Term
| In younger patients, ________ are first line. |
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Definition
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Term
| In PTs older than 75, ________ can cause hallucinations and orthostatic hypotension |
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Definition
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Term
| Dopamine Agonists may take _____ to show effects. |
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Definition
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Term
| If combined with Levadopa, Dopamine agonists affect LDopa by _______ LDopa's dose by ______ |
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Definition
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Term
| Which Dopamine agonist had patches which were withdrawn from the market? |
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Definition
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Term
| What are the currently used Dopamine Agonists? |
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Definition
Nonergot: Pramipexole, Ropinirole (PraRo)
Ergot:Bromocriptine
Apomorphine |
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Term
| What advantages do Dopamine Agonists have over LDopa? |
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Definition
| longer t1/2 and less frequent dosing |
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Term
| What drug(s) is/are associated with pulmonary fibrosis and cardiac valve fibrosis? |
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Definition
| The Ergot Dopamine Agonist, Bromocriptine. |
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Term
| Postural hypotension, psychosis, vivid dreams, compulsive behavior, lower extremity edema, sleep attacks and nausea are AEs of _____ |
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Definition
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Term
| Apomorphine is available as _______ |
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Definition
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Term
| _____ is/are used in PTs with advanced PD for intermittent tx of hypomobility and as needed for rescue |
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Definition
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Term
| Due to Apomorphine's significant SE of ______, ______ drugs should be started _______ beforehand and continued for _____ |
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Definition
| N/V; antiemetic (trimethobenzamide) 3 days prior for 2 mos. |
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Term
| For Apomorphine's side effect of _______, ________ should not be used due to _______ |
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Definition
| N/V; 5HT antagonists should not be used due to severe hypotension. |
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Term
| ______ is the most effective agent and is Dopamine's immediate precursor. |
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Definition
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Term
| Levodopa takes _____ to work |
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Definition
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Term
| _________ helps prevent peripheral Ldopa conversion do Dopamine |
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Definition
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Term
| Carbidopa increases _________, and reduces ________ |
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Definition
| increases cerebral LDopa bioavailability; decreases peripheral DA AEs |
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Term
| _______ of Carbidopa are needed to saturate Dopa decarboxylase |
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Definition
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Term
| LDopa-Carbidopa combo dosage forms are _______ |
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Definition
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Term
| LDopa-Carbidopa in ____ dosage form should be taken _____ prior to meals and _____ after |
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Definition
| IR; 30 min prior & 60 min after |
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Term
| LDopa-Carbidopa in _____ dosage form should be taken with food. Additionally, it has no added benefit for_____ |
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Definition
| SR. no benefit for motor complications. |
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Term
| LDopa-Carbidopa is contraindicated in______ |
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Definition
| glaucoma and malignant melanoma |
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Term
| When discontinuing carbidopa-LDopa, _____ dosing. |
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Definition
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Term
| Which drug(s) may cause hallucinations, psychosis, motor complications (incl fluctuations & dyskinesias), orthostatic hypotension, as well as Nausea, sedation and confusion? |
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Definition
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Term
| What may be done to counteract LDopa's wearing off? |
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Definition
| Add a DA agonist, increase DA frequency, add "LDopa extenders", e.g. COMTI, MAOB, to reduce LDopa breakdown. |
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Term
| "Delayed-On" or "No-On" response to LDopa may be treated by ______. |
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Definition
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Term
| LDopa, off-period dystonias, which are sustained muscle contractions (esp in the foot) can be treated with ________ |
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Definition
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Term
| Freezing, a fluctuation event in LDopa therapy, can be tx'd non pharmacologically or with ________ |
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Definition
| increasing dose, DA agonists |
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Term
| Concerning DA agonists vs LDopa, _______ is preferred in younger PTs due to less motor fluctuations, and ______ is preferred in elderly patients due to hallucinations and orthostatic hypotension. |
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Definition
| DA agonist in young, LDopa in elderly. |
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Term
| In general, should DA agonists or LDopa be used first? |
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Definition
| DA Agonists, as DA agonists can delay need for LDopa for 4-5 years as well as reducing likelihood of dyskinesias and motor fluctuation down the road when LDopa tx is started. |
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Term
| Which drug(s) decrease cholinergic activity to control tremor? |
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Definition
| The anticholinergics: Benztropine and Trihexyphenidyl |
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Term
| The Anticholinergics should be used in younger PTs with ______ and ______ in older PTs |
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Definition
| used in younger PTs with good cognitive function, avoided in older |
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Term
| The anticholinergics have (low/high) effectiveness and (can be stopped immediately/should be tapered) |
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Definition
|
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Term
| what specific symptom do the anticholinergics treat? |
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Definition
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Term
| Blurred vision, dry mouth, urinary retention, memory difficulty, confusion, sedation, changes in mental status and constipation are side effects of _____ |
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Definition
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Term
|
Definition
| Selegiline and Rasagiline |
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Term
| Selegiline may cause Serotonin Syndrome due to interaction with _______ |
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Definition
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Term
| Selegeline has a ______ metabolite |
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Definition
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Term
| which medication can cause hallucinations, jitteriness, insomnia, worsen dyskinesias and have speech symptoms? |
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Definition
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Term
| Selegiline is available as ______dosage form(s) |
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Definition
| transbuccal and transdermal |
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Term
| Selegiline (has/has no) low-dose tyramine restrictions. |
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Definition
| has no restrictions under 2.5 mg |
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Term
| Selegiline (does/does not) undergo 1st pass metabolism |
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Definition
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Term
| Which dosage form(s) of Selegiline has decreased metabolite effects? |
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Definition
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Term
| The _____ dosage form of selegiline has food restrictions of _____ (time frame) |
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Definition
| transbuccal; no food 5 minutes before or after dose. |
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Term
| The _____ dosage form of selegiline has food restrictions of _____ |
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Definition
| transbuccal; no food 5 minutes before or after dose. |
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Term
| Which MAOB-I has more potency? |
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Definition
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Term
| Rasagiline may be effective up to_____ |
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Definition
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Term
| Which drugs are the COMT-I's? |
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Definition
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Term
| Which drug class has an MoA of decreasing L-Dopa degradation and increasing its halflife 1.5-2x? |
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Definition
| COMT-I's; Entacapone and Tolcapone |
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Term
| Which drug(s) modestly improve motor sx and disability in advanced PD? |
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Definition
| COMTI's: Tolcapone, Entacapone |
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Term
| The COMT-I's may be used (in monotherapy and with LDopa/only with LDopa)? |
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Definition
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Term
| _____ may cause liver failure and death, and should thus have liver function monitored closely? |
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Definition
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Term
| _______ may cause diarrhea, dyskinesias and abdominal pain |
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Definition
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Term
| _______ modestly improves the symptoms of bradykinesia, rigidity, tremor as well as helping with LDopa's dyskinesias. |
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Definition
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Term
| Which drug may cause Tachyphylaxis in 4-8 wks time? What is Tachyplaxis? |
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Definition
| Amantadine; tachyphylaxis is the rapid decrease in response over a short time, where no increase in dose has an effecT) |
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Term
| Which drug should be avoided in PTs with renal dysfunction, and (unrelated to renal dysfunction) has SEs of livedo reticularis, xerostomia, confusion and dizziness? |
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Definition
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Term
| Which drug should be tapered, else risk rebound parkinsons? |
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Definition
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Term
| Which class of drugs may be used for pharmacologically caused hallucinations? |
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Definition
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Term
| For psychomotor agitation, _____ may be used. |
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Definition
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Term
| Which antipsychotics should be avoided in the event of psychomotor agitation? |
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Definition
The DA-2 blockers (haloperidol, chlorpromazine, perphenazine)
Olanzapine and Risperidone may exacerbate PD. |
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Term
| To alleviate agitation, L-Dopa dosing may be temporarily_______ |
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Definition
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Term
| To treat dyskinesias caused by L-Dopa, part of the dose may be substituted with_______ |
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Definition
|
|
Term
| what other drugs may be added to L-Dopa to aid with Dyskinesias? |
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Definition
|
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Term
| How may the secondary hallucinations be pharmacologically treated? |
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Definition
|
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Term
| ____can be tried in the case of Dementia in Parkinsons |
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Definition
| Cholinesterase Inhibitors |
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Term
| What drug may be used to treat Depression in Parkinsons? |
|
Definition
| SSRIs, but be careful if PT is on MAOIs |
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