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23 Cards in this Set

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which of the 4 symptoms of parkinsons that respond well to drugs?
- tremor

- rigidity

- akinesia (inability to initiate movement)

- gait disturbances DO NOT RESPOND WELL
what are some co-morbidities of parkinsons?
- daytime sleepiness, hallucinatios, psychosis, depression, fatigue, dementia
what is sinemet?
- levodopa + carbidopa
what do levodopa & carbidopa do?
- levodopa is converted to dopamine

- carbidopa is an inhibitor of peripheral dopa decarboxylase - competitive inhibition
why do you have to give levodopa & not just dopamine?
- levodopa is more lipophilic so it can cross the BBB
what happens if you give dopamine in the periphery?
- orthostasis & NVD
what are the side effects of levodopa?
- NVD, orthostasis, somnolence, dizziness, headache

- confusion, hallucinations, delusions, agitation, psychosis, dyskinesia
what drugs can you not take while on levodopa or COMT inhibitors?
- non-selective MAO inhibitors - end up with HTN crisis b/c too much transmitter accumulating
what are 2 concerns with chronic levodopa use?
- wearing off effect

- toxicity: dyskinesia (too much dopamine), or progression of disease vs side effect
what do COMT inhibitors do?
- inhibit transferase enzyme that methylates L dopa
what is entacapone?
- COMT inhibitor
why is entacapone vs tolcapone used?
- entacapone is less hepatotoxic

- tolcapone is too hepatotoxic
what are some COMT side effects?
- NVD, orthostasis, dyskinesia, hallucinations

- unique ones: diarrhea, discolored urine, increased LFTs

- avoid with non-selective MAO inhibitors
what is pramipexole?
- non-ergots dopamine agonists
what is ropinirole?
- non-ergots dopamine agonists
what are side effects of non-ergots?
- NVD, orthostasis, psychosis/aggitation

- somnolence - caution if driving

- compulsive behavior (addictive behaviors)
what are side effects seen in ergot-derived and not non-ergot derived?
- fibrotic pulmonary & skin reactions

- heart valve damage
what is apomorphine (apokyn)?
- strongest of the dopamine agonists - used for acute abortive therapy when a patient freezes up

- subcutaneous injection

- serious orthostasis - need to use test dose, causes NVD
what can trihexyphenidyl & benztropine do?
- they are anticholinergic agents used to correct imbalance between Ach & DA

- help tremors more than rigidity or akinesia
when would you not want to use antimuscarinic agents for parkinsons?
- when someone has narrow angle glaucoma b/c they cannot accommodate

- or also for a long time with parkinsons b/c the individuals have dementia

- also causes urinary retention
what is amantadine?
- anti-viral agent that helps PD - mechanism unknown

- side effects are CNS related and some nausea
what is selegiline?
- MAO-B inhibitor
what are some side effects of MAO-B inhibitors?
- nausea, dyskinesias, psychosis, insomnia, confusion

- metabolite is amphetamine