Ch 21 drugs for PD

Question 1

Cardinal Symptoms of PD

Answer 1

-Dyskinesias

• tremor at rest
• rigidity (due to loss of involuntary movement)
• postural instability
• bradykinesia (slowed movement)

-In adition to motor symptoms

• autonomic disturbances
• depression
• psychosis and dementia

Question 2

Causes of PD

Answer 2

• inbalance of dopamine/ ACh in the striatum
• dopamine is absent causing ACh excessive stimulation of neurons that release gamma aminobutyric acid

Question 3

two main categories of PD drugs

Answer 3

• Dopamine agents
• promote activation of dopamine receptors
• Levodopa [dopar]
• Anticholinergic agents
• prevent activation of cholinergic receptors
• Benztropine [cogentin]

Question 4

PD drug mnemonics

Answer 4

SALAD

S= selegiline

A= anticholinergics (trihexphenidyl, benzhexol, ophenadrine)

L= Levedopa + peripheral decarboxylase inhibitor (carbidopa, benserazide)

A=amantadine

D= dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide)

Question 5

drug selection determined by symptoms

Answer 5

• Mild symtoms: MAO-B inhibitor
• selegiline
• rasagiline
• More sever symptoms
• Levodopa combined w/ carbidopa or dopamine agonist
• Management of motor fluctuations
• “off times” reduced with dopamine agonist, COMT inhibitor, MAO-B inhibitors
• drug induced dyskinesias

Question 6

Levodopa

(only given in combo w/ carbidopa or carbidopa/entacapone mix)

Answer 6

• highly but benifits deminish over time
• reduces symptoms by increasing dopamine synthesis in striatum. (Making dopamine more available)

“wears off” towards end of dosing. ways to prevent wear off

• shortening dose interval
• giving drug to prolong levodopa plasma half life

(entacapone)

-give direct acting dopamine agonist

HAS ALOT OF ADVERSE EFFECTS!!!

-causes dark sweat and urine *pt. teaching*

Food interactions: (**Pt Teaching*)

-meals w/ high protein content can reduce therapeutic responses of levodopa