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24 Cards in this Set

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MOA of Levodopa
circulates in plasma to the BBB where it crosses and is converted by striatal enzymes to dopamine
MOA Carbidopa
peripheral decarboxylace inhibitor blocks conversion levodopa to dopamine in the systemic circulation & liver in order to prevent N/V & orthostatic
MOA Entacapone
COMT inhibitor is another preparation that prolongs the action of levodopa by preventing its O-methylation
interactions of Levodopa, carbidopa, entacapone
- “antipsychotics”- dopamine receptor blockers- “old” nausea meds- dopamine receptor blockers (phenothiazines, butyrophenones, benzamides) - MAO inhibitors- leads to hypertensive crisis
ADR's Levodopa
- CNS effects (vivid dreams, hallucinations, delusions, confusion & sleep disturbances) 1) induced motor fluctuations (over time) –drug itself causes tremor- motor fluctuations are b/t periods of being “on” (good) and “off” (tremors) 2) Wearing-Off phenomenon- drug works for <4 hrs at a time
Dosing of Levodopa
start with small doses of immediate release (IR) tablets - titrate up to 25/100 mg TID over several weeks as tolerated & according to patients clinical response- use the lowest dose that produces a response –dose is generally 300-600 mg of levodopa daily
drug that can counteract dyskinesias
amantadine
MOA of Selegiline
- selective monoamine oxidase (MAO type B) inhibitor, which plays a major role in the metabolism of dopamine
indications for Selegiline
Adjunctive managment in PD when levodopa efficacy is deteriorating
Ergot Derivatives for PD
Bromocriptine and Pergolide
MOA of ergot derivatives
dompamine receptor agonist
ADR of Pergolide
associated with thickening and dysfunciton of cardiac valves
non-ergot derivatives
Pramipexole and Ropinirole
MOA non-ergot derivaties
dopamine receptor agonist
indications for non-ergot derivatives
alrternative 1st line agents for PD
most commonly used med for AD
Donepezil
MOA-cholinesterase inhibitors for AD
Donepezil
Rivastigmine
Galantamine
ADR of Donepezil
bradycardia (SSS)
NMDA receptor antagonist for AD
Memantine
Migraines- Abortive
Sumatriptain,rizatriptain, zolmitriptain, almotriptain, eletriptain, naratriptain, frovatriptain
Ergotimine - Ergotimine/Caffeine
- Dihydroergotamines
- Opioids
Migraine- Prophylactic
- B-Blockers –Propranalol & timolol
- CCB’sVerapamil
- AnticonvulsantsValproic Acid
- TCA’s –Amytrpitiline
Cluster Headaches- Abortive
- O2- SQ/nasal sumatriptain- Octreotide & intranasal DHE
Cluster Headaches- Prophylactic
- Verapamil- Prednisons
who should avoid triptans
ischemic stroke/heart disease, prnismetal's angina, uncontrolled HTN and PG