5322 Pharm Test 2 Ch 46- Antiparkinson Agents

Front 1

most common neurodegenerative disease after AD; prevelence/ incidence increased with age and incidence is higher in men; PD in curable; treatment is complex and high individualized

Back 1

parkinson's disease (PD)

Front 2

Treatment goals of PD revolve around ______ _____ and help the patient maintain independence and mobility

Back 2

symptom relief

Front 3

idiopathic parkinson's disease, symptom management such as tremor at rest, bradykinesia, rigidity, postural instability, mild to moderate Parkinson's disease dementia (PDD)

Back 3

indications for antiparkinson agents

Front 4

Antiparkinson agents can be used as _______ _______ treatment of restless leg syndrome (dopamine agonists) and traumatic brain injury (Amantadine)

Back 4

off label

Front 5

first line treatment- levodopa, dopamine agonists, rasagiline, carbidopa/levodopa, MAO inhibitors (see text for more information)

Back 5

antiparkinson drugs

Front 6

all drug therapy centered around increasing the availability of dopamine in the CNS, inhibiting the effects of acetylcholine, attmepting to prevent further cell membrane damage through neuroprotective trials

Back 6

mechanism of action

Front 7

Parkinson's patients should not take antipsychotics increases risk of death in older dementia patients- examples Abilify, Seroquel

Back 7

"black box warnings"

Front 8

must stop MAOI 2 weeks before starting levodopa, contraindicated in narrow angle glaucoma, history of myocardial infarction with cardiac arrhthmias, melanoma, history of peptic ulcer disease, psychosis, renal dysfunction (see text)

Back 8

levodopa warnings

Front 9

levodopa competes with amino acids for absorption across GI membranes, patients should start Levodopa drugs with food intially and then move to 30 minutes prior to meal
patients should minimize protein intake (at AM and noon meals) if experiencing suboptimal results or fluctuations in drug effects

Back 9

education

Front 10

nausea, hypotension, psychiatric problems, patient may experience on-off phenomenon, neuroleptic malignant syndrome can develop if abruptly stopping this medicine (see table 46-2)

Back 10

levadopa adverse effects

Front 11

-antacids increase levodopa bioavailability
-anticholinergics, benzodiazepines, hydantoins, methionine, papverine, pyridoxine, TCAs decrease levodopa effectiveness

Back 11

DDI

Front 12

______ ______ An herbal DDI, can decrease effectivenss of levodopa

Back 12

Kava kava

Front 13

55% bioavailability, CYP1A2 responsible for metabilizing this line of drugs (see text for other drugs class/reactions)

Back 13

Dopamine Agonists-Requip

Front 14

Replacement and regulation of the ____________ with exogenous meds is the hallmark of PD management.

Back 14

neurotransmitters

Front 15

_______ is the single most important drug in the antiparkinson armamentarium.

Back 15

levadopa

Front 16

Combining _______ with levodopa, results in increased concentrations of levodopa in the CNS and decreased conversion of L-dopa to dopamine in the periphery, where it causes adverse effects.

Back 16

carbidopa

Front 17

In order to achieve the desired results and avoid side effects, antiparkison drugs must be able to cross the______ _______ _____ without being metabolized in the periphery.

Back 17

blood brain barrier

Front 18

Interfere with production or reuptake of acetylcholine, reduce tremor, rigidity, and drooling.

Back 18

anticholinergics

Front 19

Are less likely than levodopa to cause dyskinesias or motor fluctuations. May be given with or before levodopa.

Back 19

dopamine agonists

Front 20

Antiarkinson drugs carry a pregnancy drug risk category of _____ and safety in children under ____ years of age has not been established.

Back 20

C, 12

Front 21

Dopamine agonists are metabolized by the isoenzyme _______-

Back 21

CYP1A2

Front 22

-bromocriptine
-apomorphine
-pramipexole
-ropinirole

Back 22

dopamine agonist drugs

Front 23

-Mimic the role of dopamine in the brain. These drugs work at postsynaptic dopamine receptors in the nigrostriatal system by stimulating dopamine receptors.

Back 23

dopamine agonist MOA

Front 24

Dopamine agonists are used in _____ parkinsons to avoid _____ doses of levadopa.

Back 24

early, high

Front 25

Dopamine agonists are used in _____ parkinsons to avoid levodopa ______ ______.

Back 25

late, dose-response fluctuations

Front 26

Mechanism is not fully understood, causes inhibition of enzyme MAO-B which breaks down dopamine in the brain. These dugs cause dopamine to accumulate in surviving nerve cells and reduce the symptoms of PD.

Back 26

MAO-B MOA

Front 27

Two COMT inhibitors that have been approved to treat PD in the US.

Back 27

entacapone, tolcapone

Front 28

_________ stands for catechol-O-methyltransferase.

Back 28

COMT

Front 29

Central or peripheral blockers of dopamine metablism. Prolong the effects of levodopa by preventing the breakdown of dopamine.

Back 29

COMT inhibitors MOA

Front 30

_______ _____ are used as adjuvants with levodopa to extend the therapeutic effect in patients who experience breakthrough tremors prior to their next dose.

Back 30

COMT inhibitors