Parkinsons Disease Drugs Flashcards
What is Parkinson’s disease
Progressive disabling neurodegenerative disorder of movement
Main reason of Parkinson’s disease
Gradual loss of neurons in the substantia nigra of the brain. So loss of dopamine which coordinate movements
Clinical features of Parkinson’s diseases
Tremor
rigidity
bradykinesia
Two forms of Parkinson’s disease
Idiopathic Parkinson disease with unknown cause
Iatrogenic Parkinson disease drug induced
What type of drugs can cause Parkinson’s disease
Antipsychotic drugs like butyrophenone and phenothiazines
Genes involved in Parkinson’s disease
Alpha synuclein Parkin Glucocerebrosidase PINK1 LRRK2 DJ1
Is there a cure for parkinsonism
No
Drugs type that good provides relief in Parkinson’s disease
Levodopa
Dopamine agonists
Mono amine oxidase inhibitors
Anticholinergic agents
Most reliable and effective drug in Parkinson’s disease
Levodopa
Mechanism of action of levodopa
Precursor of dopamine which innovate dopamine level
Why is dopamine not administered directly but rather through levodopa’s
Because cannot cross the blood brain barrier contrary to level
Metabolism of levodopa
Amino acid decarboxylase in the liver kidney and GHT
How do we prevent metabolism of levodopa
By coadministering carbidopa or benserazide
Can food delay the appearance of levodopa in the plasma
Yes
When do you think the best results of levodopa treatment
In the first three or four years of therapy
Adverse effects of levodopa
Anorexia nausea vomiting so should divide doses and take antacids and anti-emetics
Cardiac arrhythmias tachycardia ventricular extrasystole’s
Dyskinesias
Depression anxiety agitation insomnia somnolence confusion delusions hallucinations nightmares euphoria
What are some miscellaneous adverse effects of levodopa
Mydriasis Various blood dyscrasias Hot flashes positive comes test precipitation of gout smell or taste abnormalities Priaprism blood urea nitrogen elevated
Can you give levodopa to Patience taking MAO
No
Can you give levodopa to psychotic patients
No
Can you give liver to fly to patient with angle closure glaucoma
No
Can you give levodopa to patient with active peptic ulcer
Yes but precaution
What is the advantage of dopamin agonist compared to levodopa
Limited adverse effects
no potential toxic metabolites
no competition at the blood brain barrier no response fluctuations and dyskinesia
Examples of dopamine agonist
Bromocriptine Pergolide Pramipexole Ropinirole Rotigotine Apomorphine
Drug used to treat Parkinson’s disease and hyperprolactinemia
Bromocripti
Receptor stimulated by bromocriptine
D2
Receptor stimulated by pergolide
D1 D2
In which way is percolate more effective than bromocriptine
Relieving symptoms and signs of Parkinson’s disease
increasing on-time response from response fluctuators
permitting levodopa dose s to be reduced
Pramipexole act on which receptor
D3
When is pramipexole effective
When used as a single agent for mild Parkinson. So used in advanced disease to reduce levodopa
Ropinirole Acton which receptor
D2
When do you use ropinirole
Does Moov in response to levodopa in More advanced disease
How do you administer rotigotine
Transdermal patch
How do you administer Apomorphine
IV injection
Dopamine agonist adverse effects
Anorexia nausea vomiting constipation dyspepsia reflux oesophagitis s bleeding from peptic ulcer confusion hallucination delusions postural hypotension painless digital vasospasm cardiac arrhythmias peripheral edema
Miscellaneous effect of dopamine agonist
Headache nasal congestion increased arousal pulmonary infiltrates Pleural and retroperitoneal fibrosis erythromelalgia Narcolepsy
Contra indications of dopamine agonist
Psychotic illness
recent myocardial infarction
active peptic ulcer ration
ergot derived agonist avoided in peripheral vascular disease
Which monoamine oxidase inhibitors are used in Parkinson’s disease treatment
The one that ACT on MAO B Which is the one concerned with metabolism of dopamine
Selegiline
Rasagiline
When should you give selegiline
When declined fluctuating response to levodopa
Should not give these drugs with selegeline
Pethidine
TCAs
serotonin reuptake inhibitors
Which is more potent , selegiline or rasagiline
Rasagiline
Can you give both MAO and levodopa
No risk of hypertensive crisis
How do drugs part of the catechol o methyltransferase inhibitors help
Prevent competition 3OMD with levodopa for active carrier mechanism
Selective COMT USED
Tolcapone
Entacapone
When can you give COMT inhibitors
Response fluctuations with levodopa
Viral agent used for Parkinson disease
Amantadine
Acetylcholine blocking drugs examples
Benztropine mesylate Biperiden Orphenadrine Procyclidine Trihexyphenidyl
Can you use antihistamine diphenhydramine as anticholinergic agent for mild Parkinson patient who can’t tolerate anything else
Yes
