Movement Disorders Pharm Flashcards
name the Monoamine oxidase inhibitors
Selegiline (Eldepyrl), Rasagiline (Azilect)
name the Dopamine agonists
Ropinirole (Requip), Pramipexole (Mirapex), Pergolide (Permax), Bromocriptine (Parlodel)
name the Catechol-o-methyltransferase inhibitor
Entacapone (Comtan)
name the Acetylcholine-blocking agents
Benzotrpine mesylate (Cogentin), Biperiden (Akineton), Trihexyphenidyl (Artane)
name the N-Methyl-D-aspartate (NMDA) receptor inhibitor
Apomorphine (Apokyn)
Gold standard of Parkinson tx
Levadopa/Carbidopa (Sinemet)
Completely or partially relieves akinsesia, rigidity and tremor in about 80% in Parkinson’s
Levadopa/Carbidopa (Sinemet)
For what drug does the effectiveness substantially decreases after 3rd year of treatment and may return to pretreatment levels in 6-7 years
Levadopa/Carbidopa (Sinemet)
Preferred initial treatment in patients over 70, particularly those with dementia
Levadopa/Carbidopa (Sinemet)
Why should you delay the use of Levadopa/Carbidopa (Sinemet)?
may directly hasten the degeneration of dopamine neurons in the substantia nigra by promoting the generation of free radicals and oxidative stress
Major physical adverse effect of Levadopa/Carbidopa (Sinemet)
Dyskinesias (80%)
When might the wearing off effect of Levadopa/Carbidopa (Sinemet) occur?
occur within 4-6 years of treatment
CI to Levadopa/Carbidopa (Sinemet)
Concurrent use with MAOI’s, Psychotic patients, Angle-closure glaucoma, Hx of melanoma
unpredictable, alternating periods of dyskinesia and immobility
on-off effect
If a patient is experiencing the wear-off effect, what can be added to their regimen to improve efficacy?
dopamine agonists, MAOB’s and COMT inhibitors
Stops the breakdown of dopamine and Enhances peak levadopa levels
MAO-B inhibitors
Major adverse effect of MAO-B inhibitors
insomnia
Medication CI to MAO-B inhibitors
Concurrent use with TCA’s, SSRI’s and Demerol
Often 1st line in patients with mild disease to slow progression and delay need for levadopa or
as adjunctive therapy to decrease “wearing off”.
MAO-B inhibitors
MOA of dopamine agonists
Stimulate dopamine receptors in the substantia nigra
Effective in delaying motor complications during the first 1-2 years of treatment
Dopamine agonists
CI to dopamine agonists
psychotic illness, recent MI, PUD, PVD
To treat acute episodes of “hypermobility” or “freezing”
Apomorphine (Apokyn)- dopamine agonist
What does Apomorphine (Apokyn) need to be given with?
antiemetic due to profound nausea as SE but can’t use Zofran or Kytril
Increases concentration of existing dopamine in the brain by inhibiting its breakdown
COMT Inhibitors
Potentiates dopaminergic function by influencing the synthesis, release or reuptake of dopamine. favorably influences akinesia, rigidity. Not really effective with tremor
Amantadine
Type of drug used primarily for tremor
Anticholinergic Acetylcholine-blocking Drugs
CI to Anticholinergic/Acetylcholine-blocking Drugs
BPH, Obstructive GI disease, Angle closure glaucoma
Antioxidant important for cellular energy
Coenzyme Q
Drug that has neuroprotective effect
Selegiline