Pharmtx - Final - Parkinson's

Front 1

Patients with PD display both motor and non-motor symptoms. The ___ symptoms may precede the ___ symptoms

Back 1

non-motors may precede motor

Front 2

What is the most useful diagnostic tool for PD, what does this include?

Whats used to do define Degree of disability?

Back 2

clinical history, including both pressenting symptoms and associated RFs

UPDRS-Unified PD rating scale

Front 3

What are the three phases of PD treatment of PD?

Back 3

1. Lifestyle changes, nutrition, exercise
2. Pharmacologic intervention, primarily with drugs that enhance dopamine concentrations.
3. Surgical treatments for those who fail pharmacologic interventions

Front 4

Risk factors of PD?

Back 4

Age
FH
Meds
Environment
Lifestyle/diet:smoking, caffeine

Front 5

Part of brain responsible for PD? Why?

Back 5

Substantia nigra has a loss of dopamine neurons

Front 6

PD will require ___ at least 4 years into disease?

Back 6

L-dopa

Front 7

Acronym for Non-motor symptoms of PD? meaning of each?

Back 7

SOAP
S=sleep(Insomnia, ExcessiveDaytimeSleepiness-EDS)
O=Oher miscellaneous symptoms(Nausea, fatigue, speech, dysesthesia)
A=Autonomic symptoms(drooling, constipation, ED, urinary probs, OH)
P-Psychological symptoms(anxiety, BPSD, OCD, Depression)

Front 8

What does the UPDRS measure(3)?

Back 8

-mentation, behavior, mood
-ADL
-Motor function

Front 9

Gold standard for PD tx? What does long term use lead to? What doesn't it treat.

Back 9

Levodopa.
Dyskinesias
May promote oxidative stress
DOes not treat: freezing, postural instability, dysautonomias, dementia, disease progression
Standard vs. CR: icnrase daily dose by 20% and decrease # doses by 30-50%

Front 10

What drug?
DOes not cross BBB
75mg/d required to sautrate peripheral dopa decarboxylase
reduce Levodopa by __%

Back 10

Carbidopa
75%

Front 11

What type of agents?
Class: ergot vs non-ergot like
REceptor acivity: non-ergot have little/no ___ activity, alpha activity.
Levodopa sparing
Does not affect disease progression

Back 11

Dopamine agonists
5-HT acitivity

Front 12

Potent D1 and D2 agonists
Benefits total __ time in advanced PD
Pre-treatment for __ required

Back 12

Apomorphine
"off"
nausea

Front 13

ROute of admin of Apomorphine?
Dose range/frequency
ADEs?

Back 13

2-6mg/inj
1-10 injections/day
ADEs dyskinesias, hallucinations, OH, sedation

Front 14

Selegiline
-Delay need for __
__ can exert stimulatory ADEs
Inhibitor of multiple ___ enzymes
Doses >__mg/d lose MAO-__ selectivity)increases risk for cheese effect, not not use at this dose with levodopa)

Back 14

Levodopa
Metabolites
P450
10mg/d
MAO-B

Front 15

these drugs are adjunctive to levodopa/carbidopa

Back 15

COMT inhibitors
-Tolcapone, entacapone

Front 16

COMT inhibitors
Reduce l-dope dose by __%
Decreased __ time

Back 16

25%
"off"

Front 17

For Tolcapone
-___toxicity
-inhibits ___ activity
Take __ hours b4 or after meal, same time qd
-___ monitoring
-onset of diarrhea may be delayed

Back 17

hepatotoxicity
inhibits 2C9
take 2 hours pre or post
LFT monitoring

Front 18

Dopaminergic adverse effects of COMT inhibitors

Back 18

Dyskinesia
N/V
Hallucination
Postural Hypotension or dizziness

Front 19

Non-dopaminergic Adverse effects of COMT inhibitors

Back 19

Diarrhea
Abdominal pain
Urine discoloration
constipation
Fatique
LFTs elevation

Front 20

Useful for tremors but should be avoided in elderly

Back 20

Anticholinergics

Front 21

Indices of Toxicity
Dyskinesias
Peripheral Dopaminergic:?
Central Dopaminergic:?

Back 21

Peripheral: N/V, diarrhea, OH
Central dopaminergic:insomnia, somnolence, sleep attacks, hallucinations, psychosis, nightmares

Front 22

Treatment strategies for the most common tremorogenic drugs:
Salbutamol:
Amiodarone:
Amitrityline or tricyclics:
Caffeine:
Ciclosporin:
EtOH:
Li+:
Metoclopramide:
Neuroleptics:
Nicotine:
SSRIs:
Tacrolimus:
Valproate:

Back 22

Salbutamol: Reduce freqency or D/C; consider using longer-acting B-adrenergic agonist

Amiodarone: Screen for hyperthyroidism, reduce dose to 200mg daily; consider adding B-adrenergic antagonist

Amitrityline or tricyclics: Allow time to see whether tremor will imrove, or D/c use and consider using an SSRI or B-adrenergic antagonist

Caffeine: Reduce caffeine intake

Ciclosporin: Avoid toxic states and consider reducing dose; try another immunosuppressive drug

EtOH: Reduce intake or abstain from it

Li+: Check drug concentrations and reduce dose; change drug; use B-adrenergic antagonist

Metoclopramide: D/C use and monitor pt

Neuroleptics: D/C or switch to a more atypical neuroleptic; add anticholinergic

Nicotine: Stop using all forms of tobacco or nicotine gum

SSRIs: Wait to see if tremor improves over time; reduce dose if depression allows

Tacrolimus: Reduce dose

Valproate: Reduce dose; switch antiepileptics

Front 23

Hallmark pathology of PD

Back 23

lewy bodies

Front 24

Acronym used to describe motor symptoms and it's meaning?

Back 24

TRAP
T=Tremor at rest("pill rolling")
R=Rigidity(stiffness and cogwheel rigidity)
A=Akinesia or bradykinesia
P=Postural instability and gate abnormalities

Front 25

What is the acronym used to describe Respnose fluctuations in PD?

Back 25

MAD
M=motor fluctuations
A=akathisia(can't sit still)
D=dyskinesias

Front 26

___thyroidism could be confused for PD

Back 26

HYPER