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26 Cards in this Set
- Front
- Back
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Explain the patho of Parkinson's disease.
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degeneration of DOPAMINE producing cells in SUBSTANTIA NIGRA, which is located in the BASAL GANGLIA
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what is substantia nigra's role in the human body?
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smooth voluntary movement, addiction and reward [patients on dopamine agonists often develop addictions]
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What neurotransmitter is responsible for Parkinson's disease?
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dopamine
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What is the etiology of Parkinson's?
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Parkinson's disease is caused by an imbalance between acetylcholine and dopamine
Parkinson's can be caused either by a decrease in dopamine, OR a relative increase in acetylcholine |
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What are the therapeutic goals of Parkinson's treatment?
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since drugs cannot reverse neuronal degeneration, they instead simply improve ability to perform ADLs.
ie improve bradykinesia, akinesia, gait disturbance, tremors, postural instability |
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What do antiparkinsonian drugs do, basically?
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since parkinson's is caused by decrease in dopamine OR reltve inc in acetylcholine, they are:
dopamine agonists or acetylcholine antagonists |
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What are direct vs indirect antiparkinsonian drugs?
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Drugs either act directly on receptors (ie improve receptor sensitivity) or they act indirectly (ie inc amt of neurotransmitter)
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Which drug is usually administered first in the course of Parkinson's disease:
dopamine agonist or a receptor agonist? |
indirect acting drugs,( ie dopamine agonists) are prescribed before direct acting drugs (ie receptor agonists)
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What are the different kinds of antiparkinsonian drugs?
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dopamine replacement drugs
dopamine receptor agonists anticholinergic drugs |
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What are kinds of dopamine replacement drugs?
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levadopa +carbidopa
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What are kinds of Dopamine receptor agonists?
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Indirect (MAO-PC)
- mao inhibitors - presynaptic dopamine release enhancers - COMT inhbitors Direct - nondopamine dopamine-receptor agonist |
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What are kinds of anticholinergic antiparkinsonian drugs?
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benzotropine (congentin)
Trihexyphenidyl (Artane) |
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What is the parkinsonian drug of choice?
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dopamine receptor agonists
MAO-PC and NDDR agonists |
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What are examples of MAO-inhibitors?
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GILINE
seleGILINE (eldepryl) rasaGILINE (Azilect) |
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What are examples of Presynaptic dopamine release enhancers?
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amantadine (symmetrel)
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What are examples of COMT inhibitors
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CAPONE
tolCAPONE (Tasmar) entaCAPONE (Comtan) |
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What are examples of non-dopamine domine receptor agonists?
is it direct or indirect? |
pramipexole (Mirapex)
ropinirole (Requip) bromocriptine (Parlodel) direct |
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What are examples of anticholinergic antiparkinsonian drugs?
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benzotropine (Congentin)
trihexyphenidyl (Artane) |
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What antiparkinsonian drugs are contraindicated for MAOI's?
how long must you wait after discontinuing MAOI? |
levadopa and COMT inhibitors
2 weeks |
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What is the cheese effect, and what drug produces it? what does it cause?
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cheese effect is the reaction with foods containing tyramine (cheese, yogurt, beer, wine) and MAOI
causes severe HTN |
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When is amantadine used?
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indicated for early stage Parkinson's but only lasts 6-12 mo
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What is main purpose of COMT inhibitors
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prolong use of levodopa
mechanism - prevents breakdown of catecholamines (dopamine) |
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What drug interactions does COMT have?
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selective MAOI - B is amicable ie seleGILINE
however, nonselective MAOI's will prodcue HTN, cardiac dysrhythm and tachycardia |
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What are off episodes?
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when symptoms return despite taking meds.
should notiffy HCP |
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what are Medication holidays?
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7-10 days of interruption of treatment. supposed to help when levadopa has inc in adverse effects, and dec in therap effects.
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When does the cheese effect take place?
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when MAOI intake exceeds 10mg/day
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