parkinsons pharmacology Flashcards
what is the goal of Parkinson’s pharmacology
correct balance between dopamine and ACh
dopaminergic
drugs that enhance dopamine
anticholenergic
block effects of ACh
MOA levodopa/carbidopa
levodopa- converts dopamine in brain and activated dopamine receptors
carbidopa- blocks destruction of levodopa
advantages of levodopa/carbidopa
mot effective drug for parkinsons
disadvantages of levodopa/carbidopa
takes several months to see improvement
does not work long term
adverse effects
levodopa/carbidopa loss of effect
dose wears off, may need shorter dose intervals
on-off phenomenon of levodopa/carbidopa
can occur at any time
abrupt loss of effect
off periods increase over time
how can you reduce abrupt loss of effect?
avoid high protein meals
side effects of carbidopa/levodopa
SE due to levodopa
nausea/vomiting (give with food, but reduces absorption)
dyskinesia’s (annoying to disabling)
postural hypotension, dysrhythmias
psychosis (hallucinations, nightmares, paranoia)
DARK URINE AND SWEAT
ACTIVATES MELANOMA
medications that decrease effects of levodopa
vitamin b6
antipsychotics
protein
medications that increase effects of levodopa
carbidopa anticholinergics MAO inhibitors (can cause toxicity)
duopa
carbidopa/levodopa infusion
instilled through feeding tube into small intestine
gel form
continuous infusion for continuous blood level up to 16 hours
important info for patients on duopa
do not take within 2 weeks of non-selective MAOI for depression
drugs that interact with duopa
anti-HTN, MAOI, antipsychotic, metoclopramide, isoniazid, iron, vitamins
high protein foods
side effects of duopa
falls asleep without warning orthostatic hypotension hallucinations unusual urges depression dyskinesia tube placement
pramipexole
dopamine receptor agonist
binds with D2 receptors
uses of pramipexole
monotherapy in early parkinsons
combine with levodopa/carbidopa in advanced parkinsons
restless leg syndrome
side effects of pramipexole when used alone
nausea
sleep attacks
pathological GAMBLING and compulsive behaviors
side effects of pramipexole when combined with levodopa/carbidopa
orthostatic hypotension
dyskinesias
hallucinations
Ropinirole
dopamine receptor agonist
used to treat idiopathic parkinsons
unknown moa
adverse effects similar to other PD drugs
what is at an increased risk of long term use ropinirole?
DM and acromegaly
rotigotine
once daily patch
apomorphine
short acting sub q injection
for fast relief
used in off phase of Parkinsons
