My Attempt At Memorizing Doses...

Front 1

intial starting dose of carbidopa/levodopa

maintenance dose

Back 1

25/100 po TID;
titrate Q 2-3 days up to 6 doses/day

200-1200 mg/day levodopa (given at least TID)

Front 2

How much carbidopa is recommended with levodopa to prevent nausea?

Back 2

75-100 mg

Front 3

what are the AEs that are consistent with the agents used for PD?

Back 3

nausea, hallucinations; orthostatic hypotension

Front 4

drug interactions with carbidopa/levodopa?

Back 4

anti-HTN drugs (increase risk of hypotension)
non-specific MAOIs (increase risk of HTn crisis)
metoclopramide (can cause dyskinesias on its own)
iron salts (effects the absorption of C/L)

Front 5

food interactions with carbidopa/levodopa?

Back 5

can be given without regards to meals (give food if stomach upset)
*Avoid high protein diets
*pyroxidine reduces the effects of levodopa when it is given by itself (with carbidopa it is fine)

Front 6

what are the 2 MAOBIs used in the tx of PD?

Back 6

selegiline & rasagiline

Front 7

dosing for selegiline?

Back 7

5 mg with breakfast & lunch (can cause insomnia so take it earlier in the day)

MAOBI's have greatest patient compliance (note BID dosing)

Front 8

dosing for rasagiline?

Back 8

monotherapy: 1 mg daily
adjunctive therapy: 0.5 mg daily (can consider dose increase to 1 mg daily if tolerated)

MAOBI's have greatest patient compliance (note daily dosing)

Front 9

what is a significant SE for selegiline?

Back 9

insomnia

Front 10

in which MAOBI are dyskinesias more common?

Back 10

rasagiline

Front 11

food/drug interactions with MAOBIs?

Back 11

avoid or limit caffeine, tyramine

Front 12

what are the dopamine agonists?

Back 12

ropinirole; pramipexole; apomorphine

Front 13

dosing: ropinirole

Back 13

0.25 mg po TID (titrate @ weekly intervals)

ER (4X IR dose): 2 mg QD (titrate Q 1-2 weeks)

max= 24 mg/day

Front 14

pramipexole dosing

Back 14

initial dose: 0.125 mg TID (titrate up at weekly intervals)

ER (3X IR dose)= 0.375 mg QD (weekly intervals)

max=4.5 mg/day

Front 15

what are 2 unique SEs with dopamine agonists?

Back 15

sleep attacks & impulse control sxs

Front 16

what is the inidication of apomorphine?

Back 16

as a rescue agent to treat acute, intemittnet occurrences of hypomobility "OFF" (both unpredictable and wearing off)

Front 17

dosign apomorphine?

Back 17

test dose of 0.2 ml SQ (injection is 10mg/ml; so 2 mg SQ)

then 0.3-0.6 ml (3-6 mg) TID

Front 18

what are the three main SEs to watch out for with apomorphine?

Back 18

1. severe orthostatic hypotension
2. severe nausea (need antiemetic)
3. sleep attacks

Front 19

what antiemetic (and dose) is used with apomorphine to treat the sever nausea that accompanies it?

Back 19

trimethobenzamide (300 mg TID) *do not give zofran! (loss of consciousness)*

Front 20

what are the COMT inhibitors?

Back 20

entacapone
tolcapone
*Stalevo (carbidopa/levodopa/entacapone)

Front 21

dosing entacapone

Back 21

200 mg with each C/L dose (max 1600 mg/day)

Front 22

tolcapone dosing

Back 22

100 mg TID as adjunct to C/L

take 1st dose with C/L, then take next dose @ 6 H, 12 H

Front 23

name the drug class.

withdrawal may lead to worsening of PD sxs; tapering may not help.

Back 23

COMT inhibitors (capones)

Front 24

which do you recommend? entacapone or tolcapone?

Back 24

entacapone

tolcapone= black box warning for acute fulminant liver failure; also, dosing regimen is more screwed up than entacapone & tolcapone is more likely to cause sleep disorders (excessive dreaming, hallucinations)

Front 25

what is the place in therapy for amantadine? dose?

Back 25

smooths out the fluctuations in movement

100 mg daily (can titrate to BID, with max dose being 400 mg)

Front 26

MOA of amantadine?

Back 26

blocks the reuptake of dopamine into presynaptic neurons or increases dopamine release from presynaptic neuron

Front 27

place in therpy: benztropine

Back 27

anticholinergic (reduces tremor associated with PD)

Front 28

dose benztropine

Back 28

0.5-1 mg QHS

(usual dose 1-2 mg QHS)

If D/C: taper slowly

Front 29

place in therapy trihexyphenidyl

Back 29

reduce tremor associated with PD

1 mg po daily

titrate weekly to a range b/t 5-15 mg /day (give 3 evenly divided doses with meals)

ADRs: anticholinergics

Front 30

what are the 2 anticholinergics used in the tx of PD?

Back 30

benztropine & trihexyphenidyl

Front 31

who is at higher risk of developing motor fluctuations with dopamine?

Back 31

pts with younger onset of PD sxs

Front 32

what are some strategies for treating motor fluctuations assoc with levodopa

Back 32

use more freq, smaller doses or levodopa

use long-acting levodopa formulations

addition of:
dopamine agonist
MAOBI
amantadine for dyskinesias
deep brain stimulation

Front 33

what is the preferred tx for tremor assoc with PD? what is the problem with these agents?

Back 33

amantadine & anticholinergics (benztropine & trihexyphenidyl)

Front 34

what agent has the highest level of evidence for treating PD-associated depression

name 3 other classes that could be used?

Back 34

clozapine (must be on clozapine national registry due to black box warning for agranulocytosis--WBC MUST be monitored Q week)

TCAs: amitriptyline & nortriptyline (may not be the best choice)
SSRIs (monitor carefully for serotonin syndrome)
atypical antipsychotics- quetiapine

Front 35

what agent can be used for PD-associated dementia?

Back 35

rivastigmine (in PD or DLB)
donepezil (PD)

Front 36

what is the treatment for swallowing difficulties associated with PD?

Back 36

speech-language therapy or occupational therapy

Front 37

recommendations for PD-assoc constipation?

Back 37

increase fiber & fluid intake
polyethylene glycol

Front 38

what is treatment for PD-assoc dry mouth?

Back 38

chewing gum/hard candy
fluids
regular dental visits
good oral hygeine

Front 39

what is more imp in a PD pt? flexibility or strength?

Back 39

flexibility

Front 40

how should weight loss be handled in PD pts?

Back 40

[protein shakes (avoid with levodopa)
appetite stimulants (avoid with selegiline)