Parkinson's Pharm Flashcards
what is the treatment goal with Parkinson’s?
help individual maintain motor function as long as possible
how does pharm work for Parkinson’s?
by correcting the imbalance between dopamine and ACh
how do drugs work to treat Parkinson’s?
drugs either enhance dopamine or block the effects of ACh
MOA of levodopa/carbidopa (Sinemet)
–levodopa: converts to dopamine in the brain and activates dopamine receptors
–carbidopa: blocks destruction of levodopa
advantage of levodopa/carbidopa
most effective drug for PD
disadvantages of levodopa/carbidopa
–takes several months to see improvement
–does not work long-term
–adverse effects
gradual loss of effect with sinemet
–dose wears off
–may need shorter dose intervals
abrupt loss of effect with sinemet
–called the “on-off” phenomenon
–can occur anytime during dosing interval
–“off” periods increase over time
–can be reduced with drugs and avoiding high protein meals
adverse effects of sinemet
–due to levodopa
–N/V
–dyskinesias
–CV
–psychosis
–dark sweat and urine
–activate malignant melanoma
N/V side effect tips for sinemet
–give low doses with food
–BUT that reduces drug absorption
CV side effect tips for sinemet
–postural hypotension
–dysrhythmias
psychosis side effects for sinemet
–hallucinations
–nightmares
–paranoia
sinemet interactions
decrease effects of levodopa:
–vitamin B6
–antipsychotics
–protein
increase effects of levodopa:
–carbidopa
–anticholinergics
–MAO inhibitors (can cause toxicity)
duopa
–carbidopa-levodopa infusion
–instilled via feeding tube into small intestine
–gel form
–continuous infusion for continuous blood level (up to 16 hours a day)
who usually uses duopa?
patients who respond to drug but response fluctuates
important information about duopa for patients
–do not take within 2 weeks of nonselective MAOI for depression
–talk about all medications currently taking
what drugs interact with duopa?
–antihypertensives
–MAOIs
–antipsychotics
–metoclopramide
–isoniazid
–iron
–vitamins
what food interacts with duopa?
high protein
side effects of duopa
–falling asleep without warning
–orthostatic hypotension
–hallucinations
–unusual urges
–depression
–dyskinesia
–side effects related to placement of tube
classification of pramipexole
dopamine receptor agonist
MOA of pramipexole
binds with D2 receptors
indications for pramipexole
–monotherapy in early PD
–combined with Sinemet in advanced PD
–restless leg syndrome
adverse effects of pramipexole alone
–nausea
–sleep attacks
–pathologic gambling and other compulsive behaviors
adverse effects of pramipexole combined with levodopa
–orthostatic hypotension
–dyskinesias
–hallucination risk doubles
classification of ropinirole
dopamine receptor agonist
who is ropinirole used for?
those with idiopathic PD
MOA for ropinirole
exact MOA is unknown; animal studies = increase in nerve impulses within the substantia nigra
adverse effects of ropinirole
–similar to other PD drugs
–with long term use, there may be an increased risk of DM and acromegaly
examples of other dopamine agonists
–rotigotine
–apomorphine
route of rotigotine
once daily patch
route for apomorphine
short-acting SQ injection
when is apomorphine used?
fast relief of symptoms (used in the ‘off’ phases of PD)
