3. Objectives
At the completion of this activity, the participant will be able to:
• Describe pathophysiological changes that occur in Parkinson’s
disease.
• List proposed risk factors for Parkinson’s disease.
• Describe clinical manifestations associated with Parkinson’s
disease.
• Describe pharmacological management of symptoms of
Parkinson’s disease.
5. Name: Alicia Silverstone Birthdate: 1976-10-04
Famous Years: 1994 - 1998
Currently Known For: Activist,
Writer and Producer
Networth: $16 Million
Famous For: Clueless, Batman
& Robin and Blast from the
Past
Name: Michael J. Fox Birthdate: 1961-06-09
Famous Years: 1985 - 2001
Currently Known For: Actor,
Activist, Producer and Author
Networth: $65 Million
Famous For: Back to the Future,
Family Ties and Spin City
6. PD Motor Symptoms
• Initial (Tremor)
• Prevalence; (first; 80%)
• Characteristics (uni to bilateral; age; pill-rolling; at rest)
• Relieved vs. worsened
• Motor (Cardinal) symptoms
• Rigidity
• Characteristics (definition; body parts: random; pain; prevalence)
• Lead-pipe; vs. Cogwheel, Patterns
• Akinesia or Bradykinesia
• Description
• Characteristics (fingers; legs - shuffling)
7. PD Motor Symptoms
• Postural Instability
• Description
• Pull-test,
• Freezing of Gait
• Description;
• Management
• Dystonia
• Other motor symptoms
• Sialorrhea, speech, face, eye
• Micrographia
12. Primary Treatment
• Treatment Approach
• Replace Dopamine (DA)
• Drug that acts like DA
• Other drugs
• Levodopa
• Carbidopa
• Dopamine Agonists
• COMT inhibitors
• Catecholo-methyltranserase
• MAO-B inhibitors
• Amantadine
• Apomorphine
• Droxidopa
13.
14. Levodopa/Carbidopa
• Introduction
• Place of therapy
• Initiation
• Metabolism
• Goal; Carbidopa
• Dosing strategy:
• ½ of 25 mg carbidopa/100 mg levodopa, BID/TID ;
• MD: 300 and 600 mg of levodopa
• Stopping the drug
• Carbidopa
• 70 mg to 100 mg/d;
• 200 mg
• Dose Adjustment
15. Levodopa/Carbidopa
• Drug Interactions
• Phenothiazines, Metoclopramide
• Absorption
• Protein-rich food; Iron
• Side Effects
• Gastrointestinal
• Motor movements
• Mental illness
• Other
• Positive Coombs Test
• Administration
16.
17. Dopamine Agonists
• Place in therapy
• Efficacy, Benefits, Place in Therapy
• Side Effects:
• Hallucination; Sleep; Impulse Control; stopping
• Pramipexole (Mirapex; Mirapex ER),
• Dose: IR: start with 0.125 mg PO TID,
• Titrate weekly to max of 1.5 mg TID
• Ropinirole (Requip, Requip XL)
• Dose: IR: start with 0.25 mg PO TID, titrate weekly to max of 8 mg TID
• XL: start with 2 mg daily, titrate weekly to max of 24 mg daily
• Rotigotine (Neupro) Patch:
• Start with 2 mg/24 hrs (early PD)
• Max dose: 8 mg/24 hour
• Patient counseling
• Administration; sulfite; seat; MRI
18. Catechol-O- methyltransferase (COMT)
inhibitors
• Mechanism
• Place in Therapy
• Agents:
• Entacapone (Comtan)
• Entacapone + levodopa/carbidopa (Stalevo), Tolcapone
(Tasmar) – liver
• Opicapone 50 mg orally once a day at bedtime
• Dose:
• Entacapone: 200 mg with each dose of
carbidopa/levodopa (max = 1,600 mg/day)
• Stalevo: carbidopa/levodopa with 200 mg of
entacapone in each tablet (example: 12.5/50/200 mg)
• Dose ratio
• Side Effects
• Movement d/o; LFT; BP/Wt loss
19. Dopamine Agonists (Apomorphine)
• Introduction
• Side effects
• Premedication: Trimethobenzamide or Phenergan;
• Domperidone; 5HT3 antagonists
• Apomorphine Hydrochloride (Kynmobi)
• Available Doses: 10 mg, 15 mg, 20 mg, 25 mg, and 30 mg
• Sublingual Film – up to 5 times/day
• Apomorphine Injection (Apokyn)
• Indication
• Dose: Subcutaneous injection
• Start with 0.2 mL (2 mg) PRN (up to 5x/day); titrate by 1 mg every few days
• Max single dose: 0.6 mL (6 mg)
• Dopamine Agonists Patient counseling
• Food effects, Nausea and drowsiness, Drowsiness & dizziness
20. Amantadine
• Mechanism
• Place in therapy
• Dose:
• Amantadine 100 mg BID-TID
• Renal impairment
• Side Effects
• CNS (Toxic delirium)
• Livedo Reticularis
21. Selective MAO-B Inhibitors
• Mechanism
• Place in therapy & Neuroprotection
• Adverse Effects
• Comparing to Others
• GI, CNS, Sleep,
• Use with levodopa or MAOI
• Food interactions
• Agents
• Selegiline
• Doses: 5 mg Twice/day with breakfast and lunch
• Orally disintegrating (Zelapar) 1.25–2.5 mg once/day
• Rasagiline (Azilect)
• Dose: 1 mg once/day
• Safinamide [Xadago)
• 4–8 times/day (with each levodopa dose)
• Advantages
22. Anticholinergics
• Mechanism
• Place in Therapy
• Agents/Dose
• Benztropine (Cogentin):
• 0.5-2 mg TID (start QHS)
• Trihexyphenidyl:
• 1-5 mg TID (start 1 mg QHS)
• Side Effects
23.
24.
25.
26. Receiving CE Credit from United States
Access Code ………park
Participants have until August 9, 2022, to earn 1.0 contact
hour of Continuing Pharmacy Education (CPE) credit for this
activity by full session attendance/participation AND
successful completion of the online activity evaluation and
post-assessment test. Access to the evaluation and test is
through use of the CE access code as displayed on this slide.
After August 9, 2022 NO CE credit will be available for this
program. Credits will be transferred electronically to the CPE
Monitor System.
https://hurxce.learningexpressce.com/index.cfm?fa=view&eventID=22656&16
56085910468&preview=true&aregid=leadmin1656085910468
27. To Claim your CPD, You
have to
Get 70% pass rate &
complete the evaluation.
Password: park
