Parkinson's meds

Question 1

These Drugs Either…

Answer 1

Enhance Dopamine
-“Dopaminergic”

OR

Block the effects of ACh
-“Anticholinergic”

Question 2

Levodopa/Carbidopa (Sinemet)

Answer 2

MOA:

• Levodopa: converts to dopamine in the brain and activates dopamine receptors
• Carbidopa: blocks destruction of levodopa

Advantage
-Most effective drug for PD

Disadvantage

• Take several months to work
• Does not work long-term
• Adverse effects

Question 3

Sinemet: “Loss of Effect”

Answer 3

Gradual loss of drug effect

• dose wears off
• may need shorter dose intervals

Abrupt loss of effect

• Called the “on-off” phenomenon
• Can occur anytime during dosing interval
• ‘OFF” periods increase overtime
• Other drugs can reduce effectiveness also avoiding high-protein meals

Question 4

Sinemet: Adverse Effects

Answer 4

Adverse effects are due to Levodopa

N/V

• give low doses with food
• But this reduces drug absorption

Dyskinesia’s (80%)
-range from annoying to disabling

Cardiovascular

• postural hypotension
• Dysrhythmias

Psychoses (20%)

• hallucination
• Nightmares
• paranoia

Others

• Darken sweat and urine
• active malignant melanoma

Question 5

Sinemet Interactions

Answer 5

Decrease effects

• Vitamin B6
• Antipsychotics
• protein

Increase effects

• Carbidopa
• Anticholinergics
• MAO inhibitors (can cause toxicity)

Question 6

Duopa

Answer 6

Carbidopa-Levodopa Infusion

• approved 2015
• instilled via feeding tube into small intestines
• gel form
• continuous infusion for continuous blood level (up to 16 hours)

Patients who respond to drug but response fluctuates

Question 7

Duopa Info

Answer 7

Do NOT take within 2 weeks of nonselective MAOI, for depression

Talk about all the medications currently taking

Question 8

DUOPA Interactions

Answer 8

Anti-HTN meds
MAOI
Antipsychotic
Metoclopramide
Isoniazid
Iron
Vitamins

Question 9

Duopa Side effects

Answer 9

SE:

• Falling asleep without warning
• Orthostatic hypotension
• Hallucinations
• Unusual urges
• Depression
• Dyskinesia

Side effects also include those related to placement of feeding tube

Question 10

Pramipexole (Mirapex)

Answer 10

Class:
-Dopamine receptor agonist

MOA:
-Binds with D2 receptors

Indications:

• Monotherapy in early PD (younger patients)
• Combines with Sinemet in advanced PD
• Also used to treat Restless leg syndrome

Question 11

Pramipexole (Mirapex) AE

Answer 11

Pramipexole Alone:

• Nausea
• Sleep attacks
• Pathologic gambling and other compulsive behaviors

Combines with levodopa

• Orthostatic Hypotension
• Dyskinesia’s
• Hallucination risk doubles

Question 12

Ropinirole (Requip)

Answer 12

Dopamine receptor agonist
-for idiopathic PD

MOA: Unknown
-in animal studies: increase in nerve impulses within the substantia nigra

AE: similar to other PD drugs
-With long-term use there may be an increased risk of DM and Acromegaly

Question 13

Other Dopamine Agonists

Answer 13

Rotigotine (Neupro)
-once daily patch

Apomorphine (Apokyn)

• Short acting subq
• for fast relief of symptoms (used for “OFF” phases)