Term
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Definition
| neurodegenerative disorder --> abnormality of movement |
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Term
| Drug-induced secondary parkinsonism |
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Definition
| caused by metoclopramide, prochlorperazine, antipsychotics, & methlydopa |
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Term
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Definition
| 1st degree relative w/ dx; rural living; drinking well water; heavy metal, HC, & pesticide exposure; male gender |
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Term
| Cardinal Motor Features of PD |
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Definition
| bradykinesia; rigidity ("cogwheel" or "lead pipe"); resting tremor (hands is worst); slow progression to postural instability (stooped, shuffling gait) |
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Term
| Other clnical manifestations of PD |
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Definition
| hypomimia (masked facial expressions); micrographia (decreased writing ability); sialorrhea (excessive salivation w/o swallowing); seborrhea (increased sebum production) |
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Term
| Initial Signs & Symptoms of PD |
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Definition
| insidious onset (occurs after 6 yrs of destruction to DA nerves); usually sensory symptoms & tremor; little impairment of activities; no pharmacotherapy required |
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Term
| Advanced Signs & Symptoms of PD |
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Definition
| greater impairment of daily activities, quality of life; psychiatric changes requiring additional pharmacotherapy; hypomobility or akinesia |
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Term
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Definition
| improve motor & nonmotor fcn; maintain quality of life; avoid drug-induced complications |
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Term
| Non-pharmacological therapy for PD |
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Definition
| exercise; nutrition; education of dx progression & therapies; support groups; neurosurgery if unresponsive to pharmacotherapies |
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Term
| MAO-B inhibitors (selegiline [Eldepryl, Zelapar], rasagiline [Azilect]) |
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Definition
| reduce degradation of DA; initial choice, mild symptoms, add-on therapy |
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Term
| COMT inhibitors (entacapone [Comtan, Stalevo], tolcapone [Tasmar]) |
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Definition
| reduce degradation of available DA; not used initially; add-on when motor fluctuations develop w/ L-dopa; NOT for monotherapy |
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Term
| levodopa agents (L-dopa [Lodosyn, Sinemet, Stalevo]) |
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Definition
| replace DA by treating with DA precursor; add or start when motor symptoms limit physical function |
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Term
| DA agonists (bromocriptine [Parlodel], pramipexole [Mirapex], ropinirole [Requip], apomorphine [Apokyn]) |
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Definition
| activate striatal DA precursors; initial choice for younger pts |
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Term
| anticholinergics (benztropine [Cogentin], trihexyphenidyl [Artane]) |
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Definition
| restoring balance b/w ACh & DA; alternate therapy for mild symptoms; useful for tremor; add-on or monotherapy; for younger pts |
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Term
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Definition
| restoring balance between ACh & DA; add-on therapy if dyskinesias develop with L-dopa therapy; useful for bradykinesia, rigidity & tremor; any age |
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Term
| levodopa/carbidopa (Lodosyn, Sinnemet, Stalevo) |
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Definition
combo product: 1st drug is direct precursor to DA --> converted to DA by peripheral & central L-amino acid decarboxylase; 2nd drug: a peripheral L-aminoacid decarboxylase inhibitor --> DA cannot cross BBB; Indication: early & late stages of PD, a MAINSTAY; Warnings/CIs: history of MI, arrhythmias, high protein diet; ADRs: nausea/vomiting, arrhythmias, orthostatic hypotension, hallucinations, confusion, depression, impaired judgment; Monitor: cardiac rhythm, dyskinesias, mental status;
MOST EFFECTIVE Tx; Start tx early ; Good for tx of akinesia, tremor, & rigidity, mood, seborrhea, & drooling; Complications: dyskinesias, motor complications |
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Term
| Dosing of Carbidopa/Levidopa |
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Definition
| Initial Dosing: IR --> 25/100 mg TID, titrate --> increase by 1 tab every other day; CR --> 50/200 mg BID, titrate --> increase by 1 tab every 3 days; Avg dose: 25/100 mg TID-QID; Max dose: 200 mg/day Carbidopa, 2000 mg/day L-dopa; 75 mg/day carbidopa REQUIRED to adequately inhibit peripheral L-amino acid decarboxylase; give CR doses 4-8 hrs apart; |
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Term
| "Delayed On" or "No-On" Effect |
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Definition
| delayed response or minimal response to previously effective dose; Tx solutions: give on empty stomach, chew or crush tabs, switch to ODT, increase dose of C/L, reduce dietary protein, add DA agonist (apomorphine, etc) |
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Term
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Definition
| decreased duration of response to dose of L, occurs at end of dose; Tx: change to CR, increase freq. of dose, add MAO-B inhibitor or DA agonist or COMT inhibitor, add IR toward end of CR dosing interval, long acting agents at night |
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Term
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Definition
| fluctuations from normal/good movement to poor movement; result from brains adaptation to varying blood levels; Tx: add DA agonist, switch to CR, consider MAO-B inhibitor or COMT inhibitor, DO NOT take a drug holiday |
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Term
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Definition
| abnormal, involuntary jerking movements of face, neck, arms, legs; occurs with high DA levels; Tx: decrease dose (increase frequency), change to CR, add amantadine |
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Term
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Definition
| temporary, sudden, involuntary inability to move, usually affecting lower extremities; Tx: increase dose or add DA agonist or MAO-B inhibitor, gait modification --> place objects in front of pt |
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Term
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Definition
| sustained muscle contractions that usually occur in early morning, occurs with low levels of DA; Tx: add DA agonist, dose CR at bedtime, use baclofen (anti-spasmotic) |
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Term
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Definition
| repetitive jerking movements, especially at night; Tx: decrease nighttime dose, add clonazepam (benzodiazepine) |
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Term
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Definition
| restless feeling associated with wearing off of levodopa effect; Tx: add nighttime dopaminergic med, use gabapentin, propanolol, clonazepam, codeine |
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Term
| dopamine agonists - Ergot agent: bromocriptine (Parlodel); non-ergot: pramipexole (Mirapex), ropinirole (Requip), apomorphine (Apokyn) |
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Definition
| MoA: direct stimulation of DA receptors; I: initial monotherapy (p,r) & adjunctive therapy to C/L (all); Warnings/CI: common CNS SEs in elderly, p requires renal dysfunction dose adjustment, avoid anti-SE antiemetics, test dose for a; ADRs: hypotension, peripheral edema, confusion, somnolence, increased compulsive behaviors, A --> high incidence of GI (nausea, constipation); Monitor: renal fcn, BP, SEs, response; CPs: longer duration, fewer motor complications, "rescue therapy" use for A, A requires pretreatment with trimethobenzamide (TIGAN) --> C/I w/ 5-HT3 antagonists |
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Term
| anticholinergics - benztropine (Cogentin), trihexyphenidyl (Artane) |
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Definition
| MoA: inhibits ACh receptors; I: adjunct therapy, tx of 2ndary parkinsonism; Warnings/CIs: glaucoma, BPH, urinary retention; ADRs: dry mouth, blurred vision, constipation, urinary retention, sedation, delirium; Monitor: improvement of tremor/drooling syndrome; CPs: useful for tremor, avoid use in elderly (little benefit to bradykinesia or other features) |
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Term
| MAO-B Inhibitors - selegiline (Eldepryl, Zelapar), rasagiline (Azilect) |
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Definition
| MoA: prevent degradation of DA, extends "on time" of L-dopa therapy; I: adjunct therapy w/ C/L, initial monotherapy in early dx; Warnings: if dosed >10 mg/day --> becomes non-selective, C/I w/ meperidine; DIs: serotnin syndrome w/ SSRIs, SNRIs, TCAs, etc; possible interaction with tyramine-containing foods (cheese, wine, beer); ADRs: mood changes, dizziness, HA, N/V, diarrhea, dyskinesias; Monitor: BP, response, CNS SEs; CPs: initial monotherapy w/ mild symptoms, controversial agent, bioavailability increased with ODT |
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Term
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Definition
| MoA: unknown; I: symptomatic & adjunct tx of PD, tx of drug-induced 2ndary parkinsonism; Warnings/CIs: Avoid use in elderly; ADRs: orthostatic hypotension, insomnia, nausea, livedo reticularis; Monitor: BP, renal fcn, mental status changes, response to therapy, CPs: use in early, mild dx, most useful tx tremor & levodopa-induced dyskinesias, decrease dose in renal impairment, avoid use in elderly |
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Term
| COMT inhibitors - entacapone (Comtan, Stalevo), tolcapone (Tasmar) |
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Definition
| MoA: inhibits peripheral & central conversion of L-dopa to DA by inhibiting COMT, extends "On period" of l-dopa therapy; I: combo therapy only, NOT 1st line; Warnings/CI: fatal liver injury, concomitant use w/ non-selective MAO-Is, caution use in renal or hepatic dysfunction; ADRs: orthostatic hypotension, chest pain, HA, dizziness, hallucinations, N/V, diarrhea, dry mouth, dyskinesias, cramps, stiffness; Monitor: BP, LFTs (T only) --> at baseline then q2 wks for 1st yr, q4 wks for 6 months, then q8 wks thereafter, requires informed consent; CPs: can allow lower dose of l-dopa |
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Term
| CNS SEs from DA agonists & C/L |
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Definition
| higher doses have higher risks --> accepted to tx SEs with another med; SEs: paranoia, hallucinations, delusions, anxiety, mood changes |
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Term
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Definition
| most effective & most studied antipsychotic in pts w/ l-dopa or DA agonist-induced psychosis; may exert some antiparkinson effects; Monitor WBC counts every 7-14 days for duration of therapy |
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Term
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Definition
| also studied in pts w/ l-dopa or DA agonist-induced psychosis; does not exert antiparkinson effects |
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