thera PD

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coal
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251593
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thera PD
Updated:
2013-12-10 09:07:09
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thera PD
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thera PD
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  1. adverse effects of carbidopa/levodopa
    • motor fluctuations
    • "wearing off, freezing"
  2. carbidopa/levodopa (sinemet) dosing
    • IR & CR - 25/100 QD increase to TID
    • IR take on MT stomach
    • CR take with food
    • max 200/2000mg
  3. dosing of DA agonists for PD if pt has dementia
    start at 50% of usual dose
  4. pramipexole - Mirapex MOA and AE
    • specific to D3 receptor
    • dose related peripheral edema (compression and elevation)
  5. pramipexole - Mirapex dosing
    • 0.125 mg TID
    • increase Q5-7d prn
    • max 4.5mg/day
  6. which DA agonist would you avoid in severe renal damage
    pramipexole - mirapex
  7. ropinirole - requip dosing
    • 0.25 mg TID
    • increase weekly
    • max 24 mg/day
    • 30% reduction of levodopa dose
  8. ropinirole (requip) MOA and a DI
    • high affinity for D2 & D3 receptors
    • CYP1A2 substrate
  9. apomorphine (apokyn) MOA and CI's
    • postsynaptic D2 receptors agonist - rescue therapy and effective in decreasing "off" episodes
    • CI- 5HT antagonists (ondansetron)
  10. apomorphine (apokyn) dosing
    • pretreatment with antiemetic is necessary
    • 2-6 mg (SQ) usually TID - 2 mg challenge doses must be given under medical supervision before routine use
    • max 20 mg/day
  11. bromocriptine (parlodel) MOA and DI
    • ergot derived agonist; stimulates D2 and blocks D1
    • CYP3A4 substrate
  12. bromocriptine (parlodel) dosing
    • 1.25 mg QD BID
    • increase to 20-90 mg/day
  13. amantadine (symmetrel) dosing
    100-400 mg/day
  14. amantadine (symmetrel) AE and DI & CI
    • confusion, nightmares
    • DI- anticholinergics increase CNS side effects
    • CI - severe renal disease
  15. what are the tx options when distinguishing between age groups
    • use DA agonist in younger pts < 65
    • older pts initiate levodopa
  16. what is the drug of choice if symptoms are severely debilitating
    levodopa
  17. selegiline (eldepryl) MOA
    • MAO-B inhibition - offers 1 hour of increased action of levodopa
    • decreases "wearing off" effect
    • up to 50% reduction of levodopa dose
  18. selegiline (eldepryl) CI and AE
    • CI - meperidine = serotonin syndrome
    • AE - hallucinations, jitteriness
    • metabolized into L-meth & L-amphetamine
  19. selegiline (eldepryl) dosing
    • 5 mg BID or 10 mg QD
    • zelapar (ODT) 1.25 mg QD
    • max 2.5 mg QD
  20. rasagiline (azilect) CI
    • cyclobenzaprine
    • dextromethorphan
    • meperidine
    • methadone
  21. rasagiline (azilect) AE and DI
    • AE = postural HoTN, dyspepsia
    • DI = 1A2 substrate - MANY!
  22. rasagiline (azilect) MOA
    • MAO-B inhibitor
    • slight reduction in levodopa
  23. tolcapone (tasmar) MOA
    • COMT inhibitor - peripherally & centrally
    • increases levodopa by up to 100%
  24. tolcapone (tasmar) AE
    hepatotoxicity - can be fatal
  25. tolcapone (tasmar) dosing
    • 100-200 mg TID
    • not as monotherapy
    • if pt sees no benefit after 3 weeks = discontinue
  26. entacapone (comtan) MOA and DI
    • COMT inhibitor peripherally
    • iron
  27. entacapone (comtan) dosing
    • 200 mg with each dose of carbi/levo up to 8 times/day
    • not as monotherapy
  28. benztropine (Cogentin) MOA and dose
    • anticholinergic, antihistamine
    • 0.5-6 mg/day
  29. trihexyphenidyl (artane) MOA and dosing
    • anticholinergic
    • 1-15 mg/day
  30. stage 1 of PD disability
    unilateral involvement only, minimal or no functional impairment
  31. stage 2 of PD disability
    bilateral involvement, w/o impairment of balance
  32. stage 3 of PD disability
    evidence of postural imbalance, some restriction in activities, capable of leading independent life
  33. stage 4 of PD disability
    severely disabled, can't walk and stand unassisted, significantly incapacitated
  34. stage 5 of PD disability
    restricted to bed or wheelchair unless aided
  35. what are the 5 cardinal clinical characteristics of PD. two of more of these
    • tremor - pill rolling
    • rigidity - stiffness and pain
    • bradykinesia - most common feature
    • postural instability - less responsive to pharmacotherapy, not diagnostic
  36. gold standard of diagnosis of PD
    neuropathologic exams
  37. methods to diagnose PD
    • cardinal manifestation
    • response to dopaminergic therapy

    • unilateral onset
    • presence of a rest tremor
    • persistent asymmetry with the side of onset most affected
  38. drugs that may produce or exacerbate PD
    • antipsychotics
    • antiepileptics
    • antidepressants
    • antihypertensives
    • amiodarone
    • cholinesterase inhibitors
    • disulfiram
    • phenothiazines
    • metoclopramide
  39. PD and the relation with cigarette smoking and caffeine
    inverse relationship

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