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29 Cards in this Set
- Front
- Back
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Dopaminergics |
Levodopa/carbidopa (Sinemet) Use: most effective therapy for severe Parkinson’s Action: crosses the BBB and is converted into DA in the brain; carbidopa prevents breakdown of levodopa in the periphery Shouldn’t be taken with high protein meals |
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Adverse Reactions of Dopaminergics (Levodopa) |
N/V Postural hypotension Psychosis Anxiety, memory impairment, insomnia, nightmares, problems with impulse control, addictive behaviors Dyskinesias (most common) Darkens sweat and urine Activates malignant melanomas |
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Dopamine Agonists |
Pramipexole (Mirapex), rospinirole (Requip) Use: treats early PD alone or with levodopa in late PD Action: activation of DA receptors in striatum |
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Adverse Effects of Dopamine Agonists |
Monotherapy: Nausea, dizziness, somnolence, insomnia, constipation, weakness, hallucinations Combined with levodopa: orthostatic hypotension, dyskinesias, increased hallucinations |
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COMT Inhibitors |
Entacapone (Comtan), tolcapone Use: used with levodopa to treat PD Action: inhibits breakdown of levodopa in the periphery |
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MAO-B Inhibitors |
Suffix—“giline” Use: first-line treatment for early PD; can reduce wearing off effect of levodopa Action: inhibits the breakdown of DA in the brain since MAOB breaks down DA |
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Amantadine (Symmetrel) |
Use: less effective treatment of PD; may reduce dyskinesias caused by levodopa Actions: inhibition of DA uptake, stimulation of DA release, blockade of cholinergic and glutamate receptors |
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Adverse Effects of Amantadine |
CNS effects: confusion, lightheadedness, anxiety Peripheral effects: blurred vision, urinary retention, dry mouth, constipation Levedo reticularis |
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Centrally Acting Anticholinergics |
Benztropine (Cogentin), trihexyphenidyl (Artane) Uses: second-line therapy for PD tremors, for younger patients with mild symptoms Action: block and inhibit ACH activity |
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Centrally Acting Anticholinergics |
Benztropine (Cogentin), trihexyphenidyl (Artane) Uses: second-line therapy for PD tremors, for younger patients with mild symptoms Action: block and inhibit ACH activity |
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Adverse Effects of Anticholinergics |
Not tolerated in the elderly CNS effects: sedation, confusion, delusions, hallucinations |
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Management of Nonmotor Symptoms of PD |
Depression: treat with amitriptyline Dementia: treat with donepezil and rivastigmine Psychosis: stop all PD drugs |
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Amitriptyline (Elavil) for Parkinson’s |
TCA antidepressant Use: treats depression in PD patients Precautions: Anticholinergics can worsen dementia, antiadrenergics can worsen hypotension |
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Cholinesterase Inhibitors for Alzheimer’s |
Donepezil, galantamine, rivastigmine Use: main class of drugs for AD; may slow progression of mild to moderate Alzheimer’s Action: prevent breakdown of ACH |
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Adverse Effects of Cholinesterase Inhibitors |
Parasympathetic side effects GI effects HA Bronchoconstriction Most common: dizziness/lightheadedness, bradycardia, fainting |
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Donepezil (Aricept) |
First-line drug for mild to severe AD Long half-life Adverse effects: N/V, bradycardia, fainting—>falls |
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Rivastigmine (Exelon) |
Use: mild to moderate AD Adverse effects: GI upset, anorexia (weight loss) Precautions (worsens symptoms): peptic ulcers, bradycardia, urinary obstruction, lung disease, fainting (falls) |
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Galantamine (Razadyne) |
Use: mild to moderate AD Adverse effects: same as rivastigmine, bronchoconstriction |
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N-Methyl D-Aspartate Receptor Antagonists |
Memantine (Namenda) Use: improves symptoms of moderate to severe AD; better tolerated Action: blocks the NT glutamate |
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Adverse Effects of Memantine (Namenda) |
Dizziness HA Confusion Constipation |
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Cholinesterase Inhibitors for Myasthenia Gravis |
Suffix: “onium”, “stigmine” Use: treat symptoms of MG Action: delay destruction of ACH at synapse; stimulates skeletal muscles Reversible CIs: neostigmine, pyridostigmine (limited CNS effects) |
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Selective Serotonin Reuptake Inhibitors (SSRIs) |
Fluoxetine (Prozac), Zoloft, Celexa, Lexapro, Luvox, Paxil Use: first line therapy for treating major depression Action: produce inhibition of serotonin reuptake; cause CNS excitation |
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Adverse Effects of SSRIs |
Serotonin syndrome (from OD): AMS, myoclonus, hyperreflexia, sweating, tremors, fever Withdrawal syndrome Teratogenic effects Extra involuntary movements (EPS) Bleeding disorders Sexual dysfunction Weight gain |
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Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) |
Cymbalta (drug of choice), Effexor, Pristiq Use: relieves depression Action: inhibits 5HT and NE reuptake, weakly inhibits DA reuptake |
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Adverse Effects of SNRIs |
Nausea Somnolence/insomnia Dry mouth Sweating HA Blurred vision Effects in pregnancy and lactation |
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Tricyclic Antidepressants |
Amitriptyline, doxepin, imipramine Use: first choice drugs for major depression Action: block reuptake of 5HT and NE |
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Adverse Effects of TCAs |
Sedation Orthostatic hypotension Anticholinergic effects Sweating Cardiac toxicity Seizures Hypomania |
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Monoamine Oxidase Inhibitors |
Isocarboxazid (Marplan), Nardil, Parnate Use: second and third choice drugs for major depression Action: inhibit MOA from breaking down 5HT, NE, and DA |
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Adverse Effects of MAOIs |
CNS stimulation Orthostatic hypotension HTN crisis from dietary tyramine |
