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14 Cards in this Set
- Front
- Back
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Parkinson's Disease general info
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-rigidity, tremor at rest, bradykinesia, akinesia
-Primary and secondary (drugs, infection, trauma) -Depression, dementia (?) -micrographia |
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Pathophysiology and diagnosis of Parkinson's disease
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-Degeneration of substantia nigra with a decrease in dopaminergic cells
-Diagnosis: based on rest tremor/rigidity/bradykinesia |
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Drug treatment for Parkinson's disease
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-Levo/carbo up to 1500mg/day
-DA agonists:bromocriptine, pergolide,ropinirole,pramipexole -COMT-I:entacapone, tocapone -anti-Ch:benztropine,triheyphenidyl -MAOI: selegiline -Amantadine:incr release of DA |
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On off phenomenon in Parkinsons Disease
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-Periods of immobility and fair mobility within seconds while on levo
-give levo in smaller more frequent doses, or extended release form of levo |
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Wearing off phenomenon of levodopa
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-Levo wears off less than 4 hours
-give levo more frequently or use XR or combo tx |
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Patient counseling/Adverse effects of parkinson's meds
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-Take right before food
-N/V with most (not the anticholinergics) -Dizziness/drowsiness -tolcapone: liver toxicity |
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DDI with anti-parkinson meds
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-DA antagonists:antipsychotics
and metoclopramide -Selegiline: SSRIs --> serotonin sydrome -COMT-I:non-selective MAOI (phenelzine -->serotonin syndr |
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Types of dementia
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-Alzheimer's
-Vascular -Both at the same time |
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Pathophysiology of Alzheimer's Disease
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-amyloid protein plaques on neurons
-neurofibrillary tangles in neurons -Reduced ACH concentrations |
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Drug treatment for Alzheimer's Disease
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-Behavioral problems: anxiolytics, antidepressants, antipsychotics, hypnotics
-To slow progression: donepezil,rivastigmine, galantamine,tacrine(not used due to hepatotoxicity) |
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Donepezil
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-Aricept, selective for acetylcholine esterase
-Once daily 10 mg, start at 5 for 4-6 weeks. -with or w/o food -GI SE |
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Rivastigmine
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-Exelon
-6 mg BID, start with 1.5 bid -Take with meals -GI, possible weight loss |
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Galantamine
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-Razadyne
-16mg BID, start at 4 mg bid -Hepatic/renal impairement: max of 16 mg daily -GI -Take with meals |
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NMDA-receptor antagonist in Alzheimer's Disease
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-Memantine(Namenda)
-10 mg BID,start at 5 mg daily -blocks glutamate(excitatory) -Reduction of dose to 5 mg bid in renal impairement -CNS effects, BP elevations, motor restlessness -DDI with dextromethorphan(also an NMDA-antagonist) |
