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23 Cards in this Set
- Front
- Back
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which of the 4 symptoms of parkinsons that respond well to drugs?
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- tremor
- rigidity - akinesia (inability to initiate movement) - gait disturbances DO NOT RESPOND WELL |
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what are some co-morbidities of parkinsons?
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- daytime sleepiness, hallucinatios, psychosis, depression, fatigue, dementia
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what is sinemet?
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- levodopa + carbidopa
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what do levodopa & carbidopa do?
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- levodopa is converted to dopamine
- carbidopa is an inhibitor of peripheral dopa decarboxylase - competitive inhibition |
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why do you have to give levodopa & not just dopamine?
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- levodopa is more lipophilic so it can cross the BBB
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what happens if you give dopamine in the periphery?
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- orthostasis & NVD
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what are the side effects of levodopa?
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- NVD, orthostasis, somnolence, dizziness, headache
- confusion, hallucinations, delusions, agitation, psychosis, dyskinesia |
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what drugs can you not take while on levodopa or COMT inhibitors?
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- non-selective MAO inhibitors - end up with HTN crisis b/c too much transmitter accumulating
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what are 2 concerns with chronic levodopa use?
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- wearing off effect
- toxicity: dyskinesia (too much dopamine), or progression of disease vs side effect |
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what do COMT inhibitors do?
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- inhibit transferase enzyme that methylates L dopa
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what is entacapone?
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- COMT inhibitor
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why is entacapone vs tolcapone used?
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- entacapone is less hepatotoxic
- tolcapone is too hepatotoxic |
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what are some COMT side effects?
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- NVD, orthostasis, dyskinesia, hallucinations
- unique ones: diarrhea, discolored urine, increased LFTs - avoid with non-selective MAO inhibitors |
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what is pramipexole?
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- non-ergots dopamine agonists
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what is ropinirole?
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- non-ergots dopamine agonists
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what are side effects of non-ergots?
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- NVD, orthostasis, psychosis/aggitation
- somnolence - caution if driving - compulsive behavior (addictive behaviors) |
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what are side effects seen in ergot-derived and not non-ergot derived?
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- fibrotic pulmonary & skin reactions
- heart valve damage |
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what is apomorphine (apokyn)?
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- strongest of the dopamine agonists - used for acute abortive therapy when a patient freezes up
- subcutaneous injection - serious orthostasis - need to use test dose, causes NVD |
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what can trihexyphenidyl & benztropine do?
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- they are anticholinergic agents used to correct imbalance between Ach & DA
- help tremors more than rigidity or akinesia |
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when would you not want to use antimuscarinic agents for parkinsons?
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- when someone has narrow angle glaucoma b/c they cannot accommodate
- or also for a long time with parkinsons b/c the individuals have dementia - also causes urinary retention |
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what is amantadine?
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- anti-viral agent that helps PD - mechanism unknown
- side effects are CNS related and some nausea |
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what is selegiline?
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- MAO-B inhibitor
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what are some side effects of MAO-B inhibitors?
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- nausea, dyskinesias, psychosis, insomnia, confusion
- metabolite is amphetamine |
