parkinsons Flashcards
COMT inhibitor
entacapone
tolcapone
inhibit levodopa breakdown to 3OMD peripherally
good w/ levodopa for motor problems
COMT ADE
dyskinesia, confusion nausea, diarrhea orthostatic hypotension liver toxicity (monitor LFTs) decrease dose with levodopa and diarrhea meds
MOAB inhibitor
rasagiline
selegine
inhibit levodopa breakdown to dopamine peripherally
MOAB ADE
nausea, orthostatic hypotension
confusion, insomina, hallucinations
serotonin syndrome w/ mepridine (narcotic)
amantidine
antiviral that increases dopamine release
NMDA receptor antagonist
good for tremor, rigidity, bradykinesia
amantidine ADE
anticholinergic side effects
anticholinergic side effects
Mad as a Hatter - delirium Hot as a hare - increased temp Dry as a bone - dry eyes and mouth less sweat Blind as a bat - pupils dilate Red as a beet - flush
anticholinergic meds
benzotriptine and trihexylphenidyl
good for tremors
ADE is anticholinergic side effects
dopamine agonist
pramipexole bromocriptine ropinirole pergolide increase dopamine activity in substantia nigra and striatum
dopamine agonist ADE
impulsive behaviors (sex and gambling)
postural hypotension
pulmonary hypotension
confusion hallucination sedation vivid dreaming = psychosis
duodopa
levodopa/carbidopa in enteral suspension straight to small intestine
for motor symptoms
levodopa/carbidopa
levodopa is precursor that goes thru BBB
carbidopa prevents conversion to dopamine b4 BBB
levodopa/carbidopa ADE
motor problems
drowsy and dyskinesia
decrease dose with COMT and MOAB
if end of dose/ wearing off
increase frequency of levo/carbidopa
add COMT/MOAB inhibitor or dopamine agonist
if delayed on/ no on response
take levo/carbidopa on empty stomach use ODT no CR add apormorphine (dopamine promoter)
start hesitation/ freezing
cant start movement
increase levo/carbidopa
add dopamine agonist or MOAB inhibitor
PT and walking device
peak dose dyskinesia
decrease levo/carbidopa
add amantidine
parkinsons no impairment
rasagaline if <65
levo/carbidopa if >65
parkinsons w/ tremor
anticholingeric and levo/carbidopa if <65
levo/carbidopa if >65
parkinsons w/ bradykinesia, rigidity
dopamine agonist and levo/carbidopa if <65
levo/carbidopa if >65
parkinsons with postural instability or gait instability
dopamine agonist and PT if <65
levo/carbidopa and PT if >65
