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13 Cards in this Set
- Front
- Back
Pathophysiology of Parkinsons'
Symptoms |
Progressive degeneration of Nigrostiatal DA tracts (substantia nigra/pars compacta)--DA/ACh balance disturbed. Too little DA/too much ACh
Signs & Symptoms: Resting tremor, bradykinesia, muscle rigidity, postural instability--loss of postural reflexes, flat facies |
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Levodopa
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L-dopa
crosses BBB--prejunctionally decarboxylated to Dopamine (by amino acid decarboxylase AAAD) to restore DA activity in corpus striatum |
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Carbidopa
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Alpha-methyldopa hydrazine--- L-amino acid decarboxylase inhibitor that acts in the periphery--does not cross BBB
Increases CNS availability of L-Dopa (fixed combo drug L-Dopa/Carbidopa "Sinemet") --dose can be reduced by 80%--less side effects |
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L-Dopa side effects
contraindications |
SE: dyskinesias (up to 80% of pt's)--may be reduced by decreasing dose but parkinson symptoms may increase
Akinesias: "end-dose akinesia"--rapid return of akinesia & muscle rigidity before end of dosing interval "On-off akinesia"--rapid fluctuation showing no beneficial & beneficial effects of L-dopa therapy--may be sign of neuron degeneration "akinesia paradoxica"--sudden freezing of movement Behavioral: anxiety, insomnia, psychosis--if preexisting problem vivid dreams, hallusinations Nausea & vomiting--better w/ carbidopa & when drug taken w/ food CV effects: postural hypotension--reduced w/ carbidopa. arrhytmias, afib, tachy, htn Mydriasis & acute glaucoma Contraindications: Psychosis, narrow angle glaucoma, peptic ulcer disease w/ MAOa--can cause HTN crisis antiemetics/antipsychotics-- reduce L-dopa activity |
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Entacapone
Tolcapone |
COMT inhibitors-- used in combo w/ L-dopa/Carbidopa
blocks peripheral conversion of levodopa to 3-O-methyl DOPA, increasing both the plasma half-life of levodopa as well as the fraction of each dose that reaches the CNS Tolcapone--hepatotoxicity --need to give 2-3 X day Entcapone--duration of action even shorter (~2hrs) |
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Selegiline
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MAO-B Inhibitor--retards DA breakdown in Striatum
(isoenzyme MAO-B is the predominant form in the striatum) Metabolites of Selegiline: Amphetamina & methamphetamine Selegiline + merperidine/tricycllics--stupor, rigidity, agitation, and hyperthermia SSRI's w/ selegiline--seems to be ok w/ PD pt's but use caution selegiline does not inhibit peripheral metabolism of catecholamines (in doses less than 10mg/day), also does not cause the lethal potentiation of catecholamine action observed when patients taking nonspecific MAO inhibitors ingest indirectly acting sympathomimetic amines such as the tyramine found in certain cheeses and wine. |
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Amantadine
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antiviral drug. Increased release of DA in CNS via unknown mechanism
used in early PD as adjunct to L-dopa. Therapeutic effect may diminish w/in weeks SE: anticholinergic, livedo reticularis (edema/skin mottling) |
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Bromocriptine
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D2 (and D1) receptor agonists
given w/ L-dopa. Also used for hyperprolactinimia SE: nausea, vomiting, hypotension--initial dose |
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Pergolide
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D2 (and D1) receptor agonists
given w/ L-dopa. Also used for hyperprolactinimia SE: nausea, vomiting, hypotension--initial dose |
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muscarinic receptor blockers
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suppress ACh activity to balance DA/ACh ratio
used w/ initial tx of PD w/ L-dopa good for tremor, rigidity little effect for bradykinesia and postural reflexes |
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muscarinic receptor blockers
list of drugs for PD |
benztropine
trihexyphenidyl M-blockers--more lipid soluble than atropine. greater CNS access biperidin orphenadrine procyclidine |
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Pramipexole
Ropinirole |
Anti-parkinsonian--combo w/ L-dopa
Pramipexole D3 agonist Ropinirole D2 agonist--also used for restless leg syndrome SE: uncontrolled sleepiness |
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Drugs for Alzheimer's
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Acetylcholinesterase inhibitors (Donepezil, rivastigmine, tagrine (liver tox) and galantamine)
SE: GI dysfunction & muscle cramps NDMA inhibitor (Memantine) |