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)
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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)
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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
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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
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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
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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
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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)
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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
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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
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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
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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
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