Alzheimer's and Parkinson's Flashcards
Anticholinesterases include
Rivastigmine (Exelon)
Donepezil (Aricept)
Galantamine (Razadyne)
MOA of anticholinesterases
decrease amount of acetylcholine breaking down in cleft
What drugs should anticholinesterases not be given with?
anticholinergics
ADRs of anticholinesterases
Nausea Insomnia HA Blurred vision Symptomatic bradycardia Syncope
Which anticholinestease is approved for dementia of Alzheimer’s disease AND dementia with Parkinsons?
Rivastigmine (Exelon)
Dose a anticholinesterase for the treatment of mild to moderate, or severe dementia of Alzheime’s type
Donepezil 10mg once a day in the EVENING
Anticholinesterases may be avoided in pts with
cardiovascular disease
peptic ulcer disease
NMDA receptors include
Memantine (Namenda)
When does Namenda dose need to be adjusted?
Renal impairment (<30) no hepatic adjustment required
ADRs of NMDA
ataxia, hypokinesia
emotion agitation, confusion, dizzy, depression, fatigue
constipation
Dose an nmda receptor antagonist
Namenda 10mg one tablet twice a day
How do you pick drug regimen for dementia?
Clinical judgement
- anticholinesterase alone or
- anticholinesterase + memantine (Namenda)
Others often thrown into mix: (BUT THEY DONT DEFINETIVLEY WORK) NSAIDs estrogen tx antioxidant vitamins statins nutraceuticals
Patients with Parkinson’s have decreased levels of
Dopamine
Patients with Alzheimer’s dementia have decreased levels of
Acetylcholine
When should you initiate medical therapy for Parkinsons?
Debatable!
not disease modifying
Disrupt withdrawal of Levodopa can lead to
neuroleptic malignant syndrome (NMS)
Dopamine precursors include
Levodopa/Carbidopa (Sinemet)
ADRs of levodopa
Nausea
Somnolence, dizzy, HA
Elderly- may have confusion, hallucinations, delusions, agitation, psychosis
Possible neurotoxicity?
Dose a dopamine precursor
Levodopa/carbidopa (variable) every 8 hours
Dopamine agonists include
Pramipexole (Mirapex)
Ropinirole (Requip)
Rotigotine (Neupro)
MOA of dopamine agonists
direct action at dopamine receptor sites
Are dopamine agonists better than dopamine precursors?
Possibly more s/e
also has withdrawal syndrome
ADRs of dopamine agonists
Postural hypotension hallucinations nausea somnolence worsen dyskinesias induce compulsive behavior (gambling)
Dose a dopamine agonist
Requip XL 12mg two tablet one a day
MAO-B inhibitors for Parkinson’s include
Rasagline (Azilect)
Selegeline (Eldepryl)
What drugs should MAO-B inhibitors be avoided with
tramadol, methadone, cyclobenzaprine, St. John’s wort
ADRs of MAO-B inhibitors
Insomina, nervousness, confusion
nausea
orthostatic hypotension
CA risk? (probably not)
Dose a MAO-B inhibitor
Azilect 1mg once daily
Dose an add on therapy for the treatment of Parkinson’s that works well with rigidity symptoms and is pretty well tolerated
Amantadine 100mg twice a day
Anticholinergics for Parkinson’s include
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
MOA of anticholinergics
Decrease acetylcholine by blocking receptor
Anticholinergics in Parkinsons is good for
Slow, resting tremor
Monotherapy in patients less than 70 years of age, with no significant akinesia, or gait disturbances
ADRs of anticholinergics
Tachycardia (not good for cardiac conditions)
Constipation, urinary retention
Hypotension
CNS effects: disorientation, hallucinations, toxic psychosis
Dose an anticholinergic
Trihexyphenidyl 2mg three time a day
Comt inhibitors include
Tolcapone (Tasmar)
Entacapone (Comtan)
Uses for comt inhibitors
add on tx to levodopa/carbidopa
assists when motor fluctuations/ “off” periods
ADRs of comt inhibitors
heightened rxns from levodopa/carbidoap
hepatotoxicity
What should be considered for dyskineisas in Parkinson’s?
amantadine
Are any treatments for Parkinson’s neuroprotective?
No
