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Flashcards in Parkinson's Generic/Brand Deck (21)
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1
Q

Parkinson’s Disease

- Cause

A
  • Due to depletion of dopamine => tx is to restore dopamine/Ach balance
2
Q

Eldepryl

  • MOA
  • Indication
  • dose
  • SEs
  • C/I
A

Selegiline

  • MOA: MAOI-B => inhibit the reuptake of DA.
    Reduces “on-off” of levodopa
  • Indication: adjunct to levo/carbidopa
  • Dose: 5mg QAM n QNOON. Max 10mg qd.
    Do not exceed max rec dose.
  • SEs: N/V, vivid dreams, hallucination, confusion, insomnia, orthostatic hypoTN
  • C/I: meperidine
3
Q

Azilect

  • MOA
  • Indication
  • Dose
  • Do not use with
  • Precaution
  • SEs
A

Rasagiline

  • MOA: MOAI-B => inhibit the reuptake of DA. Reduces “on-off” of levodopa
  • Indication: monothrapy or adjunct w/ levodopa
  • Dose: 0.5-1 mg QD

Do not use with:

  • Liver disease
  • Adrenal gland tumor (pheochromocytoma)
  • 14 days b/4 surgery
  • Meperidine
  • Tramadol
  • Propoxyphene
  • Methadone
  • Dextromethorphan, pseudoephedrine, or phenylephrine
  • St. John Wort
  • Mirtazapine
  • Cyclobenzapine
  • Amphetamines
  • MAOI
  • TCAs, SSRIs, SNRIs, MOAIs

Precaution

  • Avoid tyramine rich foods
  • Mild hepatic impairment

SEs

  • Postural hypoTN
  • Flu sx
  • Depression
  • GI upset
4
Q

Symmetrel

  • MOA
  • Indication
  • SEs
A

Amantadine

  • MOA: Dopamine re-uptake inhibitor and anticholinergic
  • Dose: 100 QD to 100 BID

SEs

  • Insomnia
  • Depression
  • Irritablity
  • Anticholinergic effects
  • Hallucinations
  • vasoconstriction
5
Q

Artane

  • MOA
  • Indication
  • Dose
A

Trihexyphenidyl

  • MOA: Anticholinergics
  • Indication: adjust tx for all forms of parkinsonism.
    DOC for pseudoPK
  • Dose: 1mg QD. Max 15mg/day
6
Q

COGentin

  • MOA
  • Dose
A

BENZtropine Mesylate

  • MOA: Anticholinergics
  • Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK
7
Q

Akineton

  • MOA
  • Indication
A

Biperiden

  • MOA: Anticholinergics
  • Indication: adjust tx for all forms of parkinsonism. DOC for pseudoPK
8
Q

Larodopa

  • MOA
A

Levodopa

  • MOA: Dopamine Precursors.
9
Q

Sinemet

  • MOA
  • Need how much carbidopa/day
  • Dose
  • SEs
  • C/I
  • DDI
A

Carbidopa/Levodopa

  • MOA: Carbidopa inhibits peripheral dopa decarboxylation to levodopa to dopamines (which doesn’t cross BBB) => increase levodopa level gets into brain.
  • Need 75mg of carbidopa to block enzyme
  • Dose: start 1 tab 25/100 (carbi/levo) PO TID, increase to max 8 tabs (200 crab/800 levo)
- SEs: 
  Psychosis
  Akinesia: DA
  Dyskinesia: DA
  HypoTN
  Aphrodisias: hypersexuality 
  • Caution
    Cardiac abnormalities
    Dietary proteins: take at different time than Sinemet)
  • C/I:
    Lactation: incre DA = decrease prolactin
    Narrow angle glaucoma

DDI

  • anticholinergic: decrease gastric emptying
  • Antipsychotics: decrease DA
  • Reglan: blocks DA
  • Phenothiazine: block DA
  • Pyridoxine (Vit B6): increase SEs
  • Food: reduce abs
  • Tacrine: inc LFTs
  • Iron: chelates to levodopa
  • MAOI: HTN crisis
  • St. John Wort
10
Q

COMpazine

A

PROchlorperazine

11
Q

Parlodel

  • MOA
  • Indication
  • Dose
  • Dose adjust:
  • SEs
  • Cautions for all dopamine agonist
  • Other agents
A

Bromociptine

  • MOA: dopamine agonist stimulate DA receptor and alpha blocking activity
  • Indication: PK mono therapy or adjunct , hyperprolactinemia
  • Dose: 1.25mg BID up to 100mg/d
  • Dose adj: ok to use in renal failure
  • SEs: H/V, HA, hallucination, hypoTN

Cautions:

  • Dose depending on peripheral edema
  • Increase change of HF
  • Falling asleep during activity
  • Compulsive behaviors

Other agents:

  • Pramipexole (mirapex)
  • Rotigotine (Neupro): patch
  • Ropinirole (Requip)
  • Apomorphine (Apokyn) => SC injection
12
Q

MiraPEX

  • MOA
A

PramiPEXole

  • Dopamine agonists
13
Q

Neupro

  • MOA
  • Indication
  • Form
  • Frequency
A

ROTigotine

  • MOA: Dopamine agonists
  • Indication: PK, restless legs syndrome
  • Dose: patch Q24H
    PK: 2mg/24H to 8mg/24H
    RLS: 1mg/24H to 3mg/24H
14
Q

Requip

  • MOA
  • Dose
  • Avd
A

ROPinirole

  • MOA: Dopamine agonists
  • Dose: 0.25mg TID. Max 24mg/d
  • Adv: good for pts with hypoTN or falls
15
Q

Apokyn

  • MOA
  • Indication
  • Dose
    Instruction
  • SEs
A

APOmorphine => SC injection

  • MOA: Dopamine agonists
  • Indication: treat “wearing-off” episodes in ppl w/ adv PK
  • Dose: Start 0.2mL. Max 0.6mL
    1st dose supervise: monitor BP
  • Due to severe N/V, initiate antiemetic Tigan (trimethobenamide) 3 days b/4 initiating APOKYN. Then continue Tigan for at least 2mo on therapy.
    ** Use with 5HT2 (ondansetron, etc) are C/I
  • SEs: QT prolongation, falling asleep during activity
16
Q

Comtan

  • MOA
  • Indication
  • Dose
  • SEs
A

Entacapone

  • MOA: COMT Inhibitor => must be on Sinemet. COMT allows more levodopa to cross the BBB which incr DA
  • Indication: adjunct to Sinemet in pots with wearing off effect.
  • Dose: Start 200 mg with each Sinemet. Max 8x (1600mg)
  • SEs:
    Hepatotoxicity, anticholinergic, GI, hallucination
    Urine discoloration: brownish orange
17
Q

Tasmar

  • MOA
  • Indication
  • Dose
  • Avoid
  • SEs
A

TOLcapone

  • MOA: COMT Inhibitor => same as above
  • Indication: adjunct to Sinemet in pots with wearing off effect and can’t use other alternative therapy
  • Dose: 100-200 TID. Max 200 TID
  • Avoid: EtOH and hepatitis => fatal hepatic failure
  • SEs: same as above
18
Q

Stalevo

  • Disadvantage
A

Carbidopa + Levodeopa + Entacapone

=> Dopa-Decarboxylase inhibitor + Dopamine Precursor + COMT inhibitor

=> May increase risk of prostate cancer

19
Q

Zelapar

A

Selegiline

  • Form: ODT
20
Q

Emsam

  • Indication
A

Selegiline

  • Indication: Major depression disorder
21
Q

Tigan

  • Indication
A

Trimethobenzamide

  • I: tx N/V of Apomorphine