Parkinson's Medications

Question 1

L-Dopa

Answer 1

can cross BBB (dopamine cannot)
Indic: Parkinsons (replace dopamine)
SE: N/V, anorexia (dopamine stims CTZ), hypotension, choreiform movements, insomnia, anxiety
usu combined with peripheral dopa-decarboxylase inhibitor
Tx only effective w/in 5 years
NEVER USE WITH MAOI–> hypertensive crisis
CI IN SCHIZOPHRENIA (may worsen psychotic Sxs)
NEVER USE WITH DOPAMINE BLOCKERS (NEUROLEPTICS)

Question 2

Sinemet

Answer 2

L-Dopa plus Carbidopa
PO TID/QID dosing
SE: nausea (less than with L-dopa alone), hallucinations, nightmares, dyskinesia, chorea

Question 3

Bromocriptine/ Parlodel

Answer 3

Dopamine agonist
Indic: Parkinsons, acromegaly, prolactin secreting adenomas
PO, crosses BBB, used to delay/augment L-dopa Tx
SE: nausea, HTN, Hypotension, confusion, hallucinations, HA, depression, dyskinesia, seizures, pulmonary fibrosis *

Question 4

Benzotropine/ Cogentin

Answer 4

Anticholinergic, agonist of muscarinic receptor sites
useful in treating parkinson tremors/drooling, and in diminishing SEs of other parkinsonian drugs
Indic: Parkinsons with prominent tremor/drooling, cognitive impairment
SE: dry mouth, blurred vision, urinary retention, constipation, confusion, drowsiness, disorientation, memory impairment, visual hallucinations, psychosis exacerbation

Question 5

Amandatine/ Symmetrel

Answer 5

anti-viral, anti-parkinsons
NMDA receptor antagonism–> reduced dopamine reuptake
Indic: used to Tx early parkinsons, or as adjunct in later stages with L-dopa
Indic: Influenza A, PD
SE: light headedness, confusion, drowsiness, nightmares, dry mouth, constipation, urine retention, N/V
short-lived effect (~6months)

Question 6

Relative strength/ efficacy in Parkinsons drugs:

Answer 6

L-dopa > Bromocriptine > Symmetrel > Benztropine/Cogentin

Question 7

Advanced parkinson Tx options:

Answer 7

surgical

neurostimulation, pallidotomy, thalamotomy, fetal cell implantation