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25 Cards in this Set
- Front
- Back
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Levadopa Mechanism
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- immediate precursor of D that must be converted by an aromatic aa decarboxlyase (aaad)
- often given w/ aaad inhibitor that cant cross BBB so its not broken down until it crosses BBB |
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Levadopa SE's
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- if no aaadI, anorexia, Nandv (direct stimulation of chemoreceptor trigger zone in lower brainstem but outside the BBB)
- increased cats cause arrhythmias - increased D causes dyskinseasea and behavioral effects (can give the 4 atypicals) - dont give to crazy's, it will make them worse! |
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carbidopa
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an aromatic aa decarboxylase inhibitor that doesn’t cross BBB give w/ L-dopa
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chlorpromazine
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antiemetic - dont give if nausea from parkinsons! it is a DR antagonist and can exacerbate the dz
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Selegiline
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- selective blocks MAO B
– alone in PD or for advanced if reduced response to levodopa-carbidopa - has neuroprotective effect |
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desmethylselegiline
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- metabolite of D (makes this and H202)
- reducing both (via Selegiline an anti oxidant / neuroprotective effect |
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rasagiline
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blocks MAO-B, and is more potent than Selegiline, but not yet approved for PD as adjuvant to L-dopa
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entacapone
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- COMT-I, levodopa adjunct
- prevents D meth to 3OMD, which is inactive but competes w/ L-dopa for CNS access - need liver testing |
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tolcapone
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- COMT-I, levodopa adjunct
- prevents D meth to 3OMD, which is inactive but competes w/ L-dopa for CNS access |
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Direct-acting dopamine agonists
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- good alone or w/ L-dopa
– don’t require functional D neurons / decarboxylase so good w/ “wearing-off” and “on-off” phenomena - SE’s like L-dopa - dont use it crazy's |
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Bromocriptine
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- ergot alkaloid D2R agonist
- can be used in como w/ l-dopa as disease progresses, but may worsen vasospasm if peripheral vascular disease |
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pergolide
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- ergot alkaloid D1R and D2R agonist
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Pramipexole
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– non-ergot, D2-R agonist
– can be used in levodopa-naïve and advanced PD – no vaso-constrictive SE |
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ropinirole
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- non-ergot, D2-R agonist
– can be used in levodopa-naïve and advanced PD - for RLS now |
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Amantadine
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- antiviral that helps PD
- MAY stimulating release of D ordelay reuptake – an NMDA-R antagonist, reduces glutamate-mediated excitotoxicity and neuronal death – loses effectiveness in 6-8 wks, so reserved for short tx intervals |
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trihexyphenidyl
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- for PD - compete w/ ACh for M R’s and to stop stimulating GABAergic output
- improves tremor, but doesnt help bradykinesias - good for drug induced parkinsonism, b/c other's make crazy people worse |
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benztropine
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- for PD - compete w/ ACh for M R’s and to stop stimulating GABAergic output
- improves tremor, but doesnt help bradykinesias - good for drug induced parkinsonism, b/c other's make crazy people worse |
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procyclidine
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- for PD - compete w/ ACh for M R’s and to stop stimulating GABAergic output
- improves tremor, but doesnt help bradykinesias - good for drug induced parkinsonism, b/c other's make crazy people worse |
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biperiden
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- for PD - compete w/ ACh for M R’s and to stop stimulating GABAergic output
- improves tremor, but doesnt help bradykinesias - good for drug induced parkinsonism, b/c other's make crazy people worse |
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diphenydramine
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antihistamines w/ anticholinergic properties used for PD (esp. drug induced)
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Huntingtons etiology
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- too much D
- so too little GABA - so too much movement |
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Huntingtons drugs
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- block post D and help psychosis
- Phenothiazines (fluphenazine, perphenazine), haloperidol, and olanzipine - reserpine and tetrabenazine deplete cerebral D by preventing intraneuronal storage - Amantadine and riluzole are NMDA-R antagonists that reduce glutamate-mediated excitotoxicity – Benzos (diazepam) may help potentiate GABA signaling |
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Tics and Tourette's drugs
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- haloperidol, pimozide, and atypicals (risperidone, olazapine)
– can also try α2-agonist / anti-hypertensive clonidine (and related guanfacine) – benzodiazepine’s clonazepam and diazepam – anticonvulsive carbamazepine |
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Tremor Tx
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- Tx physiologic and essential w/ propranolol, a β-blocker
- if you cant use them, try off-label use of the anticonvulsant primidone |
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RLS tx
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- iron tends to make it worse, so take iron, B12, or folate
– levodopa and other D agents - non-ergot, D2R agonist ropinirole recently approved |
