Treatment of parkinson's Flashcards
general aim
increase dopamine
agonists
increase secretion
decrease enzyme activity, lengthening time in the synaptic cleft
levadopa
most effective and improves motor symptoms significantly
converted by body into dopamine
some SE: nausea and vomitting confusion postural hypotension somnolence long term: dyskinesia
end of dose fluctuations where the drug starts to wear off
freezing
confusion and hallucinations
management of motor complications
fractionate dose
adjuvant treatment
cont.
dopamine agonist
act directly on post synaptic dopamine receptors
oral, sub cut or transdermal
similar side effects to l-dopa and also impulse control disorders - eg gambling, hypersexuality, compulsive buying, binge eating
mono-amine oxidase inhibitors
decrease breakdown of dopamine so increase the levels in the cleft
possible neuroprotective effect
same side effects as l-dopa
potential interaction with antidepressants such as SSRI’s leading to serotonin syndrome
catechol-O-methyltransferase inhibitors
inhibit COMT inhibitors to increase the amount of l-dopa available to cross the BBB to produce prolonged effect
SE
as l-dopa
also can cause diarrhoea, discolouration of body fluids
amantadine
not commonly used, sometimes used in the later stages
increases dopamine release at the synaptic cleft
anticholinergics
occasionally in younger patients with early symptoms
decrease the relative central ACh excess that occurs due to dopamine insufficiency