Parkinson's Disease Flashcards
This is the immediate precursor to dopamine. It is the gold standard for treatment of Parkinson’s. Crosses the BBB
Levodopa
This drug inhibits aromatic L-amino acid decarboxylase in the periphery
Carbidopa
What are 3 strategies to address wearing off of Levodopa/Carbidopa
- increase dose or dose number
- add a dopamine agonist
- use a COMT inhibitor
ADRS are N/V/anorexia, tachycardia, arrhythmias, visual and auditory hallucinations, depression, mania, anxiety, dyskinesia
Levodopa/Carbidopa
Drug interactions with vitamin B6 (pyridoxine), MAO inhibitors, antipsychotics
Levodopa/Carbidopa
This class of drugs have reduced risks of motor complications and dyskinesias compared to Levodopa/Carbidopa
Dopamine agonists
These two dopamine agonists are FDA indicated as monotherapy
Pramipexole
Ropinirol
This class of drugs can be neuroprotective. It decreases autooxidation and free radical formation in the brain. Reduces levodopa requirements
Dopamine agonists
ADRs include N/V, orthostasis, psychosis, narcolepsy
Dopamine agonist
Can cause increased risk of compulsive gambling due to stimulation of dopamine release in the mesolimbic pathway
Dopamine agonists
This dopamine agonist has a 3 hour half life, high first pass metabolism and is highly protein bound
Bromocriptine
This dopamine agonist has an 8-12 hour half life and is renally excreted
Pramipexole
Adverse effects include sedation, hypotension, delusions or psychosis, dyskinesias, N/V, and leg edema
Dopamine agonists
This dopamine agonist is transdermal, has a high affinity for DA receptor subtypes, and can be used as monotherapy or adjunct therapy
Rotigotine
AEs of this dopamine agonist include application site rxns, nausea, somnolence, sudden onset of sleep, and brief LOC while driving
Rotigotine
This MAOB inhibitor can extend the time before l-dopa is needed by 9 months and can extend its action for up to an hour
Selegiline
ADRs include insomnia, jitteriness, HTN, worsen preexisting hallucinations and delusions. Can cause a rare serotonin syndrome with concomitant SSRI treatment
Selegiline
This is transdermal Selegiline
Emsam
This is a selective, irreversible MAO-B inhibitor that is 5x more potent than Selegiline
Rasagiline
2 Parkinsons drugs metabolized by CYP 1A2
Ropinirole, Rasagiline
This drug is used as an adjunct to L-dopa, is more efficacious than anticholinergic agents, and relieves symptoms of bradykinesia, rigidity, and tremor
Amantidine
This drug has fewer side effects than L dopa or anticholinergic agents. Can cause hallucinations. confusion, and nightmares when administered with an anticholinergic
Amantidine
ADRs include insomnia, dizziness, and slurred speech. CAUTION in patients with renal disease
Amantidine
Indicated for tx in pts with PD experiencing end of dose wearing off with l-dopa
COMT inhibitors
These agents have NO ROLE AS MONOTHERAPY
COMT inhibitors
This COMT I is highly protein bound and readily absorbed. You need to do strict LFT monitoring, DC if signs of liver failure (there is even an informed consent on package insert)
Tolcapone
Can cause delayed onset diarrhea and brownish orange fluid discoloration, and orthostasis
Tolcapone
This COMT I causes diarrhea and orthostasis, brownish-orange urine discoloration, but NO evidence of hepatotoxicity
Entacapone
This drug is a combo of carbidopa, levodopa, and entacapone
Stalevo
These 2 anticholinergic drugs arent as effective as l-dopa but CAN be effective against tremor and dystonic features. Ineffective against bradykinesia
Trihexphenidyl
Benzotropine
ADRS: dry mouth, blurred vision, constipation, urinary retention, sedation memory impairment, confusion, dysphoria, hallucinations
Anticholinergics
