PARKINSONS Drugs

Question 1

Two categories

Answer 1

Dopaminergic agents (mostcommon) levodopa

Anticholinergics agents
(Prevent activation of cholinergic receptors ) benztropin

Question 2

Levodopa

Answer 2

Highly effective, but diminish over time
Orally but absorbed in small intestine
Food delays absorption (high protien )

Question 3

Teaching for levodopa

Answer 3

Don’t take protein with medication

Take levodopa first later eat protein

Don’t take vitamin b12 with this medication

Question 4

Carbidopa

Answer 4

Prevents peripheral destruction of levodopa

Seen by physician regularly to check plasma levels and to see if its still working effectively

Question 5

Adverse effects of levodopa/carbidopa

Answer 5

N&V, dyskinesias,postural hypotension, dysrhythmias, psychosis , impulse control , darkened sweat and urine and loss of effect

Question 6

Dopamine agonist

Answer 6

First drug of choice for mild or moderate symptoms
Less effective than levodopa

Pramipexole

Question 7

Pramipexole

Answer 7

Dopamine agonist
Used alone in early PD and with levodopa in advanced PD

Rare: causes gambling urge addiction

Question 8

Adverse effects monotherapy PRAMipexole

Answer 8

SLEEP ATTACKS

Question 9

Anticholinergics

Answer 9

Trihexiphenidyl and benztropine
Decrease activity of ACh

Question 10

Adverse effects of anticholinergics

Answer 10

Dry mouth , urinary retention, Tachy cardia blurred vision, constipation , photophobia, confusion, hallucination

Question 11

What should you teach to prevent dry mouth?

Answer 11

Drink water,chew gum

Question 12

In any medications

Answer 12

Teach not to ever stop abruptly

Question 13

COMT inhibits

Answer 13

Entacapone , tolcapone
Taken with levodopa
Helps levodopa get through membrane

Question 14

MAO-B inhibitors

Answer 14

First line drugs for PD in early stages but will be combined with levodopa later

Selegiline
Rasagiline

Question 15

Selegilene(mao-b inhibitors)

Answer 15

Inhibits breakdown of dopamine
Can only be taken for breakfast or lunch avoid taking at night because it can cause insomnia

Can cause dry mouth Orthostatic hypotension, dizziness, hypertensive crisis and GI symptoms

Question 16

Rasagiline(MAO-b inhibitors )

Answer 16

Early stages monotherapy later with levodopa

Avoid foods with tyramine (processed) can cause hypertensive crisis

Question 17

Other agents used to managePD

Answer 17

Antihistamines with anticholinergics or b-adrenergic blockers are used to manage tremors
Antiviral agent amantadine
Apomorphine for hypomobility