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PD IOS 8-4

Parkinson's Meds

QuestionAnswer
Parkinsons disease symptoms Bradykinesia, Rigidity, resting tremor, poor balance,orthostatic hypotension, Dementia
Parkinsons disease etiology Alpha-synuclin,parkin, ubiquitin-C-terminal hydroxylase, rural-pesticides, age
PD areas of neuronal death substantia niagra par compacta
Supstantia niagra par compacta produces Dopamine and stimulates striatum
cerebral cortex stimulates Striatum, SNpr/MGP, STN
IF SNpc is lost what pathways are no longer regulated SNpr (direct), LGP (indirect) decreasing inhibition
DIrect pathway Striatum to (GABA) SNpr/MGP to (GABA) VA/VL to stimulate (GLU) cerebral cortex
Indirect Pathway Striatum to LGP to STN to SNpr/MGP to VA/VL to cerebral cortex
Deep brain stimulation to which are Subthalamic nucleus
Paladotimity is Removal of Lateral Globus Pallidus (GABA ergic)
MPTP MOA MOAb metabolizes, utilizes DA transporter and shuts down complex I in e transporter- ROS kills neurons
Synthesis of DA Tyrosine is converted via tyrosine hydroxylase to DOPA then aromatic amino acid decarboxylase converts to dopamine
Dopamine precursor Levodopa-prodrug able to cross BBB, competes with other gut proteins for abs (t 1/2 1-3 hrs)
Sinamet or altamet Levodopa and Carbidopa=Less GI and Cardio SE
Carbidopa Used to decrease degradation of levodopa by dopa decarboxylase. It does not cross the BBB, just reduces extracerebral decarboxylation to increase levopoda in CNS and decrease SE.
Levodopa most effective against Bradykinesia
Levodopa SE N/V (tolerance),orthostatic Hypotension, Dyskinesia, Flucutations, depression
Dopamine agonist-class ergot and non-ergot
Ergot of PD Bromocriptine pergolide
Non-ergots for PD Pramipexole -D3, ropinrole
Dopamine precursor contraindication psychotic, glaucoma
Dopamine agonist SE orthostatic hypotension, fatique, insomnia, somnolence, confusion, dyskinesia
MAOb inhibitor Selegiline
COMT inhibitors entacapone,tolcaptone
COMT indication Decrease wearing off must be used with Sinamet
Antiviral for PD amatadine
Ach blocking drug Beztropine mesylate
Beztropine mesylate MOA balance NT, and Ach to match the decreased DA
Benztropine mesylate caution Elderly patients -confusion and hallucinations
PD wearing off Fluctuations occur due to timing of Levodopa. Ridigity return at end of dose.
PD On, off Fluctuations are unrelated to timing of doses. Periods are characterized by marked akinesia altering with periods of improved mobility.
Managing flucutations Decrease interval, give with sinamet, reduce dietary protein, take drug holiday
Newer approaches for PF treatment Transplantation, Pallidotomy, Deep Brain stimulation, antioxidants
Pathophysiology Defective ROS, e-transport, GABA defect, Ischemia, low tyrosine hydroxylase,dopa-decarboxylase, low NE, 5HT
Drug induced PD MTPT, metoclopramide, antiemetic, antipsychotic
PD diagnosis Bradykinesia and 2 of three (rigid,resting tremor, postural instability
Non-pharm PD treatment Support groups, education,exercise,nutrition, (increase CA +Vit D)
Sinamet dose 200-800 levodopa, 75-100 carbidopa
Sinamet DI Increase with PPI, H2, metoclopramide-- Decrease with protein
Levopdopa cause Generation of ROS which believed to damage neurons over time
Selegline dosing 5 mg BID morning, afternoon
Anticholinergics in PD Effective for treating tremor in patients younger than 60, inhibit M1 and M2, and NMDA to alleviate akinesia
Apomorphine indication D4 agonist treats "freeze" to reverse levopdopa freezing episodes
Coemzyme Q 10 Neuroprotective effects
NMDA receptor antagonist Memantine, Neuramaxane,Remacemide,Amantadine -studies for neuroprotective effects
PD hallucinations Reduce dose then can give clozapine
Orthostatic hypotension PD Change antihypertensive meds, compression stockings, salt
Falls PD Check for orthostatic hypotension
Wearing Off PD Increase frequency of dosing
PD steps 1. Sinamet 2. Pramipexole 3. COMT-Entacapone 4. Selegiline
Created by: liza001
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