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39 Cards in this Set
- Front
- Back
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MOA of PD
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degeneration of dopaminergic neurons in the basal ganglia (substania nigra), need 60-70% lost before see clinical symptoms
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Levodopa
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Bipsynthetic precursor of dompamine
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Whys is L-dopa given with carbidopa?
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To inhibit the conversion of L-dopa to dopamine in peripheral tissues and get more of the L-dopa in the brain
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L-dopa side effects
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GI, cardiac arrhythmias, postruarl hypotension, hypertension, dyskinesias (dose related), behavioral effects, and "on" and "off" periods
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Can you give anti-emetics for L-dopa GI side effects in PD?
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No because most anti-emetics will exacerbate PD because they decrease dopamine
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L-dopa + carbidopa combo side effects
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decreased GI, behavioral effects
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Treatment for behavioral side effects
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atypical antipsychotics
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Clozapine, Olanzapine, Quetiapine, Risperidone
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atypical antipsychotics
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L-dopa interactions
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if combined with monoamine oxidase A inhibitors will get a hypertensive crisis
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L-dopa contraindications
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psychotic patients, angle-closure glaucoma, and history of melanoma/undiagnosed skin lesions
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Selegiline, Rasagiline
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Monoamine oxidase inhibtors
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Tolcapone, Entacapone
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COMT inhibitors (Catechol-O-Methyl Transferase)
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Selegiline MOA
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inhibits MAO-B which would normally breakdown dopamoine
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Selegiline use
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adjunctive therapy, allows for lower doses of L-dopa, and taken at breakfast and luch to prevent insomnia
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Rasagiline MOA
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inhibits MOA-B to prevent dopamine breakdown
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Rasagiline use
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more potent than Selegiline, prevents MPTP induced PD, monotherapy early and adjuctive in advanced dz
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Selegiline, Rasagiline contraindications
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pts on Meperidine, Anti-depressants, and Tyramine would cause a serotonin crisis
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Entacapone MOA
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Decreases metabolism of L-dopa in the periphery
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Tolcapone MOA
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Decreases metabolism of L-dopa in BOTH periphery and CNS
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Entacapone side effects
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Dyskinesias, nause, confusion, ORANGE URINE,
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Tolcapone black box effect
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increased liver hepatotoxicity, needs signed constent in US
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Stalevo
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L-dopa + Carbidopa + Entacapone
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Amantadine
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antiviral with antiparkinson properties
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Amantadine MOA
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Enhances domapine release
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Amantadine use
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less potent than L-dopa, benefits short lived, treatment lasts only weeks
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Amantadine side effects
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Livedo Reticularis (purple skin) which goes away when stop drug
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When can you give a dopamine receptor agonists?
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intially with L-dopa + Carbidopa combo or later when L-dopa treatment produces end-of-dose akinesia, "on-off," or when there is a lack of response to L-dopa
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Pramipexole, Ropinirole
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Dopamine agonists for PD
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Pramipexole traits
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specific for D3, monotherapy for mild PD, adjunctive in advanced PD, renal impairment may require dose adjustments
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Ropinirole traits
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selective for D2
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Pramipexole, Ropinirole side effects
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GI, Cardio, Dyskinesias, Mental disturbances (more severe with L-dopa), sudden sleep attacks
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Dopaminergic dysregulation syndrome
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compulsive, no impulse control, seen with L-dopa and esp. the domainergic agonists
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Apomorphine
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potent dopamine agonist
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Apomorphine use
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temporary relief of off-periods of akinesia
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Apomorphine side effects
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nausea, pretreament with an atiemetic (trimethobenzamide)
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Bentropine mesylate, trihexyphenidyl, biperiden, orphenadrine, procyclidine
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acetylcholine blockers for PD
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Acetycholine blockers use in PD
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start low and increase until see benefit or side effects, used to improve the tremor and rigidity with little effect on bradykinesia
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Surgical treatments for PD
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Ablative surgery, Deep-Brain Stimulatoin, Transplantation of domaingergice tissue
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Tx for restless leg syndrome
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Ropinirole, Pramipexole
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