Parkinson disease (PD) is a

neurological disorder

PD occurs when

neurons in the substantia nigra (a part of the brain) die or become impaired

The neurons that die or become impaired produce

the neurotransmitter dopamine which allows smooth, coordinated function and movement of body muscles

Pathophysiology of PD

less dopamine --> less instructions to the brain --> movement problems (TRAP symptoms)

Symptoms of PD (TRAP)

tremor: when resting

rigidity: in legs, arms, trunk and face

akinesia/bradykinesia: lack of/ slow start in movement

postural instability: imbalance, falls

What can be used to measure involuntary movements from medications

The Abnormal Involuntary Movement Scale (AIMS)

Dopamine blocking drugs that can worsen PD

phenothiazines (prochlorperazine), butyrophenones (haloperidol), first and second generations antipsychotics, metoclopramide

Psychosis can occur with

advanced disease or can be due to side effects of drug treatment

Preferred antipsychotic for psychosis due to low risk of movement disorders

quetiapine

______ has a low risk of worsening movement disorders but has a high risk of seizures, agranulocytosis and other serious complications

clozapine

MOA of Nuplazid

5HT2A/2C receptor inverse agonist (FDA approved to treat hallucinations and delusions in PD)

Rapid withdrawal of levodopa or dopamine agonist can lead to a condition called

neuroleptic malignant syndrome (NMS)

Prodrug of dopamine and is the most effective agent

levodopa

Why is carbidopa given with levodopa

to prevent the peripheral metabolism of levodopa, which would destroy most of the drug before it crosses the blood-brain barrier

MOA of carbidopa/levodopa

levodopa is the precursor of dopamine, carbidopa inhibits dopa decarboxylase enzyme preventing peripheral metabolism of levodopa

Brand name of carbidopa/levodopa

Sinemet

if this test is positive, carbidopa/levodopa should be discontinued due to hemolysis risk

Coombs test

Brand name of carbidopa/levodopa ER

Rytary (can take whole or sprinkle on a small amount of applesauce)

Side effects of carbidopa/levodopa

can cause brown/black/dark discoloring of urine/saliva/sweat, priapism, orthostatis, psychosis, hallucinations, xerostomia

How many mg/day of carbidopa is required to inhibit dopa decarboxylase

70-100 mg/day

MOA of COMT inhibitors

increase the duration of action of levodopa; inhibit the enzyme catechol-O-methyltransferase (COMT) to prevent peripheral conversion of levodopa

Which drugs are COMT inhibitors

entacapone, opicapone, tolcapone

Brand name of entacapone

Comtan

Brand name carbidopa/levodopa/entacapone

Stalevo

How many of entacapone is needed with each dose of carbidopa/levodopa

200 mg PO

Brand name of opicapone

Ongentys

Brand name of tolcapone

Tasmar

Drugs thats are dopamine agonist

pramipexole, ropinirole, rotigotine, apomorphine

Brand name for pramipexole

Mirapex

Brand name of ropinirole

Requip XL

Brand name of rotigotine

Neupro (patch)

How to apply neupro (patch)

apply once daily at the same time each day to the stomach, thigh, hip, side of body, shoulder or upper arm; do not use the same site for at least 14 days

Which dopamine agonist is used as a "rescue" movement drug for "off" periods

apomorphine (injection)

MOA of amantadine

blocks dopamine reuptake into presynaptic neurons and increases dopamine release from presynaptic fibers, primarily used to treat TD associated with peak-dose of carbidopa/levodopa

Brand name for amantadine

Gocovri

amantadine can cause

cutaneous reaction called livedo reticularis (reddish skin mottling)

MOA of selective MAO-B inhibitors

blocks the breakdown of dopamine which increases dopaminergic activity

Drugs that are MAO-B inhibitors

selegiline, rasagiline, safinamide

Brand name selegiline

Emsam

Brand name of rasagiline

Azilect

What are centrally acting anticholinergics used for in PD

tremors

MOA of istradefylline

adenosine receptor antagonist

Brand name istradefylline

Nourianz

alpha/beta agonist that is used for neurogenic orthostatic hypotension

droxidopa

Brand name for droxidopa

Northera

While taking MAO-B inhibitors, what foods should you avoid

foods high in tyramine, including aged or matured cheese, air-dried or cured meats, sauerkraut, fava