How to treat parkinsons Flashcards
why do ppl get parkinson’s
striatum in the extrapyrimidal area gets messed up bc of an imbalance of dopamine and acetylcholine due to degeneration of neurons that supply dopamine
What is purpose of drug therapy
prolong/improve quality of life
NO CURE - NO STOPPING DISEASE PROGRESSION
catagories of parkinson drugs
Dopaminergic agents
-more common
-promote activation of dopamine receptors
-Levodopa
Anticholinergic agents
-prevent activation of cholinergic receptors
Benztropine
Drugs for mild symptoms
MAO-B inhibitors
-selegiline
-rasagiline
drugs for more severe symptoms
Levodopa or dopamine afonist
-Levodopa works better, but more risks esp for dyskinesias
Management of motor fluctuations (“on off”
dopamine agonists
COMT inhibitors
MAO-B inhibitors
Levodopa
-co drug
-diagnostic purpose
-how long does it last
carbidopa
diagnosis of PD questioned if levodopa fails
Works well for 2 years; stops working by end of yr 5
How does levodopa work
increases dopamine synth in striatum
crosses BBB and is converted to dopamine
Levodopa adverse effects
N/V from activation of chemoreceptor trigger zone
**helps to start w/ low dose w/ food and carbidopa
Cardiovascular issues
Ortho hypo
**helps to increase Na+ and H2O intake
Psychosis/ hallucinations/ nightmeres/ paranoia/ memory issues/ impulse control
**helps to lower dosage
Dyskinesias
*** helps to reduce dose, add amantadine, have surgury/electrical stimulation
Dark sweat/urine
Activates malignant melanoma
Levodopa drug interactions
1st gen antipsychotics block levodopa effects
MAO inhibitors –> htn crisis if nonselective
Anticholinergic drugs –> increases dyskinesias
Pyridozine –> reduces effect of levodopa
***taken care of by carbodopa
Carbidopa
*useless by itself
*increases levodopa effects by stopping decarboxylation –> don’t need as much levodopa
*cant cross BBB
*literally no downside
Dopamine agonists
1st line drugs
Ergot derivitives: Bromocriptine and Cabergoline
Nonergot derivatives: Pramipexole, Ropinirole, Rotigotine, Apomorphine,
Pramipexole
used alone early on; then with levodopa later
takes a while to work
Sleep attacks
same side effects of levodopa including compulsive behavior
Ropinirole
Used early alone and later with levodopa
Don’t use when pregnant
Same side effects as levodopa –> compulsive behavior
Rotigotine
Used throughout PD treatment
good for restless leg syndrome
dose-related hallucination and dyskinesia
Apomorphine
Treats hypomobility during off episodes
DONT GIVE PO
Only use acutely
Bromocriptine and Cabergoline
Bromo: approved for PD
-directly activates dopamine receptors
-used early alone and later with levodopa
-reduces dyskinesias and allows for lower levodopa dose
-adverse effects of fibrosis and Raynaud stuff
Cabergoline: not approved
-maybe effective during off times
COMT inhibitors
-stop peripheral metabolism of levodopa
Entacapone
- side effects = yellow/orang urine and GI issues
- keeps levodopa working longer
Tolcapone
- not as safe
-keeps levodopa working better and longer at lower doses w/o motor function issues
LIVER FAILURE
Lev/Carb/Entacapone
-available in 3 strengths in immediate dose tablets
MAO-B inhibitors
1st line drugs with modest benefits
combo with levodopa
Selegiline
-by itself or with levodopa
-improves motor funcs and helps lev work better
-good for 1-2 yrs
Rasagiline
-Can cause insonmnia, ortho hypo, mouth issue, htn
-bad with levodopa, meperidine, and SSRIs
Amantadine
-was an antiviral first
-response w/in 3 days
-Not first line or very effective, but can help with dyskinesias from levodopa
-dries you up and blurs vision and fucks up skin color
Centrally acting anticholinergic drugs
Benztropine
-helps reduce tremors
-2nd line therapy
-Bad for old ppl bc of sedative and psych effects
- GI issues, peeing, ortho hypo, sleep issues, depression, dementia, psychosis
Depression when taking PD meds
only take amitriptyline
Tricyclic antidepressants
-anticholinergic effects exacerbate dementia
-antiadrenergic effects exacerbate hypotension
