Chapter 47 - Parkinson's Disease and Anticholinergics

Question 1

levodopa/carbidopa (Sinemet)

Answer 1

Class: Dopamine Receptor Agonists

Question 2

levodopa/carbidopa (Sinemet)
MOA:
Uses:
AE:

Answer 2

MOA: Increase the amount of dopamine in the brain; mostly given with carbidopa –> makes more drug available to brain with lower dose. Levodopa converts to dopamine once in the brain (carbidopa does not cross BBB)
Uses: PD, parkinsonism diseases, RLS
AE: Headache/anxiety, depression, SI, cardiovascular effects

Question 3

tolcapone (Tasmar)

Answer 3

Class: Catechol-O-Methyltransferase Inhibitors

Question 4

tolcapone (Tasmar)
MOA:
Use:
Admin:
AE:
BBW:

Answer 4

MOA: Inhibits metabolism of levodopa in the bloodstream –> increases duration of drug in the body
Use: Idiopathic PD
Admin: Only in conjuction with levodopa/carbidopa
AE: CNS, cardiovascular, dermatologic, GI, respiratory effects. Fulminant liver failure, disorientation, confusion, hallucinations, psychosis
BBW: Acute fulminant liver failure –> LFTs initially and Q 2 weeks

Question 5

atropine sulfate (“belladone alkaloid”)

Answer 5

Class: Anticholinergic

Question 6

atropine sulfate ("belladone alkaloid")
MOA: 
Actions:
Uses:
AE:

Answer 6

MOA: Competitively blocks the effects of Ach at muscarinic cholinergic receptors. It prevents the action of Ach in the CNS
Actions: Dilates bronchi, depresses salivary and bronchial secretions, inhibits vagal influences on heart, relaxes GI and GU tracts, inhibits gastric acid secretion, relaxes pupil of eye
Uses: Restore cardiac rate and arterial pressure, relieves bradycardia, cholinergic crisis, decreases secretions resp. tract, antidote for muscarinic poisoning
AE: Cardiovascular, CNS, GI, decreased sweating, Anticholinergic toxicity (“blind as a bat, mad as a hatter, red as a beet, hot as Hades, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone”) –> like SLUD in cholinergic

Question 7

benztropine mesylate (Cogentin)

Answer 7

Class: Centrally Acting Anticholinergic

Question 8

benztropine mesylate (Cogentin)
MOA:
Use:
AE:
Contra:

Answer 8

MOA: Acts in CNS and believed to help normalize imbalance of cholinergic and dopaminergic neurotransmitters in basal ganglia
Use: Parkinsonism, extrapyramidal disorders (tardive dyskinesia)
AE: Disorientation, confusion, hallucinations, memory loss, psychosis, agitation, euphoria, light-headedness, depression, giddiness, heaviness in limbs
Contra: Glaucoma, GI obstruction, prostatic hypertrophy, urinary obstruction, MG

Question 9

oxybutynin (Ditropan)

Answer 9

Class: Urinary Antispasmodics

Question 10

oxybutynin (Ditropan)
MOA: 
Use:
AE:
Contra:

Answer 10

MOA: Acts directly to relax the smooth muscle and inhibits the effects of Ach at muscarinic receptors (inhibiting effects needed for contraction, not allowing bladder to contract –> so not allowing incontinence episodes)
Use: Relieve the symptoms of urinary incontinence and frequency that accompany an overactive bladder
AE: Drowsiness, dizziness, blurred vision, nausea, urinary hesitancy, decreased sweating
Contra: Similar to other anticholinergics