Questions and Answers
What are the initial treatments for mild symptoms of Parkinson's disease?
Dopamine agonists are the first-line drugs for the treatment of Parkinson's disease.
True
What is the mechanism of action for Levodopa?
Increasing dopamine synthesis in the striatum
Levodopa should be avoided with a high _____ diet.
Signup and view all the answers
What are some adverse effects of Levodopa?
Signup and view all the answers
What should be monitored annually in patients prescribed Levodopa?
Signup and view all the answers
Which of the following is a dopamine agonist?
Signup and view all the answers
Entacapone has direct therapeutic effects on its own.
Signup and view all the answers
Amantadine's responses typically diminish after _____ to _____ months.
Signup and view all the answers
What is the major black box warning (BBW) for Selegiline?
Signup and view all the answers
Which of the following are cholinesterase inhibitors used in Alzheimer's disease? (Select all that apply)
Signup and view all the answers
The hallmark of Alzheimer's Disease is the presence of tau tangles.
Signup and view all the answers
What is the APOE4 gene associated with?
Signup and view all the answers
Donepezil causes _______ inhibition of acetylcholinesterase.
Signup and view all the answers
What type of drug is Memantine?
Signup and view all the answers
What is a common side effect of cholinesterase inhibitors?
Signup and view all the answers
Galantamine is derived from daffodil bulbs.
Signup and view all the answers
What should be avoided when treating Alzheimer's patients?
Signup and view all the answers
Which medication is the first-line treatment for focal seizures?
Signup and view all the answers
Which drug is primarily used for absence seizures?
Signup and view all the answers
Phenytoin can cause gingival hyperplasia.
Signup and view all the answers
What is the drug of choice for status epilepticus?
Signup and view all the answers
What adverse effect is associated with Carbamazepine?
Signup and view all the answers
The therapeutic levels for Phenytoin are _____.
Signup and view all the answers
Which of the following drugs is known for the risk of permanent loss of vision?
Signup and view all the answers
What should be monitored when administering Oxcarbazepine?
Signup and view all the answers
Match the following seizure types with their first-line medications:
Signup and view all the answers
Levetiracetam is used as monotherapy for focal seizures.
Signup and view all the answers
Study Notes
Parkinson Disease
- Characterized by degeneration of neurons supplying dopamine to the striatum, causing tremor at rest, rigidity, postural instability, and bradykinesia
- Balance between acetylcholine and dopamine is essential for proper striatal function
- Drug therapy helps maintain functional mobility and quality of life
Treatment Options
- Initial treatment for mild symptoms: selegiline or rasagiline
- Long-term use of dopamine increases the risk of dyskinesias and "off" periods
- Combining dopamine with COMT inhibitors or MAO-B inhibitors can help reduce "off" periods
Levodopa/Carbidopa
- Avoid high protein diet to minimize interactions
- Gradual loss of effect or "wearing off" develops near the end of the dosing interval
- Can be minimized by shortening the dosing interval, giving a drug that prolongs levodopa's half-life (COMT inhibitors), or giving a direct-acting dopamine agonist
- Mechanism of action: increases dopamine synthesis in the striatum
- Adverse effects: nausea, dysrhythmias, postural hypotension, psychosis, visual hallucinations, vivid dreams, paranoia, CNS effects
- Dyskinesia can be managed by reducing the dosage of levodopa, adding amantadine, or surgery and electrical stimulation
Dopamine Agonists
- First-line drugs for treating Parkinson's disease
- Cause direct activation of dopamine receptors
- Less effective than levodopa, but not dependent on enzymatic conversion to be active
- Do not compete with dietary proteins, lower incidence of response failure, and less likely to cause dyskinesias
- Examples:
- Pramipexole • Used alone in early stages and with levodopa in advanced stages • Maximal benefits take several weeks • Adverse effects: nausea, dizziness, daytime somnolence, insomnia, constipation, and hallucinations
- Ropinirole • Selective for D2/3 receptors • Same adverse effects as pramipexole • Do not use in pregnancy
- Rotigotine • Adverse effects: skin reactions at the site of application, hyperhidrosis, or excessive perspiration
- Apomorphine • Acute treatment of hypo-mobility during "off" periods • Not for routine Parkinson's management
- Ergot derivatives • Poorly tolerated, limited use
COMT Inhibitors
- Inhibit the metabolism of levodopa in the periphery
- No direct therapeutic effects of their own
- Examples:
- Entacapone • Selective and irreversible • Use with levodopa • Inhibits the metabolism of levodopa in the intestines and peripheral tissues, prolonging levodopa availability to the brain • Adverse effects: dyskinesias, orthostatic hypotension, nausea, hallucinations, and sleep disturbances • Side effects: nausea, vomiting, diarrhea, constipation, and yellow/orange urine • Interactions: increased levels of drugs metabolized by COMT
- Tolcapone • Use only with levodopa • Black box warning: liver failure and death • Treatment should be limited to 3 weeks and especially if beneficial response is absent
MAO-B Inhibitors
- Examples:
- Selegiline • Selective and irreversible • Benefits decline within 12-24 months • Black box warning: antidepressants increase the risk of suicidal thoughts in pediatric and young adults • Monitor during the first 1-2 months of therapy or during dose adjustments
- Rasagiline • Adverse effects: insomnia, orthostatic hypotension, buccal mucosa irritation, and hypertension crisis • Increases the risk of malignant melanoma
Other Medications
- Amantadine • Responses diminish within 3-6 months • Adverse effects: confusion, anxiety, blurred vision, retention, dry mouth, and livedo reticularis (mottled discoloration)
Alzheimer's Disease
- Neuronal degeneration occurs in the hippocampus (early) and cerebral cortex (later)
- Characterized by a loss of acetylcholine
- Hallmark of AD: neurotic plaques (beta-amyloid) and Tau tangles
- APOE4 gene is associated with AD
- Foods rich in folic acid may be beneficial
Treatment of Alzheimer's Disease
- Goal: improve symptoms and reverse cognitive decline
- Cholinesterase inhibitors:
- Donepezil
- Inhibits acetylcholinesterase reversibly
- Highly protein-bound, long half-life (15 days to reach steady state)
- AE: GI, dizziness, headache, bronchoconstriction, and symptomatic bradycardia
- Galantamine (derived from daffodil bulbs)
- Same as donepezil
- Rivastigmine
- Causes irreversible inhibition of acetylcholinesterase
- Donepezil
- Avoid anti-psychotics and tricyclic anti-depressants
Memantine
- For moderate to severe AD
- Can be taken with donepezil for added benefits
- Modulates the effects of glutamate
- AE: dizziness, headache, confusion
Seizures and Treatment Options
- Focal seizures: Carbamazepine, Phenytoin, Fosphenytoin, Valproic acid, Lamotrigine, Lacosamide, Topiramate, Oxcarbazepine, and Eslicarbazepine are first-line treatment options.
- Generalized seizures: Carbamazepine, Phenytoin, Valproic acid, Lamotrigine, and Topiramate are first-line treatment options.
- Absence seizures: Valproic acid, Ethosuximide, and Lamotrigine are first-line treatment options.
- Atypical, Myoclonic, and Atonic seizures: Valproic acid, Lamotrigine, and Clonazepam are first-line treatment options.
Medication-Specific Information
-
Phenytoin:
- Therapeutic levels: 10-20
- Adverse effects: nystagmus, sedation, ataxia, diplopia, gingival hyperplasia, skin rash, toxic to fetus, and CV
- Decreases effects or oral contraceptives, warfarin, and glucocorticoids
- Increases levels of diazepam, isoniazid, cimetidine, alcohol, and valproic acid
- Administer with food
-
Carbamazepine:
- Adverse effects: pruritus, rash, c/n/v, ataxia, dizzy, somnolence, blurred vision, retention, xerostomia, hyponatremia, blood dyscrasias, and SIADH
- Important to test for HLA-B1502 genetic marker in people of Asian descent due to risks of dermatologic reactions, aplastic anemia, and agranulocytosis
-
Oxcarbazepine:
- CYP inducer
- Adverse effects: hyponatremia, necolysis, SJS, and toxic epidermal necolysis
- Lower birth control and raises phenytoin levels
- Monitor serum sodium levels when given with diuretics
-
Eslicarbazepine:
- Focal seizures in adults and children >4
-
Valproic acid:
- Uses: seizure, bipolar, and migraines
- Adverse effects: hepatotoxicity, pancreatitis, teratogenic, and hyperammonemia
- Liver failure is a black box warning
-
Ethosuximide:
- Drug of choice for absence seizures
- Adverse effects: blood dyscrasias, CNS depression, SLE, cutaneous reactions
- Major substrate: serum concentrations affected by CYP inducers/inhibitors
-
Phenobarbital:
- Anticonvulsant barbiturate
- Adverse effects: dependency, exacerbation of porphyria, rickets, osteomalasia, nystagmus, and ataxia
- Do not give in pregnancy due to malformations and bleeding
- Gradually stop medication to avoid withdrawal
-
Primidone:
- Active against all seizures except absence
- Similar to phenobarbital
-
Gabapentin:
- Off-label uses: neuropathic pain, prophylaxis of migraines, fibromyalgia, post-menopausal hot flashes
- Adverse effects: hypersensitivity (angioedema, rhabdomyolysis)
-
Pregabalin:
- Enhances sedative effects of CNS depressants
- Increases fluid retention of thiazolidinediones
- Adverse effects: weight gain
- High risk for dependency/abuse
-
Lamotrigine:
- Adverse effects: meningitis, risk for suicide
-
Levetiracetam:
- Focal, myoclonic, and tonic clonic seizures
- Monotherapy for focal and general seizures
-
Lacosamide:
- Add-on therapy for partial onset in patients 17 years or older
- Adverse effects: prolonged PR, euphoria
-
Tiagabine:
- Partial seizures in children >12
-
Perampanel:
- Focal seizures in patients >4 and adjunctive for general tonic clonic seizures >12
- Adverse effects: psych reactions
-
Topiramate:
- Adjunctive therapy with Lennox-Gastaut syndrome
- Adverse effects: weight loss, thinking issues, kidney stones
-
Zonisamide:
- No specific adverse effects mentioned
Status Epilepticus
- Maintain ventilation and treat hypoglycemia
- Drug of choice: benzodiazepine (lorazepam or diazepam)
Lennox-Gastaut Syndrome in Children
- Responds to valproic acid, benzodiazepine, and lamotrigine
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
Description
This quiz covers the symptoms and drug therapy for Parkinson disease, including tremor, rigidity, postural instability, and bradykinesia. Learn about the balance between acetylcholine and dopamine and how drug therapy can impact quality of life.
