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24 Cards in this Set
- Front
- Back
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Parkinson's Drugs
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Levodopa, Ropinirole
Carbidopa/levodopa Amantadine Selegiline Benztropine Bromocriptine Pramipexole |
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Alzheimer's disease
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Donepezil
Memantine |
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L-Dopa
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L-dopa crosses teh blood brain barrier and is a precursor of Dopamine synthesis
monotherapy results in peripheral side effects: Nausea and vomiting |
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L-Dopa/Carbidopa
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When L-Dopa is combined with carbidopa, peripheral side effects are reduced
Carbidopa is a dopa decarboxylase inhibitor does not cross the Blood Brain Barrier |
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L-Dopa/Carbidopa
Pharmacokinetics |
1) Given orally
2) Aminoacids will compete for absorption 3) Short half life |
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L-Dopa/Carbidopa
Uses |
1) Bradykinesia of parkinson's
2) Effectiveness decreases over time due to reduction in dopaminergic neurons |
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L-Dopa/Carbidopa
Side effects GI |
1) Nausea and vomiting
2) Develop tolerance after a few months |
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L-Dopa/Carbidopa
Side effects Cardiovascular |
1) postural hypotension
2) Hypertension when combined with MAOI |
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L-Dopa/Carbidopa
Side effects Dyskinesias |
1) Excessive involuntary movements
2) Develop over time 3) Lowering dose decreases dyskinesia but also reduces mobility |
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L-Dopa/Carbidopa
side effects Behavioral |
1) Depression anxiety agitation
2) Insomnia somnolence 3) Confusion, delusions, hallucinations 4) Psychosis treated with clozapine, quetiapine, or aripiprazole |
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L-Dopa/Carbidopa
On/Off phenomenon |
1) Only with L-Dopa
2) adaptation to treatment 3) "off" periods of akinesia Tx: Increase frequency of administration, decrease dietary amino acids, or selegiline (dopamine agonist) |
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L-Dopa/Carbidopa
Drug holiday |
Abrupt withdrawal of drug causes: akinesia or neuroleptic malignant syndrome.
Dangerous don't do it |
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L-Dopa/Carbidopa
Drug interactions |
MAOI- Hypertension
Pyridoxine(B6)->increases peripheral metabolism |
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L-Dopa/Carbidopa
Contraindications |
1) Psychosis
2) Closed angle glaucoma 3) Cardiac disease 4) Active peptic ulcer 5) Malignant melanoma |
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Selegiline
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1) Inhibits MAO-B in striatum,
2) Decreases free radicals Side effects 1) Do not combine with Meperidine, TCAs or SSRI may cause stupor, rigidity agitation and hyperthermia. |
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Bromocriptine
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Dopamine agonist
1) Acts directly on receptors 2) Does not decrease in efficiency as disease progresses 3) Ergot derivative = vasospasm 4) Decrease release of prolactin |
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Bromocriptine Side effects
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1) GI: Nausea vomiting, anorexia
2) Cardio: Postural hypotension, arrythmias 3) Dyskinesia 4) Mental disturbance 5) Erythromelalgia: red tender swollen feet due to vasospasm |
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Pramipexole/ Ropinirole
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Dopamine agonist
1) Do not cause Erythromyalgia, vasospasm, or fibrosis 2) Well tolerated 3) Less on and off phenomenon |
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Amantadine
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Antiviral, may increase dopamine release.
Side effects: 1) Toxic psychosis, convulsions 2) Spotting of skin (livedo reticularis) 3) Peripheral edema: Contraindicated: 1) History of seizures 2) Congestive heart failure |
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Benztropine
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Anticholinergic
1) Improves rigidity or tremors, drooling 2) Decrease effects of cholinergic drugs to match loss of dopamine 3) diphenhydramine may be used |
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Donepezil
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Cholinesterase inhibitor
1) Compensate for loss of acetylcholine 2) Slows progression of disease Side effects: 1)GI 2) Tacrine causes liver toxicity |
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Memantine
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Noncompetative antagonist of NMDA receptor
1) Used for severe Alzheimer's 2) Reduce over stimuation of NMDA |
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Memantine
Side effects |
1) Enhances side effects of L-Dopa
2) Agitation 3) UTI 4) Urinary incontinence 5) Insomnia 6) Diarrhea |
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Memantine
Drug interactions |
Meperidine
Dextromethorphan |
