Anti-parkinsonism Flashcards
This drug should not be given with MAO inhibitor as this may result to
Hypertensive crisis
What drug should not be given with apomorphine that it may precipitate hypotension
5-HT3 antagonist
Cardiac valvulopathy is observed in patient on this medication
Pergolide
Drugs that induced parkinsonism
Reserpine - depletes monoamine storage
Haloperidol - blocks dopa receptor
Acts both centrally and peripherally COMT inhibitor
Tolcapone
Cardiovascular effect of L-Dopa
Tachycardia
Postural hypotension
Hypertension
What trial evaluate the neuroprotective benefit of MAO-inhibitors
ADAGIO
Most common side effect of L-dopa
Anorexia, nausea and vomiting
Peripheral COMT-inhibitor
Entacapone
This is more potent in MPTP induced parkinsonism
Rasagaline
What exacerbates the GI adverse effect of L-dopa and should be avoided
Phenothiazine
Ergot derivatives stimulates both D1 and D2
Pergolide
Elimination of Pramipexole is thru
Renal
Mechanism of action of Pramipexole
- D3 agonist
- scavenge hydrogen peroxide
- enhance neutrophic activity in mesencephalic dopaminergic cell culture
Adverse effect of Entacapone and Tolcapone
orange discolioration of urine
Dyskinesia
nausea
elevated live enzymes (tolcapone)
Peak plasma concentration of Levodopa
1-2 hours
Contraindication for L-DOpa
- Known psychotic patients
- Angle-Closure glaucoma
- Bleeding gastric ulcer
- Active malignant melanoma
Levodopa effects usually diminishes after how many years
3-4 years
Contraindication in using ergot derivatives
Peripheral vascular disease
Reason for L-dopa non-responders
Loss of dopaminergic nigostriatal nerve terminals
This drug may cause digital vasospasm
Bromocriptine
What are the 3 drugs combination of Stalevo
Levodopa, carbodpa and entacapone
This is a non-ergot derivatives that has preferential affinity rto D3 family receptors
Pramipexole
half life of amantadine
2-4 hours
What is the mechanism of behavioral effects of L-Dopa
Common in patient on carbidopa because higher level reach the brain
D2 agonist
Bromocriptine
Adverse effects of Amantadine
Livedoreticularis Peripheral eddema Restlessness Hallucination Caurtion in patient with hepatic and seizure
Pergolide is not being used because of this
Development of valvular heart disease
Mechanism of action of Apomorphione
Non-ergonaline Dopa agonist in postsynaptic D2 receptor in caudate and putamen
Half-life of levodopa
1-3 hours
What is the mechanism of Ropinirole
Pure D2 receptor agonist
Mechanism of action of Amantadine
- Potentiate dopaminergic function by influencing synthesis, release or reuptake of dopamine
- Antagonize A-2A receptor that inhibit D2 receptor function
Mechanism of action of Selegeline
irreversible MAO-B inhibitor
What medication improves tremor and rigidity
Anti muscarinic
Benztropine, biperiden, trihexyphenidyl
This medication reduces the amplitude of tremor
Propanolol
May result with Serotonin syndrome if given with the following drugs
SSRI and TCA
How is Ropinirole metabolize
CYP1A2
This is a skin patch that is a dopamine agonist
Rotigotine
Reason fro GI upset with L-Dopa
Stimulation of CTZ
This drug depletes cerebral dopa and reduces the severity of chorea in HD
Tetrabenzine
Mechanism of action of COMT inhibitors
Prolong action of L-dopa by diminishinh peripheral metabolism
Erythromyelgia can be seen in this dopa agonist
Pramipexole and ropinirole
Product of excretion of Dopamine are
HVA and Dihydroxyphenelyacetic acid
What medication enhances the extracerebral metabolism of L-Dopa
Vitamin B6
Duration of effect of apomorphine
10mins to 2 hours