Lecture 1 Flashcards
What are the Treatments for Parkinsons Disease
DA Replacements
DA receptor agonists
COMT inhibitors
MAO B inhibitors
Anticholinergics
Amantadine
what are DA replacement medications
Levodopa and Carbidopa
what is Levadopa
DA replacement medication
Crosses BBB
taken up into neurons and converted by DA decarboxylase to Dopamine
Extremely effective in early treatment - over time may develop motor fluctuation
AE: dyskinesia, hallucinations/confusion and Nausea, hypotension and arrythmias
what is Carbadopa
peripheral inhibitor of L-dopa
prevents conversion to DA in periphery
does not cross BBB
reduces peripheral side effects and allows for more drug to reach the brain
what are DA receptor agonists
Ropinirole
Bromocriptime
Pramprexole
what is Ropinirole
D2, D3, D4 receptor agonist
useful in treatment of Parkinsons and restless leg syndrome
metabolized by CYP450
AE: drug interactions, less risk of cardiac valve fibrosis, D3 agonism is linked to increased risky behavior (gambling/hyper-sexuality)
What are COMT inhibitor medications
Entacapone
what is Entacapone
COMT inhibitor
secondary pathway to metabolize levodopa as well as DA and NE
prevents degradation of Levodopa
AE: dyskinesia, Nausea and Diarrhea
What are MAO B inhibitors
Selegiline
Rasagiline
what is Selegiline
MAO B inhibitor
prevents metabolism of DA
selective for Straitum, mild effect
reduces dose of Levodopa needed
Metabolized in liver by CYP450
AE: ampetamine like side effects, Seratonin syndrome
What are anticholinergic medications used to treat Parkinsons
Trihexyphenidyl
Benztropine
What is Trihexyphenidyl
anticholinergic
effective at reducing dyskinetic movements and spastic contractions
often used in combo with DA drugs
AE: anticholinergic side effects: sedation, confusion, constipation, urinary retention, HTN tachycardia
pharmacokinetics: excreted unchanged
What is Amatadine
Treatment for Parkinsons
Anti-viral medication
increases DA release and blocking NMDA reuptake
used in akinetic crisis
less effective than L-dopa
AE: may cause confusion/psychosis
What are medications used for Alzheimers treatments
Cholinesterase inhibitors and NMDA anatgonists
what are cholinesterase inhibitors used to treat Alzheimers
Donepezil
Rivastigmine
what is Donepezil
Cholinesterase inhibitor
goal is to raise Ach levels in damaged areas of the brain
readily enters the CNS, relatively long lasting and may also increase ACh synthesis and release
metabolism through acetylcholinesterase activity - thus no major drug interactions
AE: GI disturbances (N/V/D), sleep disturbances - vivid dreams
What is NMDA antagonist medications used to treat Alzheimers
Memantine
what is Memantine
NMDA antagonist used to treat Alzheimers
blocks pathological activation of NMDA receptors
thought to reduce excitotoxicity
not as effective as Donepezil, but useful for patients that do not respond or cannot tolerate side effects
can be used in addition to Donepezil
AE: Dizziness, headache, constipation, confusion
What are the symptomatic treatment of essential tremors
Beta Blockers
Anticonvusants
what are the beta blockers used to treat essential tremors
Propranolol
what are the anticonvulsants used to treat essential tremors
Primidone and Gabapentin
What are the groups of medications used to treat seizures
Glutamate inhibitors and GABA protectors
What are the subtypes of Glutamate inhibitors
Sodium channel blockers
Calcium channel blockers
SV2A blockers???
What are Migraine medicatiosn
Sumatriptan and Ergotamine
what is Sumatriptan
used for migraines
5-HT1 receptor
serotonin agonist, acting on small peripheral nerve receptors that innervate intracranial vascular
can be given SubQ, Intranasal or orally
short duration of action, elimination half life of 2 hours
AE: significant increase in BP and cardiac events, pain and pressure sensation in the chest, neck, throat and jaw
do not use for CAD patients
What is Erotamine
migraine medication
all 5-HT receptors
given IV
biological activity of a vasoconstrictor
binds to several receptors acting as an agonists and causes constriction of intracranial extracerebral BV through serotonin receptors and by inhibiting trigeminal neurotransmission
AE: hepatotoxic
What are sodium channel blocker medications used to treat epilepsy
Carbamazepine
Lamotrigine
Phenytoin
What are the calcium channel blockers used to treat epilepsy
Ethosuximide and Pregabalin
What are prophylactic medications used to prevent Migraines
Propranolol
anticonvulsants
CGRP antagonists
what are the acute headache management medications
NSAIDs
Triptains
Ergots
steroids
