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33 Cards in this Set
- Front
- Back
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What is the cause of Parkinson's?
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Parkinson's is due to the depletion of dopamine in the body
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What are the S/Sx of Dopamine loss?
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***TRAMP
Tremor Rigidity Akinesia (initiation of movement is difficult) Mask face Pill rolling/Posture |
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What are the drugs that cause Pseudoparkinsonism?
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Haldol
Reglan (Metoclopramide) - has a black box warning for Tardive dyskinesia - blocks dopamine |
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What are the different group of drugs to treat Parkinson's?
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Anticholinergic drugs
Dopamine precursors MAOI's Dopamine Reuptake Inhibitor Dopamine Agonists COMT Inhibitors |
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List the Anticholinergic drugs used for Parkinson's.
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***The Baby Boy Dances
Trihexyphenidyl (Artane) Benztropine (Cogentin) Biperiden (Akineton) Diphenhydramine (Benadryl) |
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What forms does Benztropine come in? DoC for what?
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Benztropine (Cogentin) comes in tabs, IM/IV injection.
DoC: acute dystonic reaction |
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What is Levodopa? Contraindications? Why?
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Levodopa (Larodopa) is a dopamine precursor. It is contraidicated in glaucoma & cardiac abnormalities. Levodopa, by increasing dopamine, has an anticholinergic effect.
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Levodopa side effects?
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***HANPAD
- Hypotension - Aphrodisiac - N/V - Psychosis - Akinesia - Dyskenisia |
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What are the MAOI's used for Parkinson's?
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Selegiline (Carbex, Eldepryl, Zelapar, Emsam)
Rasagiline (Azilect) |
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What is Eldepryl? Dosing?
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Selegiline, 5mg caps BID. 2nd dose should not be later than 2PM.
Max: 10mg QD |
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What is Zelapar? Monotherapy dose?
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Selegiline (Zelapar) is a 1.25mg ODT (contains phenylalanine) taken QD.
Monotherapy: 1mg QDay |
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List some Rasagiline cautions.
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Rasagiline (Azilect)
- Liver disease - pheocromocytoma - Don't take 14 days before surgery |
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What are some medications that you should never give if patient is on Rasagiline?
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Meperidine (Demerol)
Tramadol (Ultram) Methadone (Methadose, Dolophine) Dextromethorpan Pseudoephedrine Phenylephrine St. John's Wort Mirtazapine (Remeron) Cyclobenzaprine (Flexeril) TCA's, SSRI's, SNRI's, MAOI's Tyramine rich foods |
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What is Sinemet? MoA?
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Carbidopa + Levodopa, with the former blocking the breakdown of levodopa in the periphery.
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How much of Carbidopa is needed to block the enzyme?
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75mg of Carbidopa QDay
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What are the cautions with using Sinemet?
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Cardiac abnormalities
Dietary proteins (will compete with levodopa for intestinal absorption) |
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What are the contraindications to using Sinemet?
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Lactation
Narrow angle glaucoma |
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What is Symmetrel? MoA? Indications?
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Amantadine (Symmetrel) increases presynaptic dopamine release & exerts anticholinergic effects.
Indications: Influenza A Parkinson's |
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Symmetrel dosing? Excretion?
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Dose: 100mg BID, 100% renally excreted
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List the Dopamine Agonists used for Parkinson's.
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***BRAPP
Bromocriptine (Parlodel) Ropinorole (Requip) Apomorphine (Apokyn) - SC Inj Pergolide (Permax) Pramipexole (Mirapex) |
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Dopamine MoA? Why do you need to titrate Dopamine Agonists?
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Stimulate DA receptors & alpha blocking activity. Dopamine agonists need to be titrated due to severe hypotension.
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What is Parlodel?
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Bromocriptine (Parlodel) is used for HYPERPROLACTINEMIA and PARKINSON'S.
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What is Permax? Caution in?
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Pergolide (Permax), caution in Liver disease.
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What is Mirapex? Metabolized where?
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Pramipexole (Mirapex) is 100% renally excreted.
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What is Requip? DoC for? Caution with?
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Ropinirole (Requip) is a good option for patients who are prone to hypotension or falls because it has less orthostasis. Caution with liver dysfunction.
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What is Apomorphine? Indication? Form?
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Apomorphine (Apokyn) si to treat "wearing-off" episodes in people with advanced Parkinson's. Given SC.
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Apomorphine dosing?
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PRN up to 5x/day (2mL/day)
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What do you give for severe N/V associated with Apokyn use?
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Trimethobenzamide (Tigan), an antiemetic, should be given 3 days prior to initiating Apokyn.
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Can you use Apokyn with 5HT3 inhibitors (which are also for emesis)?
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5HT3 (Ondansetron, granisetron, dolasetron, palonosetron, alosetron) is CONTRAINDICATED based on reports of profound hypotension and loss of consciousness.
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What are the COMT inhibitors?
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Entacapone (Comtan)
Tolcapone (Tasmar) |
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What is Comtan? Dosing?
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Entacapone (Comtan) is used as an adjunct to Levodopa.
Start dose: 200mg Max: 1600mg |
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What is Tasmar? Warning? Dose?
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Tolcapone (Tasmar) could result to FATAL HEPATIC FAILURE.
Dose: 100-200mg TID Max: 200mg TID |
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What is Stalevo?
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Carbidopa + Levodopa + Entacapone
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