5. Neural Disease Treatment Flashcards
(15 cards)
Treatment of Parkinson’s Disease
Agonize dopamine receptors
- Bromocriptine (ergot)
- Pramipexole (non-ergot)
- Ropinirole (non-ergot)
- Non-ergots preferred
Increase dopamine
- Amantadine
- L-dopa / carbidopa
Prevent dopamine breakdown
- Selegiline (centrally acting MAO B inhibitor)
- Entacapone (peripherally), Tolcapone (centrally and peripherally acting COMT inhibitor)
Tone down excess cholinergic activity
- Benztropine (anti-muscarinic)
- “PARK your mercedes BENZ
BALSA - Bromocriptine, Amantadine, Levodopa, Selegiline, Antimuscarinics
L-dopa / Carbidopa - MOA
Increase dopamine levels in the brain
- L-dopa crosses BBB and is then converted to dopamine by dopa decarboxylase
- Carbidopa blocks the peripheral conversion of L-dopa to dopamine
L-dopa / Carbidopa - Clinical Use
Parkinsonism
L-dopa / Carbidopa - Toxicities
- Arrhythmias from peripheral conversion to dopamine (limited by Carbidopa)
- Long term use can lead to dyskinesia following administration and akinesia between doses
Selegiline - MOA
Selective MAO-B inhibitor, which is selective for Dopamine –> increases Dopamine levels
Acts centrally
Selegiline - Clinical Use
Adjunctive to L-Dopa in treatment of Parkinson’s disease
Selegiline - Toxicities
May enhance side effects of L-dopa
Treatment of Alzheimer’s
- Memantine
- Cholinesterase Inhibitors (Donepezil, Galantamine, Rivastigmine)
Memantine - MOA
NMDA receptor antagonist –> helps prevent excitotoxicity (mediated by Ca)
Memantine - Clinical Use
Alzheimer’s
Memantine - Toxicities
Dizziness, confusion, hallucinations
Treatment of Huntington’s Disease
- Amine depletion - Reserpine, Tetrabenazine
- Antagonize dopamine receptors - Haloperidol
Sumatriptan - MOA
5-HT 1B/1D agonist
- Vasoconstriction, inhibition of trigeminal activation and vasoactive peptide release
Half life < 2h
Sumatriptan - Clinical Use
Acute migraine and cluster headaches
Sumatriptan - Toxicities
- Coronary Vasospasm - CI in coronary artery disease or Prinzmetal’s angina
- Mild tingling
