Parkinson's Disease

Front 1

Bromocriptine

Back 1

partial agonist at D2
used for hyperprolactinemia

Front 2

Pergolide

Back 2

D2 agonist

Front 3

Effect of bromocriptine and pergolide taken together on L-Dopa

Back 3

prolong effectiveness

Front 4

Pramipexole

Back 4

1st line drug
D2 agonist

Front 5

ADR of D2 stimulators

Back 5

GI side effects, postural hypotension, dyskinesia

Front 6

Sinemet

Back 6

dopa prep containing L-dopa and carbidopa

Front 7

Carbidopa

Back 7

inhibits peripheral DOPA-decarboxylase

Front 8

On-off phenomenon

Back 8

off-periods of marked akinesia alternate over the course of a few hours with on-periods of improved mobility

Front 9

Pyridoxine (B6)

Back 9

enhances metabolism of L-dopa therefore preventing therapeutic effects

Front 10

L-Dopa + psych patient =

Back 10

exacerbation of mental disturbance

Front 11

L-Dopa + angle closure glaucoma =

Back 11

C/I

Front 12

L-Dopa + open angle glaucoma=

Back 12

okay if well controlled

Front 13

L-Dopa + skin =

Back 13

L-dopa is a precursor of skin melanin therefore it may activate mal. melanoma

Front 14

GI effects of L-Dopa w/o carbidopa

Back 14

anorexia, and nausea and vomitting

Front 15

CVS effects of L-dopa

Back 15

arrhythmias: tachycardia, ventricular extrasystole, and rarely a.fib

Front 16

Motor side effect of L-Dopa

Back 16

dyskinesia (chorea, ballism)
choreoathetosis of face and distal extremities

Front 17

Behavioral effects of L-Dopa

Back 17

Changes in mood or personality:
depression, anxiety, hallucinations
(more w/ L-dopa +carbidopa)

Front 18

How do you increase dopamine levels?

Back 18

1. dopamine precursors
2. stimulate D2 receptors
3. inhibit enzymatic degradation of dopamine

Front 19

Pathophysiology of Parkinson's Disease

Back 19

decrease in striatal dopamine levels
an imbalance between dopamine and acetylcholine
degradation of D. neurons in nigrostriatal pathway
loss of dopamine leads to xs excitation of cholinergic neurons

Front 20

How do you decrease cholinergic levels?

Back 20

anticholinergic drugs

Front 21

Drugs that inhibit enzymatic degradation of dopamine

Back 21

COMT-I, MAO-I

Front 22

MAO-B

Back 22

metabolizes dopamine to NE and 5-HT

Front 23

Selegiline

Back 23

selective MAO-B
adjunct to L-Dopa

Front 24

ADR selegiline

Back 24

insomnia, mood changes, GI distress and hypotension

Front 25

MAO-I + meperidine=

Back 25

agitation, delirium, death

Front 26

Cheese rxn.

Back 26

MAO-B

Front 27

MAO-I+ (TCA or SSRI) =

Back 27

serotonin syndrome

Front 28

entacoapone
tolcapone

Back 28

COMT-I
used in adjunct to L-Dopa
increases "on-time" in on-off phenmenon

Front 29

COMT

Back 29

converts L-dopa to 3-0-MD

Front 30

Increased plasma levels of 3-0-MD-->

Back 30

poor response to L-Dopa

Front 31

ADR COMT-I

Back 31

GI, dyskinesias, postural hypotension

Front 32

ADR tolcapone

Back 32

hepatic damage

Front 33

Amantadine

Back 33

antiviral drug
enhances dopaminergic neurotransmission
M-block
MOA: increased synthesis, release and inhibition of dopamine reuptake

Front 34

Drug induced Parkinsonism

Back 34

Reserpine (atypical)
antipsychotics
Rx. anticholinergics

Front 35

Benztropine, biperiden, procyclidine & trihexyphenidyl

Back 35

anticholinergic drugs

Front 36

anticholinergic drugs used in Parkinson's

Back 36

improve tremor and rigidity
used in adjunct to L-dopa
Use:
- reverse EPS of antipsychotics
- treating drug induced parkinsonism

Front 37

ADR anticholinergics

Back 37

drowsiness, inattention, confusion, delusion, and hallucination

Front 38

Effectively relieves the symptoms of bradykinesia

Back 38

L-Dopa
NOT RELIEVED BY ANTICHOLINERGICS