Drugs in Parkinson's Flashcards
resting tremor in parkinosns Is what frequency
4-6Hz
Healthy looks black – neuromelanin = believed to protect neruones from oxidative stress
Men more affected
dementia usually later seen in parkinosns
what is the amino acid precursor fro L -dopa before dopamine
tyrosine - melanin comes off this
COMT and MAO degrade this
Akineton( biperiden) is a prescription medicine used to treat the symptoms of
Akineton may be used alone or with other medications. Akineton belongs to a class of drugs called Anticholinerigic.
stiffness, tremors, spasms, and poor muscle control of Parkinson’s disease.
l-dopa and carbidopa as well a entacapoone , bromocritien and rasagiline act on substantial nigra to prevent
akinesia
Excitotoxicity
neural injury from excess glutamate - mediated by NMDA increases calcium influx initiation destructive processes
in Parkinson there is relatively more cholinergic and GABA. activity
dopamine agonist example
pramipexole
L -dopa need converting by decarboxylase into dopamine peak plasma time of 0.5-2 hours long and whats if half life
1-3 Horus so short
use early if motor symptoms affect quality of life
can carbidopa cross blood brain barrie r
no
given together to improve efficacy
A 72-year-old female patient with PD runs into big financial
problems. Her husband reports that with her credit card, she has
purchased online 150 designer handbags.
1. Which drugs could have caused the symptoms?
2. How can the problem be solved?
In principle, all drugs stimulating the dopaminergic
system cause the pathological shopping behaviour.
Most important causes are levodopa + carbidopa,
followed by dopamine agonists such as
bromocriptine, MAO-B inhibitors such as rasagiline,
and the COMT inhibitor entacapone.
The patient and her husband have to be informed
about the link between the pathological shopping
behaviour and the medication. In the next step, a dose
MOA-b inhibitors example
rasagiline
A 72-year-old female patient with PD runs into big financial
problems. Her husband reports that with her credit card, she has
purchased online 150 designer handbags.
1. Which drugs could have caused the symptoms?
2. How can the problem be solved?
In principle, all drugs stimulating the dopaminergic
system cause the pathological shopping behaviour.
Most important causes are levodopa + carbidopa,
followed by dopamine agonists such as
bromocriptine, MAO-B inhibitors such as rasagiline,
and the COMT inhibitor entacapone.
The patient and her husband have to be informed
about the link between the pathological shopping
behaviour and the medication. In the next step, a dose
reduction has to be considered.
Disconnection from the Internet has to be considered as
well, but practically, this is difficult to accomplish.
In the end, one has to find a good compromise
between therapeutic effects and ADRs that needs to be
negotiated between the neurologist, the patient, and
her family.
1st line treatment for Parkinsonism
MOA- B inhibitor, dopaminergic agent and amatidine and exercise and add additional l-doap and doperidoen if needed
amatadniden is anti-viral
anticholinergic
L dopa improves motor symptoms, activates in daily living but has motor complications compared to dopamine agonists or MOA-B inhibitors but what has more adverse events
dopamine agonists
moderate Parkinson 1st line
MOA-B INHBITR, DOPAMINERGIC AGETN, amantidine
exericse
if refractory tremor - deep brain stimulation
with wearing off - add more caarbidopa and L -dopa
