Neuro Pathology Pharm

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Parkinson's drugs

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Agonize Dopamine Receptors

Inc Dopamine

Prevent Dopamine breakdown

Curb excess cholinergic activity

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BALSA tx of parkinsons

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Bromocriptine
Amantadine
Levodopa (w/ carbidopa)
Selegiline (and COMT inhibitors)
Antimuscarinics

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Agonize dopamine receptors

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Bromocriptine
pramipexole, ropinirole = non-ergot
NOn ergots are preferred

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Inc dopamine

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Amantadine
- may inc dopamine release; also antiviral against infulenze A and rubellas; tox: Ataxia

L-dopa/carbidopa
(converted to dopamine in CNS)

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Prevent dopamine breakdown

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Selegiline (selective MAO type B inhibitor)

-capones (COMT inhibitors = prevent L-dopa degradation, thereby inc. dopamine availability)

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Curb excess cholineregic activity to aid in Parkinsons

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Benztropine
Antimuscarinic = improves tremor and rigidity but has little effect on bradykinesia

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Essential of Familial tremors

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use Propranolol

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Levodopa (L-dopa)/carbidopa

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MOA: increase level of dopamine in brain; unlike dopamine L-dopa can cross BBB
- converted by dopa decarboxylase to in the CNS to dopamine

Tox: Arrhythmia (due to peripheral conversion to dopamine);
Long-term use: dyskinesia on administration and akinesia b/t doses

Carbidopa = peripheral decarboxylase inhibitor; given w/ L-dopa to inc bioavailability to L-dopa in the barin and to limit side effects

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Selegiline

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MOA: selectively inhibits MOA-B, which metabolizes dopamine

Use: parkinson's and preventing damage by MPTP

Tox: may enhance adverse effects of L-dopa; insomnia (amphetamine)

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Huntington's disease

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Disease = inc dopamine, dec GABA & ACh

Haloperidol = dopamine receptor antagonist

Reserpine + tetrabenazine = amine depleting

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Sumatriptan

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MOA = 5-HT 1B/1D agonist
- causes vasoconstritction
inhibition of Trigeminal activation adn vasoactive peptide release
- Half-life < 2 hours

Use: Acute migraine and clute headache

Toxicity = CORONARY VASOSPASM (contraindicated in pats w/ CAD or PRIZMENTALS)
Mild tingling

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Alzheimer's drugs

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Acetylcholinesterase inhibitors

NMDA receptor antagonist

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Memantine

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NMDA receptor antagonist
prevents glutamate exitotoxicity (mediated by Ca+2)

Tox: Dizziness, confusion, hallucinations

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Donepezil, Galantamine, rivastigmine

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MOA: AChE inhibitor

Tox: Nause, dizzinees, insomnia

- Alzheimers