Neurodegenerative disease pharm Flashcards
L-DOPA
Treat Parkinson’s
Restore dopamine in basal ganglia
Given w/:
Carbidopa-inhibits L-AAAD in peripheral tissue
Entacapone-COMT inbitior
Effects short-live (not used until impaired)
L-DOPA side effects
Dyskinesias
Dementia/confusion/psychosis
Postural hypotension
Hypertension
L-DOPA drug interactions
Pyridoxine (vit b6 incraeses peripheral dopa) MAO inhibitors (cause hypertension) Halothane (arrhythmias) Typical antipsychotics (DA antagonists)
L-DOPA contraindications
Glaucoma
Psychosis
Cardiac arrhythmias
Malignant melanoma (catecholamines promote)
Dopamine receptor agonists
D2 agonists: (initial therapy in young)
Pramipexole & Ropinerole
D4 agonists (2-5): (refractory to others) Apomorphine
Side effects of Pramipexole and Ropinerole
Nausia
Fatigue
Sudden daytime sleep attacks
CNS toxicity (esp. in elderly)
MAO-B Inhibitors
Prolongs dopamine action
Selegiline
Rasagiline
Usually prescribed at diagnosis
Modest benefit
Selegiline and Rasagiline side effects
Metabolized to amphetamine/methamphetamine
~anxiety and insomnia
Can lead to serotonin syndrome (stupor, rigidity, agitation, hyperthermia)
COMT Inhibitors
COMT metabolizes dopamine
Tolcapone (hepatotoxicity)
Entacapone
Tolcapone and Entacapone side effects
Nausea
Orthostatic hypotension
Vivid dreams
Hallucinations
Tolcapone causes liver toxicity (rarely used)
Antimuscarinics
Dopamine normally inhibits cholinergic system
Loss of dopamine results in overactivity
Trihexyphenidyl
Benztropine
*Third choice
Side effects of antimuscarinics
Sedation/confusion
Atropine like effects (GI/voiding)
Amantadine
Anti-Viral agent used for Parkinson’s
Increased dopamine release
Anticholinergic
Blocks NMDA receptors
*less effective (used in combo)
Amantadine side effects
Dizziness
Lethargy
Sleep disturbances
Sympathetic effects
CONTRAINDICATED IN CHF
Memantine
Alzheimer’s treatment
NMDA antagonist
S/W: Dizziness, confusion, hallucinations
