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Term
|
Definition
| most often caused by carbidopa/levodopa; excess DA may lead to involuntary movements; not common with newly diagnosed patients |
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Term
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Definition
| longer duration of treatment, higher dosages, "peak dose", individual patient sensitivity |
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Term
| Since disease progression is an issue |
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Definition
| people who have PD longer will have greater likelihood of dyskinesias |
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Term
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Definition
| fluctuating response to the drug; excessive levodopa storage; increase dosing frequency (e.g. 8 x per day) |
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Term
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Definition
| onset of PD symptoms before next dose; increase dosing frequency |
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Term
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Definition
| protein or high fat diets later in disease state may alter drug absorption |
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Term
| Dopamine Agonists: Ergot derived |
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Definition
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Term
| Dopamine Agonists: non-ergot derived |
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Definition
| Ropinirole (Requip, Requip XL), PRamipexole (Mirapex), Rotigotine (Neupro) Patch, Apomorphine (Apokyn) |
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Term
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Definition
| binding to dopamine receptors will not give all the same benefits and side effects as dopamine itself; generally very effective medications; less effective than carbidopa/levodopa but less risk of dyskinesia |
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Term
| Dopamine agonists: Ropinirole and Pramipexole |
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Definition
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Term
| Rotigotine patch became available again in 2012 |
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Definition
| steady drug level potentially beneficial, side effects still similar to other dopamine agonists |
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Term
| activate dopamine receptors; slow titration; side effects: N/V, diarrhea, hallucinations are more common in older people; lower incidence of dyskinesias |
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Definition
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Term
| Injectable dopamine agonist: used as needed for off episodes in advanced PD |
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Definition
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Term
| Apopmorphine (Apokyn) AEs |
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Definition
| hypotension (1st dose administered at physicians office); nausea/vomiting (gien with trimethobenzamide 300 mg TID daily 3 days prior to 1st dose; do not use ondansetron (Additive hypotension) |
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Term
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Definition
| may occur with all dopaminergic medications, educate about lack of warning with onset |
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Term
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Definition
| Catechol-O-Methyltranserase inhibitors |
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Term
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Definition
| converts levodopa to 3-O methyldopa; 3-o methyldopa competes with levodopa to cross BBB |
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Term
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Definition
| converts dopamine to 3 methoxytyramine |
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Term
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Definition
| Tolcapone (Tasmar); Entacapone (Comtan); Carbidopa/levodopa/entacapone (Stalevo) |
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Term
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Definition
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Term
| Entacapone (Comtan) 200 mg/dose (amx 8 doses) |
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Definition
| must take levodopa, reduces "off time", useful for "wearing off"; SE: stain bodily fluids orange, diarrhea |
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Term
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Definition
| Selegiline (Zelapar ODT, Eldepryl); Rasagiline (Azilect) |
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Term
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Definition
| Dopamine is converted to 3,4 dihydroxy-phenylacetic acid |
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Term
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Definition
| loses selectivity at doses 4-8 x therapeutic dose; dosed at breakfast and lunch |
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Term
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Definition
| Loss of selectivity occurs at 2-4 mg/day |
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Term
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Definition
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Term
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Definition
| Antiviral: tremor, rigidity, bradykinesia (slowed movements), levodopa induced dyskinesias |
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Term
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Definition
| Livedo reticularis (remodeling of skin, purple spots); edema; dry mouth |
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Term
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Definition
| second line therapy used since 1940s; Tremor (Trihexyphenidyl, benztropine, diphenhydramine, procyclidine, biperiden HCl) |
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Term
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Definition
| blurred vision, dry mouth, urinary retention, constipation, confusion, sedation, hallucinations |
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Term
| alpha 1 agonist (help raise blood pressure) |
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Definition
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Term
| mineralcorticoid (help raise blood pressure) |
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Definition
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Term
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Definition
| may have substantial benefit for some patients: essential tremor or dystonia, Parkinson's disease |
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Term
| Deep brain stimulation: who to refer w/ parkinsons |
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Definition
| L-dopa responsive, no atypical parkinsons disease, no dementia, access to follow up care, ambulatory, younger is better, generally healthy |
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Term
| Carbidopa/levodopa ER capsule Rytary |
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Definition
| pending FDA approval; differ from sinemet ER- longer duration of action |
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