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PD: drugs

Parkinson's Disease drugs

QuestionAnswer
Etiology of Parkinson's Disease Destruction of dopaminergic neurons in the substantia nigra
What is the Substantia Nigra? located in the midbrain. controls reward/addiction/movement
Inhibitory/Excitatory? (1) Dopamine Inhibit
Inhibitory/Excitatory> (2) GABA Inhibit
Inhibitory/excitatory? ACh excitatory
"Can't SEE, can't PEE, can't SPIT, can't SHIT" Anticholinergic Drugs
What do anticholinergic drugs do? they block muscarinic receptors
what do muscarinic receptors do? inhibit metabolism which increases drug availability
non-motor symptoms of Parkinson's Disease depression, dementia, psychosis (usually dt drug)
How much Levodopa reaches the brain? Why? only 2% because it is metabolized in the periphery by decarboxylase
Levodopa is administered via what route? Oral
how does food interact with Levodopa? it delays absorption. It does NOT inhibit absorption, just delays it
High protein foods interact with Levodopa by what? decrease therapeutic effects
where is Levodopa absorbed? in the small intestine
what are the adverse effects of Levodopa? dark sweat/urine n/v dyskinesias postural hypotension dysrhythmias psychosis
Levodopa drug interactions 1st generation antipsychotics MAO inhibitor Anticholinergic drugs Pyridoxine (Vit. B6)
1st generation antipsychotics interaction with Levodopa blocks receptors for dopamine in stratum
how does MAO inhibitors interact with levodopa? inhibits breakdown of NE/dopamine/ leading to increased amount of these which leads to activation of alpha1 --> HTN CRISIS!
Anticholinergic drugs interacting with Levodopa enhances response to Levodopa
Pyridoxine (Vitamin B6) interacts with Levodopa stimulates decarboxylase activating
why administer Levodopa/Carbidopa? carbidopa inhibits decarbocxylation which will increase amount of levodopa that reaches the brain.
/Can carbidopa cross the BBB? NO
what are the therapeutic effects of carbidopa? none on its own.
advantages of Levodopa/Carbidopa decreased levodopa dose decreased cardio side effects decreased n/v pt CAN take B6
Disadvantages to Levodopa/Carbidopa abnormal movements and psychiatric disturbances sooner and more intense.
Dopamine Agonists PRO no conversion needed decreased drug failure decreased disabling dyskinesis
CONs of dopamine agonists more serious side effects: Hallucinations, daytime sleepiness, postural hypotension
Categories of dopamine agonists. and tell me about them. Ergot vs Nonergot Nonergot = highly selective to dopamine receptors
Premipexole [Mirapex] Adverse Effects when used alone: n/v, dizziness, INSOMNIA, DAYTIME SOMNOLENCE, constipation, weakness, hallucinations Combined: Orthostatic hypotension, Dyskinesias SLEEP ATTACKS! COMPULSIVE SELF-REWARDING BEHAVIORS
Drug interaction with Premipexole [Mirapex] Cimetidine: drugs used for peptic ulcers decrease renal excretion which increases plasma level
Ropinirole [Requip]: adverse Effects Same as Mirapex
Ropinirole [Requip]: drug interactions SAME as Mirapex
MAO-B inhibitors: what does it do? can decrease wearing off effects when combined with Levodopa
Which PD drug may delay neurodegeneration Selegiline
What does selegiline do? causes selective irreversable inhibition of MAO-B
discuss metabolism of Selegiline metabolized by liver: 2 metabolites = harmful because they are CNS stimulant -> agination/insomnia
what kind of drug is Selegiline Dopamine Agonist
what kind of drug is Premipexole? dopamine agonist
how long does it take for levodopa to see therapeutic effects? 6 months
should you take Requip with food? yes
Created by: 1398660434
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