Anti-Parkinson

Question 1

Levodopa

Answer 1

Co-Carelopa
Co-Beneldopa

1st line treatment in Parkinson’s disease

• Problems with long-term use, therefore should delay introduction if possible and then start low and titrate up as required
• Also include non-pharma management (OT, PT, speech therapy, dietician)
• Nausea / vomiting
• Postural hypotension (big problem because gait is already an issue)
• Confusion
• Hallucinations
• Psychosis

Question 2

Dopamine Agonist

Answer 2

1) Ergot derivatives (e.g. Pergolide)
2) Non-Ergot derivatives (e.g. Ropinirole)

Parkinson’s Disease (PD)

• Often used initially to delay the need for L-Dopa
• Using a combination of different meds is key in PD
• Nausea / constipation
• Postural hypotension
• Cardiac arrhythmia
• Drowsiness
• Hallucinations
• Psychosis

Question 3

COMT Inhibitors

Answer 3

Entacapone
Tolcapone

Prevents the peripheral breakdown of levodopa by inhibiting

Side effects are similar to levodopa.
Tolcapone is hepatotoxic

Question 4

MAO-B Inhibitors

Answer 4

Selegeline

Rasagiline

Increases extent and duration of response to levodopa by protecting domapine from extraneuronal degradation
*Does not cause cheese reaction of non-selective MAOIs used for antidepressant therapy.

Adverse effects of increased dopamine effect

• Segeline is metabolised to amphetamine:
• Anxiety -Insomnia