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Flashcards in Movement Disorders Meds Deck (13):
1

Parkinsons Tx
Class: Levodpa/Carbidopa
-medication name
-medication effectiveness
-SE of prolonged use?
-MOA
-Adverse Effects
-CI
-Precautions

Name:Levodopa/carbidopa (Sinememt) "GOLD STANDARD"

Effectiveness decreases after 3 years of tx and may return to pretreatment levels in 6-7yrs; relieves akinesia, rigidity, and tremor

SE: prolonged use may directly hasten the degeneration of dopamine neurons in the substantia nigra

MOA: levadopa is an immediate metabolic precursor to dopamine, penetrates the brain where its converted to dopamine. Carbidopa is given in conjunction to inhibit the conversion to dopamine before it reaches the BBB

Adverse Effects:
-Physical:
--low BP, arrhythmia, GI effects, hair loss, dyskinesias**
-psychiatric:
--confusion, anxiety, vivid dreams, hallucinations

CI: concurrent use with MAOI's, psychotic pts, angle-closure glaucoma, hx of melanoma (melanoma is dopamine driven)

Precautions:
-cardiac dz
-PUD

2

Parkinsons Tx:
Class; MOA-B inhibitors
-medication names
-MOA
-adverse effects
-Caution
-CI

-Slegiline *may have neuroprotective properties*
-Rasagiline

MOA: stops the breakdown of dopamine

Adverse Effects: Insomnia(take in AM), jitteriness, dyskinesias, orthostatic hypotension

Caution:
-Psychiatric Disorders*
-CV dz
-seizures
-hyperthyroid
-DM

CI:
-TCAs, SSRIs, Demerol

3

Parkinsons Tx
Class: Dopamine Agonists
-medication names
-MOA
-Adverse Effects
-CI

Newer:
-Ropinirole (requip)
-Pramipexole (mirapex)

Older agents:
-pergolide (permax)
-bromocriptine(dont use much d/t fungus attacking heart valves)

MOA: wakes up receptor sites to increase dopamine utilization

*only use when sinemet effectiveness is declining as add on therapy, when we add this on we decrease sinemet.

Adverse effects:
-drowsiness/sleepiness
-Nausea and constipation
-HA
-ortho Hypotension
-nasal congestion
-nightmares, hallucinations, psychosis
-dyskinesias

CI:
-pts with psychotic illness
-recent MI
-PUD

4

Parkinsons Tx
Class: COMT inhibitors
-medications
-moa
-adverse effects

Entacapone (Comtan), Tolcapone (Tasmar)

MOA: inhibits dopamine breakdown by selectively inhibiting COMT.

Adverse effects:
-involuntary muscle movements
-mental confusion/hallucination s
-cramps, Nausea, diarrhea
-insomnia, HA
-urine discoloration

*try this for 2-3 weeks and if its not working then stop it and you dont do it again*

5

Parkinsons Tx:
Class: Amantidine
-MOA
-when is this useful?
-SE

MOA: potentiates the dopaminergic function by influenciig the synthesis, release, or reuptake of dopamine.

-useful for early mild sx

SE:
-sedation, vivid dreams, dry mouth, depression, hallucinations

6

Parkinsons Tx:
-Class: Ach Blocking
-medications
-MOA
- Adverse effects
-CI

Trihexyphenidyl (Artane), Benztropine (Cogentin)

MOA: blocks Ach thereby blocking inhibition, so Ach not as effective in blocking dopamine.

Adverse Effects
-CNS: drowsiness, mental slowness, restlessness, confusion, hallucination

-SYstemic: dry mouth, blurred vision, consitpation, urinary retention

CI:
-BPH, obstructive GI dz, angle closure glaucoma

7

Parkinsons Tx:
-Class: NMDA receptor inihibtors

Apomorphine (Apokyn) ??

8

Patient with mild parkinsons, what medication is used first line?

selegiline, this is the only medication that may provide benefit with slowing some progression of the dz

9

If experienceing the "wearing off effect" while taking sinemet what is the next best step?

how can you prevent this "wearing off effect"?

bridge therapy; add on COMT inhibitor*, MAOBs, dopamine agonists

Prevention:
-multiple small doses on empty stomach to maintain a constant level
-liquid form
-controlled release formulation

10

What are some causes of the wearing off effect?

-dz progresses beyond the ability of levodopa to control it

-become tolerant to prolonged exposure to dopamine

-dopamine neurons become incapable of storing dopamine and when the levodopa wears off there is no dopamine remaining.

-L-dopa itself accelerates the dz by producing oxygen free radicals, this increases injuries to the brain and dopamine degredation

11

Dopamine Agonists:
-AMpomorphine (apokyn)
--use
--SE

Use: treat acute episodes of "hypermobility or freezing" give subQ

SE: profound nausea, must be given with antiemetic (NOT zofran, kytril b/c they block dopamine)

12

Symptomatic treatment of mild parkinsons is probably best avoided until there is some degree or disability or sx begin to have a significant impact on ADLs, T/F?

True

13

Despite the fact that the benefits of levadopa diminish with time, evidence is accumulating that dopaminergic therapy at a relatively early stage may be the most effective in alleviating sx and may affect the mortality rate d/t the dz, t/f?

True