parkinson drugs csv Flashcards
Parkinson’s dz
most common movement do in 1-2% of pt > 65 yo with mortality 3x that of general population; #2 common neurodegenerative (#1 is alzheimer)
parkinson’s dz is aka
shaky palsy
what neurotransmitter is low in parkinson
dopamine loss of arm swing
what neurotransmitter is high in parkinson
ach (tremors)
why give drugs for parkinsons
ease s/s of dz and hep pt be mobile and function for as long as possible
parkinson drugs treat what
tremor; rigidity; akenisia and bradykinesia, postural instability; affective flattening
what kind of drugs are used for parkinson
anticholinergic, dopaminergic, adjunctive
valerian and kava kava with anticholinergic leads to
more sedation
1 drug for parkinson is
anticholinergic (also used to tx s/e of phenothizine)
can you use anticholinergic with dopaminergic
yes. Use alone or with dopaminergic
antcholinergic action
it inhibits parasympathomimetic so it blocks ach release
anticholinergic suppress
tremors and muscle rigidity
anticholinergic don’t really affect (x) that well
mobility and muscle weakness
name 7 parkinson drugs
benztropine cogentin (decrease memory and thinking), trihexyphenidyl artane, phenadrine norflex, diphenhydramine benadril (antiH2 for elder d/t can’t tolerate dopaminergic), procyclidine kemardin, ethopropazine parisdol
anticholinergic effects
dry mouth (hard candy, ice chips, sugarless gum, CONTRA COPD EMPHYSEMA will get thick dry mucous secretion; CONTRA DYSPHAGIA), flush from vasodilation, blurred vision (A SAFETY CONCERN, photophobia sunglassess, NOT FOR GLAUCOMA, get routine eye exam), dizziness, urinary retention (pee before taking anticholinergic), dysuria, tachycardia, muscle weakness, confusion, nervousness, disorientation, constipation (consume more fiber and 2-3L water)
dopaminergic increases what, stimulates (x) receptors
dopamine in substantia nigra to restore balance between inhibitory and stimulating neurons inhibit the enzyme dopa decarboxylase allowing LEVODOPA to reach brain.
dopaminergic act on what
sympathetic nervous system
dopamine affect what in the brain
the content.
name 6 dopaminergic drugs
levodopa dopar larodopa, carbidopa-levodopa sinemet combo 10/100, 25/100, 25/250, 50/200
levodopa crosses what and becomes what?
cross blood brain barrier to become dopamine; carbidopa-levodopa sinemet does this better than plain levodopa BUT LEVODOPA IS THE GOLD STANDARD
GOLD STANDARD drug for parkinson
levodopa; it increases dopamine, reduce muscle rigidity and tremor; BENEFIT IS INCREASED MOBILITY
how long before levodopa works
2-4 mon to achieve max benefit
early s/s of levodopa toxicity
spasmodic eye winking and muscle twitching; WATCH FOR EPS
Levodopa contra for
cardiac, renal, psych pt
can you stop levodopa abruptly?
no.
levodopa s/e
n/v, diskinesia, ortho low bp, cardiac dysrhthmia, psychosis
PROS and CONS of carbidopa levodopa sinemet
PRO: more dopamine reach the basal ganglia, small dose needed for effect (can increase dose to protect from nausea); CON: more levodopa, more s/e (combo IS NOT THE GOLD STANDARD)
carbidopa levodopa sinemet a/e
suicidal ideation, hallucination
carbidopa levodopa sinemet die
agranulocytosis, hemolytic anemia, thrombocytopenia, cardiac dysrhythmia, NEUROLEPTIC MALIGNANT SYNDROME
carbidopa levodopa sinemet s/e
anorexia, n/v, dysphagia, fatigue, dizzy, HA, dry mouth, bitter taste, blurred vision, insomnia, DARK URINE
how long to take sinemet
2-4 days
when to stop sinemet
when pt get rebound parkisonism; and definitely do NOT stop abruptly
sinemet not for (x) pt
glaucoma, heart dz, peptic ulcer, kidney, liver, psychosis
can you chew extended release sinemet, but do take with food to avoid GI upset even if it’s slower in absorption
nope
what interferes with sinemet
high protein diet
what color urine with sinemet
dark urine
what to report for dopamine amantadine
skin lesion, seizure, depression, SE intense with antiparkinson drugs
what to report for dopamine bromocriptine
lightheaded with position change (ortho low bp), dysrhythmia; NO ETOH, do not stop abruptly
s/e of dopamine bromocriptine
n/v, ortho low bp, palpitation, chest pain, BLE edema, vivid dreams, delusion, tolerance; so DECREASE THE DOSE
what sort of drug-drug interaction with sinemet
levodopa or bromocriptine (ortho low bp), anticholinergic, increased tyramine with MAOI so HTN crisis
do you want to do an EKG if pt on sinemet?
yes. Do ekg to monitor dysrhythmia
sinemet does not go with which vitamin
pyridoxine Vit B6 (in beans and cereal); but if Vit B6 is too low pt gets peripheral neuritis and muscle weakness; solution is to give Vit B6 before dopaminergic tx
adjunt parkinson drugs are
pram pexole mirapex
s/e adjuct PD pram pexole mirapex
nausea, dizzy, somnolence, weak, constipation, dyskinesia, hallucination
what does adjunct PD pram pexole mirapex do?
D2, D3 agonist; use in combo with levodopa; it has fewer s/e than amantidine
CONTRAS FOR DOPAMINERGIC
angle closure glaucoma, suspicious skin lesion (might be melanoma), CVD, bronchial asthma, urinary obstruction, peptic ulcer dz
why use adjunctive pram pexole mirapex
extends sinemet effectiveness so less sinemet needed; for pt who can’t tolerate max dose of sinemet
MOA-B inhibitors are used in
parkinson dz
list 2 MAOB inhibitors
selegiline eldepryl, rasagiline azilect
how does selegiline eldepryl work?
inhibit onoff fluctuation; prolong levodopa actions or delay more need for levodopa; mets tyramine in GI, so risk of HTN crisis
drug-drug interaction with MAOB inhibitor
TCA and SSRI
parkinson patient teaching
assess tremors, gait, strength, drooling, speech pattern, frustration level, injury prevention, bowel function, avoid high pyridoxine Vit B6 foods (beef, ham, egg yolk, sweet potato, oatmeal, fortified cereal); dry mouth, avoid high protein meals, day time sleepiness, dark urine/sweat/saliva, avoid OTC, increase fiber and water, monitor renal and liver function, takes several months for full effect, change position slowly, caution about low bp, caution on-off effect, fucking horny and gonna wanna gamble
ANTIDOTE FOR antiPD drug
APOMORPINE apokyn
8 Ds of dopaminergics
dizzy/drowsy/avoid driving, dyskinesia/vivid dream; decrease bp, decrease reality/hallucination; decrease protein diet/eat shortly after med; decrease pyridoxine Vit B6; discolored sweat/urine is harmless; decrease dry mouth with good hygiene.
