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24 Cards in this Set
- Front
- Back
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MOA of Levodopa
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circulates in plasma to the BBB where it crosses and is converted by striatal enzymes to dopamine
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MOA Carbidopa
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peripheral decarboxylace inhibitor blocks conversion levodopa to dopamine in the systemic circulation & liver in order to prevent N/V & orthostatic
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MOA Entacapone
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COMT inhibitor is another preparation that prolongs the action of levodopa by preventing its O-methylation
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interactions of Levodopa, carbidopa, entacapone
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- “antipsychotics”- dopamine receptor blockers- “old” nausea meds- dopamine receptor blockers (phenothiazines, butyrophenones, benzamides) - MAO inhibitors- leads to hypertensive crisis
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ADR's Levodopa
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- 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
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Dosing of Levodopa
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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
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drug that can counteract dyskinesias
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amantadine
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MOA of Selegiline
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- selective monoamine oxidase (MAO type B) inhibitor, which plays a major role in the metabolism of dopamine
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indications for Selegiline
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Adjunctive managment in PD when levodopa efficacy is deteriorating
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Ergot Derivatives for PD
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Bromocriptine and Pergolide
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MOA of ergot derivatives
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dompamine receptor agonist
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ADR of Pergolide
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associated with thickening and dysfunciton of cardiac valves
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non-ergot derivatives
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Pramipexole and Ropinirole
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MOA non-ergot derivaties
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dopamine receptor agonist
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indications for non-ergot derivatives
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alrternative 1st line agents for PD
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most commonly used med for AD
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Donepezil
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MOA-cholinesterase inhibitors for AD
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Donepezil
Rivastigmine Galantamine |
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ADR of Donepezil
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bradycardia (SSS)
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NMDA receptor antagonist for AD
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Memantine
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Migraines- Abortive
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Sumatriptain,rizatriptain, zolmitriptain, almotriptain, eletriptain, naratriptain, frovatriptain
Ergotimine - Ergotimine/Caffeine - Dihydroergotamines - Opioids |
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Migraine- Prophylactic
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- B-Blockers –Propranalol & timolol
- CCB’sVerapamil - AnticonvulsantsValproic Acid - TCA’s –Amytrpitiline |
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Cluster Headaches- Abortive
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- O2- SQ/nasal sumatriptain- Octreotide & intranasal DHE
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Cluster Headaches- Prophylactic
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- Verapamil- Prednisons
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who should avoid triptans
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ischemic stroke/heart disease, prnismetal's angina, uncontrolled HTN and PG
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