Parkinson's Disease

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  1. benztropine
    • Cogentin
    • Anticholinergic
  2. trihexyphenidyl
    • Artane
    • Anticholinergic
  3. Anticholinergic
    • Tremors in younger pts (cognitive impairment in elderly)
    • < 70 with tremors and preserved cognitive function
    • Use as monotherapy (for tremors) or adjunct to address other cardinal Sx
    • - Cogentin (benztropine)
    • - Artane (trihexyphenidyl)
  4. amantadine
    • Symmetrel
    • Antiviral that increases DA in prefrontal cortex
    • Tremors, rigidity, bradykinesia
    • Levodopa induced dyskinesia
    • Renal dose adjustment
    • Good for older patients
  5. carbidopa/levodopa
    • Sinemet
    • - carbidopa inhibits carboxylase in periphery (70-100 mg/day)
    •   * GI distress, N/V- too much levodopa is getting converted in the periphery, increase carbidopa
    • - levodopa crosses BBB, converts to DA, and gets stored
    • Titrate up slowly
    • Motor complications
    • - End of dose wearing off
    • - Peak dose dyskinesia
    • - Off period dystonia
    • - Delayed on
    • - Freezing

    • End of dose wearing off
    • Return of Sx
    • Depletion of DA stores (nowhere to store DA- 1 hr ½ life)
    • Increase frequency, add COMT inhibitor, MAO-B inhibitor, DA agonist
    • - Acute episodes: SQ apomorphine (DA agonist- rescue)
    • Occurs mostly at night- use CR/XR
  6. Delayed On/No On
    • Absence of drug effect
    • Decreased absorption or delayed gastric emptying
    • Crush/chew tabs (CR should not be crushed/chewed)
    • - ODT on empty stomach
    • Rescue- SQ apomorphine
  7. Freezing
    • Inhibition of lower extremities
    • Physical Therapy
    • Increase dose of carbidopa/levodopa
    • Add MAO-B inhibitor or DA agonist
  8. Peak dose dyskinesia
    • Involuntary movements of neck, trunk, upper and lower extremities
    • Lower dose - Parkinson’s symptoms may return
    • Add amantadine or increase dose
  9. Off Period Dystonia
    • Sustained muscle contractions
    • Occurs in lower extremities (feet), in the morning prior to first dose
    • At bedtime- DA agonist, XR formulation, baclofen
    • Acute/Persistent Dystonia- Focal Botox injection
  10. MAO-B
    • Inhibits breakdown of DA
    • Monitor for serotonin syndrome
    • selegiline (Eldepryl)
    • rasagiline (Azilect)
  11. selegiline
    • Eldepryl
    • MAO-B inhibitor, higher doses MAO-A
    • - Doses > 9 mg watch for serotonin syndrome
    • May exacerbate peak dose dyskinesia
    • Monotherapy- control of motor Sx
    • Adjunct to Sinemet- prolongs DA activity
    • Insomnia, hallucinations, jitteriness
  12. rasagiline
    • Azilect
    • MOA-B inhibitor
    • Used early to help with cognitive decline
  13. COMT inhibitors
    • Prevents peripheral conversion of L-dopa to DA
    • DNU as monotherapy, must be on Sinemet
    • Urine discoloration (brown/orange) and late onset diarrhea
    • tolcapone (Tasmar)
    • entacapone (Comtan)
  14. tolcapone
    • Tasmar
    • COMT inhibitor
    • Not 1st line- hepatotoxicity
    • - Monitor ALT/AST (Q2-3 wks x6 months)
    • - D/C if ALT/AST is 2x UNL
  15. entacapone
    • Comtan
    • COMT inhibitor
    • Preferred (1st line)
  16. Dopamine Agonist
    • —Bromocriptine (Parlodel
    • - Ergot derived
    • Pramipexole (Mirapex), —Ropinirole (Requip)
    • - Non-ergot derived (safer)
    • - Used as monotherapy or adjunct (DA agonist reduce motor complications)
    • - Preferred in younger patients
    • - Common ADRs
    •   * N/V, vivid dreaming, sedation, confusion, hypotension, lightheadedness
    • apomorphine (Apokyn)
  17. bromocriptine
    • Parlodel
    • Ergot derived- 2nd line
    • Vasospasms, cardiac complications
  18. pramipexole
    • Mirapex
    • Non-ergot derived- 1st line (RLS)
    • Preferred in younger patients
    • - Reduce motor complications
    • Vivid dreams, sedation, confusion, hypotension, light headedness
  19. ropinirole
    • Requip
    • Non-ergot derived- 1st line (RLS)
    • Preferred in younger patients
    • - Reduce motor complications
    • Vivid dreams, sedation, confusion, hypotension, light headedness
  20. Hallucinations/Delusions
    • 1) Investigate alternative causes
    • 2) Simplify Parkinson’s disease regimen
    • 3) Add clozapine or quetiapine at bedtime
  21. Apomorphine
    • Apokyn
    • Used in acute/emergency situations
    • SQ- triggers “on” DA
    • N/V- give trimethobenzamide (Tigan) before
    • CI (5HT)- dolasetron (Anzemet), granisetron (Sancuso, Granisol), ondasteron (Zofran)
    • - Severe hypotension, confusion
  22. Unified Parkinson’s Disease Rating Scale
    Standardized assessment used to document progression of the disease and response to treatment

Card Set Information

Author:
ebmalonzo
ID:
319439
Filename:
Parkinson's Disease
Updated:
2016-04-28 18:58:42
Tags:
Parkinsons
Folders:
IT 3
Description:
IT 3 (MT 2): Parkinson's Disease
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