Parkinson's Flashcards
Levodopa - Brand Names
L-Dopa, L Doram C, Neurastoz
Levodopa - Dosages
Often combined with carbidopa or benserazide. Available in various dosages including 25/100, 25/250, and sustained release formulation.
Levodopa - Indications
Primary treatment for Parkinson’s disease. Addresses rigidity, akinesia, flat face, and gait issues.
Levodopa - Dosing
Starts with low doses and gradually increases. Often taken multiple times per day, typically with a meal or snack.
Levodopa - Adverse Effects
Nausea, vomiting, low blood pressure, dyskinesia, motor fluctuations, psychosis, hallucinations, and urine discoloration.
Levodopa - Tips
Administer with meals to decrease GI upset. Avoid high-protein foods and antacids close to dosing time.
Carbidopa - Brand Names
Often combined with levodopa.
Carbidopa - Dosages
Available in combinations such as 25mg/100mg or 25mg/250mg with levodopa.
Carbidopa - Indications
Inhibits peripheral decarboxylase to reduce levodopa’s peripheral side effects and increase its brain availability.
Carbidopa - Dosing
Given in combination with levodopa.
Carbidopa - Adverse Effects
Minimal side effects unless used at high doses, such as inhibition of cerebral decarboxylase.
Carbidopa - Tips
Typically given with levodopa. More potent than benserazide.
Benserazide - Brand Names
Often combined with levodopa as Madopar.
Benserazide - Dosages
25 & 50
Benserazide - Indications
Inhibits peripheral decarboxylase to reduce levodopa’s peripheral side effects.
Benserazide - Dosing
Given in combination with levodopa.
Benserazide - Adverse Effects
Generally minimal side effects.
Benserazide - Tips
Typically given with levodopa. Less potent than carbidopa.
Selegiline - Brand Names
Deprenyl, Eldepryl.
Selegiline - Dosages
5 mg tablets.
Selegiline - Indications
MAO-B inhibitor used in Parkinson’s disease. Reduces levodopa breakdown and has neuroprotective effects.
Selegiline - Dosing
5-10 mg daily, best taken in the morning or midday to avoid insomnia.
Selegiline - Adverse Effects
Insomnia.
Selegiline - Tips
Mild effect when used alone but enhances levodopa effects.
Entacapone - Brand Names
Comtan. Available in combination with levodopa and carbidopa as Stalevo.
Entacapone - Dosages
200 mg.
Entacapone - Indications
COMT inhibitor, used to reduce the metabolism of levodopa in the periphery.
Entacapone - Dosing
Taken with each dose of levodopa.
Entacapone - Adverse Effects
Diarrhea, blood disorders, and liver issues.
Entacapone - Tips
Should be used in conjunction with levodopa. Dose of Levodopa should be reduced by 30% when starting entacapone.
Tolcapone - Dosages
Available in 100 mg and 200 mg tablets.
Tolcapone - Indications
COMT inhibitor that works both peripherally and centrally.
Tolcapone - Dosing
Taken with each dose of levodopa.
Tolcapone - Adverse Effects
Diarrhea, blood disorders, liver issues, and risk of acute liver failure.
Tolcapone - Tips
Longer half-life and stronger effect than entacapone. Use with caution due to liver damage risk.
Pramipexole - Brand Names
Sifrol, Sifrol ER.
Pramipexole - Dosages
Available in base and salt forms (e.g., 0.25 mg base = 0.7 mg salt). Extended release versions are available. Usual dose ranges from 1.5 to 4.5 mg per day.
Pramipexole - Indications
D2 selective dopamine agonist for Parkinson’s disease. Used as monotherapy for mild disease and affects affective symptoms.
Pramipexole - Dosing
Starts at 1.5 mg daily and increases every two weeks to a maximum of 4.5 mg.
Pramipexole - Adverse Effects
Nausea, vomiting, low blood pressure, psychosis, sudden sleep attacks, and compulsive behaviors.
Pramipexole - Tips
Caution advised with driving. Renally excreted, use with caution in patients with kidney disease.
Ropinirole - Brand Names
Requip, Ralnea XL.
Ropinirole - Dosages
Available in 0.25 mg and 1 mg tablets, with extended release versions available. Typical dose is 3-24 mg per day.
Ropinirole - Indications
D2 dopamine agonist used in Parkinson’s disease.
Ropinirole - Adverse Effects
Nausea, vomiting, low blood pressure, psychosis, sudden sleep attacks, and compulsive behaviors.
Ropinirole - Tips
Hepatically metabolized, may be useful in patients who cannot tolerate pramipexole.
Amantadine - Dosages
100 mg and 300 mg capsules.
Amantadine - Indications
Antiviral drug used to treat dyskinesia in Parkinson’s disease. Has anticholinergic properties and may affect dopamine reuptake.
Amantadine - Dosing
100 to 300 mg per day.
Amantadine - Adverse Effects
Livedo reticularis, peripheral edema, hallucinations, psychosis, urinary retention, and dry mouth.
Amantadine - Tips
Tolerance to its effects can develop. Use with caution in elderly patients due to anticholinergic effects.
Trihexyphenidyl - Brand Names
Artane.
Trihexyphenidyl - Indications
Anticholinergic, mainly used for tremor in Parkinson’s disease.
Trihexyphenidyl - Adverse Effects
Confusion, hallucinations, dry mouth, and urinary retention.
Trihexyphenidyl - Tips
Not recommended for elderly patients.
Biperiden - Indications
Anticholinergic, mainly used for tremor in Parkinson’s disease.
Biperiden - Adverse Effects
Confusion, hallucinations, dry mouth, and urinary retention.
Biperiden - Tips
Not recommended for elderly patients.
Diphenhydramine - Indications
Anticholinergic, can be used for drug-induced parkinsonism.
Pimozide - Brand Names
Orap, Orap forte.
Pimozide - Dosages
2 mg and 4 mg tablets.
Pimozide - Indications
Antidopaminergic drug used for tics, including Tourette’s syndrome.
Haloperidol - Indications
Antidopaminergic medication. Not used in Parkinson’s, but can be used for chorea in Huntington’s disease.
Clozapine - Indications
Atypical antipsychotic used to treat psychosis associated with Parkinson’s disease.
Clozapine - Tips
Works through a mechanism different from dopamine pathways.
Quetiapine - Indications
Atypical antipsychotic used to treat psychosis associated with Parkinson’s disease.
Quetiapine - Tips
Works through a mechanism different from dopamine pathways.
Tetrabenazine - Indications
Depletes dopamine stores in the nerve terminal, used to treat Huntington’s disease.
Tetrabenazine - Adverse Effects
Extra pyramidal symptoms may develop.