Parkinson's Pharm (Exam 2) Flashcards
Parkinson’s Disease: Pharmacotherapy
Correct imbalance between dopamine and ACH
Drugs either enhance dopamine (Dopaminergic)
or
Block the effects of ACH (Anticholinergic)
Treatment Goal of Parkinson’s Disease
Help people maintain motor function for as long as possible
Parkisons treatment is started when
Symptoms start to interfere with dominant hand / work / adl / social function
Sinemet is
combination of levodopa and carbidopa
levodopa/carbidopa (Sinemet): MOA
Levodopa = Converts to dopamine in the brain and activates dopamine receptors (increase dopamine)
Carbidopa = Blocks destruction of levodopa
Sinemet: Advantage
Most effective drug for Parkinson’s Disease
Sinemet: Disadvantages
Takes several MONTHS to see improvement
Does not work long term
Adverse effects
Sinemet: Gradual loss of Effect
-Dose wears off
-May need shorter dose intervals
Sinemet: Abrupt Loss of Effect
-Called on-off phenomenon and can occur anytime
-Off periods increase overtime
-Can be reduced with drugs and avoiding high protein meals
Sinemet: Adverse Effects
Related to levodopa
N/V
-Give with food
-Will decrease absorption
Dyskinesias (80%)
-Range from annoying to disabling
Cardiovascular
-Postural Hypotension
-Dysrhythmias
Psychosis (20%)
-Hallucinations
-Nightmares
-Paranoia
Darken sweat and urine
Activate malignant melanoma
(good skin assessments beforehand)
Sinemet: Interactions that decrease effects
-Vitamin B6
-Antipsychotics
-Protein
Sinemet: Interactions that increase effects
-Carbidopa
-Anticholinergics
(block ACH)
-MAO Inhibitors (Toxicity)
Duopa
Carbidopa - Levodopa Infusion
Instilled via feeding tube into small intestine
Gel form
Continuous infusion for continuous blood level (16 hrs per day)
Duopa is given for people who
PO L/C drug isn’t lasting long enough (on / off effect)
Duopa: NSG Consideration
Do not take within 2 weeks of non selective MAOI, for depression
Talk about all medication currently taking
Duopa: Interactions
Anti-HTN
MAO-I
Antipsychotic
Metoclopramide
Isoniside
Iron
Vitamins
Protein
Doupa: Adverse effects
Falling asleep without warning
Orthostatic hypotension
Hallucinations
Unusual urges
Depression
Dyskinesia
PLACEMENT OF PEJ
pramipexole: Class
Dopamine Receptor Agonist
Stimulates dopamine receptors (more dopamine)
pramipexole: MOA
Binds with D2 receptors and stimulates the receptors
D2 = Dopamine receptors
what is pramipexole also used to treat?
Restless leg syndrome
pramipexole: Indications
Monotherapy in early PD
Combined with sinemet in advanced PD
Restless leg syndrome
pramipexole: Adverse Effects
Nausea
Sleep attacks
Pathologic gambling and other compulsive behaviors
pramipexole combined with levodopa: Adverse Effects
Orthostatic hypotension
Dyskinesias
Hallucination Risk Doubles
ropinirole: Class
Dopamine Receptor Agonist
Stimulates dopamine receptor
