Pharm Test 2

Front 1

what is the cause of parkinsons?

Back 1

decreased input from the substantia nigra to the basal ganglia and an imbalance of overactivity of acetylholine and decreased dopamine

Front 2

what is the basal ganglia?

Back 2

a region of the brain which helps control movements

Front 3

stage 1 of parkinson's

Back 3

unilateral involvement

Front 4

stage 2 of parkinson's

Back 4

bilateral involvement but no postural abnormalitites

Front 5

stage 3 of parkinson's

Back 5

bilateral involvement with mild postural imbalace on examination or history of poor balance or falls; patient leads independent life

Front 6

stage 4 of parkinson's

Back 6

bilateral involvement with postural instability; patient requires substantial help

Front 7

stage 5 of parkinson's

Back 7

sever, fully developed disease; patient restricted to bed or wheelchair

Front 8

primary features of parkinson's

Back 8

bradykinesia, postural instability, resting tremor, rigidity (pill rolling)

Front 9

motor symptoms of parkinson's

Back 9

decreased dexterity, dysphagia, freezing at initiation of movement, hypophonia, slow turning, festinating gait

Front 10

autonomic symptoms of parkinson's

Back 10

bladder and anal sphinctor disturbances, constipation, diaphoresis, orthostatic blood pressure changes, sexual disturbances

Front 11

mental status changes of parkinson's

Back 11

confusional state, demientia, psychosis, sleep disturbance

Front 12

physical features of parkinson's

Back 12

fatigability, oily skin, pedal edema, seborrhea, weight loss

Front 13

what drugs are the standard of therapy for parkinson's

Back 13

carbidopa/l-dopa first in conjunction with dopamine agonists

Front 14

when should anticholinergics be used with caution?

Back 14

In the elderly or those with preexisting cognitive difficulties, glaucoma, BPH

Front 15

What is a useful drug in the elderly with mild features of parkinson's

Back 15

amantadine

Front 16

list some non-parmacologic treatments for parkinson's

Back 16

nutrition, exercise, education, peer and group support, professional counseling, in-home help

Front 17

How does carbidopa/levodopa (sinemet) work?

Back 17

levodopa is converted to dopamine and prelaces deficient dopamine in the basal ganglia. Carbidopa blocks peripheral conversion of levodopa to dopamine by dopa decarboxylase therby reducing peripheral side effects of dopamine (n/v/tachycardia)

Front 18

What is the onset/duration of regular sinemet?

Back 18

onset 15-30 min, duration lasts 2-5 hrs

Front 19

What is the onset/duration of CR sinemet?

Back 19

onset 45-60 min, duration lasts 3-7 hrs (need 30% more than regular due to decreased absorption)

Front 20

what are the side effects of c/l?

Back 20

nausea, postural hypotension, dyskinesias, dystonia, myoclonus, akathisia, nightmares, hallucinations (visual), confusion, insomnia

Front 21

What foods should be avoided when taking c/l?

Back 21

High protein, interferes with absorption

Front 22

symptoms of parkinson's that are unresponsive to sinemet

Back 22

postural instaility, freezing, speech abnormalities, dementia, depression, constipation, sexual dysfunction, urinary problems, and sweating.

Front 23

list some problems with levodopa

Back 23

shortened dose duration, wearing off effects, on/off effects, drug resistant off periods, decline in maximum effect, involuntary movements such as dyskinesias and dystonias

Front 24

How do anticholinergics work?

Back 24

restore balance of acetylcholine/dopamine by blocking acetylcholine in basal ganglia

Front 25

List some anticholinergics

Back 25

benztropine, trihexyphenidyl, and kiphenhydramine

Front 26

what stages are anticholinergic meds effective?

Back 26

1-3, useful in tremor

Front 27

S/E's of anticholinergics

Back 27

impaired cognitive function, constipation, dry mouth, sedation, urinary retention and blurred vision

Front 28

when are anticholinergics contraindicated

Back 28

in patients > 60

Front 29

how does amantadine (symmetrel) work?

Back 29

promotes release of dopamine from intact neurons, binds glutamate receptors which compensate for dopamine deficiency

Front 30

What stages are symmetrel useful for

Back 30

1-4 for mild bradykinesia, tremor, ridigity

Front 31

S/E's of amantadine (symmetrel)

Back 31

confusion, hallucinations, nightmares, insomnia, ankle edema, worsening CHF, peripheral anticholinergic effects, TOLERANCE

Front 32

when is symmetrel contraindicated

Back 32

in patients >60 d/t congnitive effects

Front 33

When is symmetrel generally used

Back 33

in initial or early therapy or adjunctive later in treatment

Front 34

How does selegiline (eldepryl) work

Back 34

(MAO-B inhibitor) decreases metabolism of dopamine which results in less oxidative damage to remaining neurons (neuroprotective)

Front 35

what stages does Eldepryl work in

Back 35

Stage 1-4 for symptomatic management

Front 36

S/E's of eldepryl

Back 36

augments levodopa toxicities, insomnia (give in am), confusion, agitation, hypomania, diarrhea, sweating, shivering, serotonin syndrome, hyperreflexia, myoclonus, hypertension, incoordination

Front 37

What are the DI's of eldepryl?

Back 37

antidepressants and meperidine

Front 38

List some dopamine agonists

Back 38

Pergolide (permax), bromocriptine (parlodel), ropinerole (requip), pramipexole (mirapex)

Front 39

how do dopamine agonists work

Back 39

stimulate the post-synaptic dopamine receptor and minics the action of dopamine (also used in RLS)

Front 40

what stages are affected by dopamine agonists?

Back 40

stages 2-5

Front 41

How are dopamine agonists used in relation to the disease course?

Back 41

monotherapy in early disease, adjunctive therapy with other agents, when added to sinemet the sinemet dose should be reduced

Front 42

what causes dopamine to be poorly tolerate by 30% of patients?

Back 42

allergy, palpitations, sinus tachycardia, agitation, dizziness, fainting

Front 43

what 2 ergot derivatives cause peripheral edema, pleural effusions, and erythromyalgia?

Back 43

bromocriptine and pergolide

Front 44

list COMT inhibitors

Back 44

tolcapone (tasmar), entacapone (comtan)

Front 45

How do COMT inhibitors work?

Back 45

they block the enzyme catechol-O-methyltransferase (COMT) which metabolizes levodopa, increases bioavaiability of levodopa and prolongs the half-life

Front 46

what stages are COMT inhibitors used for

Back 46

stages 2-5

Front 47

How are COMT inhibitors used in conjunction with other PD meds?

Back 47

used as add-on therapy with sinement (to prolong levodopa) resulting in smoother, more prolonged levodopa effects (dose of sinemet needs to be reduced)

Front 48

S/E's of COMT inhibitors

Back 48

diarrhea, hepatotoxicity

Front 49

what drug has no therapeutic effect when given alone?

Back 49

tolcapone