pharm antiparkinsonian drugs Flashcards by maya chan

parkinsons

progressive neurodegenerative disease

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parkinsons affects

dopamine-producing neurons by having an imbalance of dopamine and ACh

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symptoms occur when

80% of dopamine stored in basal ganglia is depleted

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symptoms can be controlled when

nerve terminals can uptake dopamine

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parkinsons symptoms include

bradykinesia (slow movement)
TRAP- tremor, rigidity, akinesia, postural instability.

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dyskinesia

difficulty preforming voluntary movements.
when too much dopamine is present

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2 types of dyskinesia

chorea- spasmodic movement in face or limbs
dystonia- abnormal muscle tone leading to abnormal movements

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drug therapies aimed at

increasing levels of dopamine and antagonizing ACh

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levdopa

precursor for dopamine, allowed in blood-brain barrier (unlike dopamine).

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nondopamine dopamine receptor agonist ex

ergot derivative- bromocriptine

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bromocriptine

works by direct stimulation of presynaptic receptors in brain. stim production of dopmine in brain and inhibits production of proalctin

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bromocriptine adverse effects + use with caution

use with caution with ppl w/ peripheral vascular disease
GI upset, dyskinesias, sleep disturbances

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bromocriptine drug interactions

erythromycin and adrenergic drugs

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levodopa is a ____ drug

replacement

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levodopa action

works presynaptically to increase blood levels of dopamine

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___ is given with levodopa

carbidopia

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carbdopia action

binds with levodopa, doesnt cross blood brain barrier, helps prevent breakdown in periphery. results in more levodopa in bb barier

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levodopa uptake route

taken up by the dopaminergic terminal and converted into dopamine and then neurotransmitter imbalance is controlled.

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after 5-10 years of levodopa therapy…

terminals dont work as good, levodopa is not as effective

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levodopa adverse effects

confusion, involuntary mvmt, GI distress, hypotension, cardiac arrythmias

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levodopa-carbidopa is counterindicated in cases of

angle closure glaucoma

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use levodopa-carbidopa with caution when person has

open angle glaucoma

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levodopa-carb interactions

pyridoxine, nonselective MAOIs, benzodiazepines, antipsychotics, dietary protein

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carbidopa alone

treats nausea associated with sinemet

sinemet CR

controlled release. increase on time and decrease off time

carbidopa levodopa is best taken__

on an empty stomach

selective monoamine oxidase inhibitor therapy

inhibit the break down of catecholamines in CNS

selective MAO -B inhibitor exs

selegiline hydrochloride and rasagiline mesylate

selective MAO -B inhibitors action

inhibit breakdown of catechlomides

cheese effect

MAO-A interact with cheese, results in hypertension

rasagiline and selegiline are used with

used as adjuncts with levodopa

rasagiline and selegiline are used with

use with meperidine (opiate)

dopamine modulator ex

amantadine hcl - antiviral used to treat influenza -indirect -release dopamine and catechlomides from presynaptic

amantadine hcl blocks....

blocks reuptake of dopamine into the nerve fibers

amantadine is used (when and how long) ____

early in the course of the disease for 6-12 months

anamtadine is used to treat____

dyskinesia assicoated with carbidopa- levodopa

amantadine adverse effects

mild. dizziness, insomnia, nausea

amantadine drug interactions

increased anticholinergic adverse effects when given with anticholinergic drugs

COMT inhibitor ex and MOA

entacapone -block COMT (blocks enzyme that breaks down catechlomides)

entacapone prolongs ______

duration of action of levodopa

entacapone adverse effects

GI upset, urine discoloration, worsen dyskinesea

anticholinergic therapy

anticholinergics blocks the effects of ACh

anticholinergics are used to treat _____

muscle tremors and muscle rigidity

anticholinergics doesnt relieve ____

bradykinesia (slow movements)

ACh is responsible for causing SLUDGE

salivation, lacrimation, urinating, diarrhea, GI motility and emesis

anticholinergics have ____ effect

opposite (dry SLUDGE)

benztropine mesylate

antichol drug used for PD and extrapyramidal symptoms form antipsychotic drugs

benzotropine caution

use caution with hot weather, may cause hyperthermia

benztropine adverse effects

tachycardia, confusion, disorientation, urinary retention, N and V

what should you avoid when taking benztropine mesylate

alc

what kinds of questions to ask when performing hh

CNS, GI tract, phys and emotional status

signs and symptoms of PD

masklike expression, speech prob, dysphagia, shuffling gait

taking levodopa with MAOIs can cause

a hypertensive crisis

can you discontinue antiparkisonians suddenly

naur

what drug can darken pts urine and sweat

entercapone

therapeutic effects of COMP inhibitor can take

a few days

positive results of drug therapy

imroved mental status, increased appitite, less parkinsons symptoms