Parkinson's drugs Flashcards
1
Q
Levodopa (L-DOPA)
A
- Dopamine precursor: oral, absorbed in small bowel
- Given with carbidopa
- First like for Parkinson’s unless patient is young
- Side effects: hallucinations, dyskinesias, of-on phenomenon, pschosis, N/V, hypotension, dizziness
- MAO-A inhibitors contraindicated (except MAO-B)
2
Q
Carbidopa
A
- Aromatic amino acid decarboxylase inhibitor
- Inhibits peripheral conversion of L-DOPA to Dopamine, does NOT cross BBB
- Parkinson’s- given with L-DOPA to lower side effects
- Side effects: dyskinesias, on-off phenomenon
- MAO-A inhibitors are contraindicated (except MAO-B)
3
Q
Bromocriptine
A
- Ergot derivative: D2 agonist, D1 antagonist
- Mild parkinson’s, DA agonism in NMS, hyperprolactinemia
- Side effects: pleural effusions, cough, SOB, pulmonary fibrosis, peripheral DA-like effects, sedation, dizziness
- Titrate slowly due to hypotension
4
Q
Pramipexole
A
- Non-ergot DA receptor agonist: selective D2 agonist
- Mild parkinson’s (first line), to delay L-DOPA treatment, usually in combo with ropinorole, can use in RLS
- Side effects: more acute, psychosis, mania, nausea, dizziness, sedation, edema, compulsive behavior
- Less effective with motor symptoms of PD
5
Q
Ropinorole
A
- Non-ergot DA receptor agonist: Selective D2 agonist
- Mild Parkinson’s, restless leg syndrome
- Side effects: more acute, psychosis, mania, nausea, dizziness, sedation, edema, compulsive behavior
- Less effective with motor symptoms of PD
6
Q
Rotigotine
A
- Non-ergot DA receptor agonist: Selective D2 agonist
- Mild Parkinson’s, restless leg syndrome
- Side effects: more acute, psychosis, mania, nausea, dizziness, sedation, edema, compulsive behavior
7
Q
Apomorphine
A
- Non-ergot DA receptor agonist
- Rescue therapy for ‘off’ periods (immobility)
- Side effects: more acute, psychosis, mania, nausea, dizziness, sedation, edema, compulsive behavior, peripheral DA effects
- Injectable only, serotonin receptor antagonists contraindicated (eg ondansetron)
8
Q
Entacapone
A
- COMT inhibitor: prevents breakdown of DA
- Prolongs half life of levodopa, reduces ‘off’ time, primarily works peripherally
- Side effects: dyskinesias, urine dyscoloration, diarrhea, DA side effects
- Short acting: 2 hours
9
Q
Tolcapone
A
- COMT inhibitor: prevents breakdown of DA
- Prolong half-life of levodopa, reduce ‘off’ time, primarily works peripherally
- Side effects: fatal hepatotoxicity (use only if entacapone fails), dyskinesias, diarrhea, urine dyscoloration, DA side effects
- Short acting: 2 hours
10
Q
Selegiline
A
- MAO-B inhibitor: prevents breakdown of DA
- Mild early Parkinson’s (monotherapy), may delay onset of l-dopa therapy
- Side effects: hypotension, GI distress, dyskinesia, psychosis, N/V
- Antidote to environmental toxins; at high doses is a MAO-A inhibitor and would have same diet and drug interactions, tyramine crisis, serotonin syndrome, etc. For depression it comes in a patch called EMSAM
11
Q
Rasagiline
A
- MAO-B Inhibitor: prevents breakdown of DA
- Mild early parkinson’s (monotherapy), may delay onset of l-dopa therapy, adjunct with l-dopa
- Side effects: Hypotension, GI distress, dyskinesia, psychosis, N/V
- Antidote to environmental toxins; at high doses is a MAO-A inhibitor and would have same diet and drug interactions, tyramine crisis, serotonin syndrome, etc. For depression it comes in a patch called EMSAM