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22 Cards in this Set

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  • Back
What does TRAP stand for?
T: tremor
R: rigidity
A: Akinesia
P: Postural instability
What are 4 drug therapy approaches for treating Parkinson's?
1. Increase dopamine concentration via synthesis (precursors)
2. Replace dopamine
3. Decreasing the breakdown of dopamine via inhibiting the metabolism of Ddopamine.
4. Adjunctive anticholinergic drugs, additional drugs (agonists?)
What is the underlying biochemical model used with drug treatment?
A decrease in dopaminergic activity accompanied by an increase in cholinergic activity.
What is the goal of drug therapy when treating Parkinson's?
Increase QOL.
Name four drugs used to treat Parkinson's.
1. Levodopa
2. Bromocriptine
3. MOA
4. Anticholinergic drugs
What is Levodopa?
Metabolic precursor of DA. Levodopa gets converted into DA via enzyme. Restores DA levels in substantia nigra.
What is Levodopa's MOA?
Levodopa is readily transported into the CNS and is converted to DA. DA itself does not cross the blood-brain barrier.
What are pharmacological actions of Levodopa?
-How is it active?
-How should it be taken?
-1/2 life?
Decreases rigidity, tremors and other Sx.
-Active orally
-Taken on an empty stomach, about 45 minutes after a meal.
-Short 1/2 life (1-2 hours). Sustained release, but may produce on-off phenomenon.
What are some SE of Levodopa?
Main SE are:
1. Peripheral effects-anorexia, nausea, and vomiting due to stimulation of emetic center.
2. CNS effects: depression, anxiety, confusion, hallucinations if given too much DA.
Other SE:
Tachycardia, cardiac arrhythmias, hypertension
-Abnormal involuntary movements
-Tolerance w/ prolonged therapy
What drug is Levodopa commonly combined with?
Carbidopa. The two together are a very effective drug for Parkinson's.
What is the MOA of Carbidopa?
Inhibits the metabolism of Levodopa in GI tract and peripheral tissues leading to an increased availability of Levodopa in the brain.
What is the most difficult SE associated with Levodopa and Carbidopa?
Difficulty tolerating the GI SE, especially the nausea.
Bromocriptine is a DA......
DA receptor AGONIST
How is Bromocriptine different than Levodopa?
SE are similar except hallucinations, confusion, delirium, nausea and orthostatic hypotension are much more common. Dyskinesia is less common.
What is the major MOI drug for Parkinsons?
selegiline, ELDEPRYL
How does MOI work?
Inhibits enzyme that metabolizes dopamine, therby increasing the levels of DA in the brain. Enhances the effect of Levodopa, resulting in lower doses of Levodopa being used.
What has current research shown in regards to Selegiline and Parkinsons?
It has been shown to slow the progression of Parkinson's in RATS. Prolongs their life.
Anticholinergic drugs are considered....
Adjunctive therapy for Parkinson's.
Name a common drug that is an anti-cholinergic but is also used for Parkinson's.
Benadryl
How do anticholinergic drugs work?
Block muscarinic acetylcholine receptors. Alleviate Sx of Parkinson's, esp. tremor and rigidity. Controls SE of antipsychotics.
How does PT impact Parkinson's?
-Exercise may improve body strength, so pt is less disabled.
-Exercise improves mobility, ROM, balance while decreasing gait problems.
-Strengthen muscles for swallowing/speech
-Improve emotional well-being
-Improve QOL and function of pt.
Things for PT's to remember when working with Parkinson's pts.
-Impact of disease
-Drug therapy SE, esp CNS, that can affect exercise capacity
-Lack of motor control and rigidity can hinder physical performance.