How to treat parkinsons

Question 1

why do ppl get parkinson’s

Answer 1

striatum in the extrapyrimidal area gets messed up bc of an imbalance of dopamine and acetylcholine due to degeneration of neurons that supply dopamine

Question 2

What is purpose of drug therapy

Answer 2

prolong/improve quality of life

NO CURE - NO STOPPING DISEASE PROGRESSION

Question 3

catagories of parkinson drugs

Answer 3

Dopaminergic agents
-more common
-promote activation of dopamine receptors
-Levodopa

Anticholinergic agents
-prevent activation of cholinergic receptors
Benztropine

Question 4

Drugs for mild symptoms

Answer 4

MAO-B inhibitors
-selegiline
-rasagiline

Question 5

drugs for more severe symptoms

Answer 5

Levodopa or dopamine afonist
-Levodopa works better, but more risks esp for dyskinesias

Question 6

Management of motor fluctuations (“on off”

Answer 6

dopamine agonists
COMT inhibitors
MAO-B inhibitors

Question 7

Levodopa
-co drug
-diagnostic purpose
-how long does it last

Answer 7

carbidopa
diagnosis of PD questioned if levodopa fails
Works well for 2 years; stops working by end of yr 5

Question 8

How does levodopa work

Answer 8

increases dopamine synth in striatum
crosses BBB and is converted to dopamine

Question 9

Levodopa adverse effects

Answer 9

N/V from activation of chemoreceptor trigger zone
**helps to start w/ low dose w/ food and carbidopa

Cardiovascular issues

Ortho hypo
**helps to increase Na+ and H2O intake

Psychosis/ hallucinations/ nightmeres/ paranoia/ memory issues/ impulse control
**helps to lower dosage

Dyskinesias
*** helps to reduce dose, add amantadine, have surgury/electrical stimulation

Dark sweat/urine

Activates malignant melanoma

Question 10

Levodopa drug interactions

Answer 10

1st gen antipsychotics block levodopa effects

MAO inhibitors –> htn crisis if nonselective

Anticholinergic drugs –> increases dyskinesias

Pyridozine –> reduces effect of levodopa
***taken care of by carbodopa

Question 11

Carbidopa

Answer 11

*useless by itself
*increases levodopa effects by stopping decarboxylation –> don’t need as much levodopa
*cant cross BBB
*literally no downside

Question 12

Dopamine agonists

Answer 12

1st line drugs
Ergot derivitives: Bromocriptine and Cabergoline
Nonergot derivatives: Pramipexole, Ropinirole, Rotigotine, Apomorphine,

Question 13

Pramipexole

Answer 13

used alone early on; then with levodopa later
takes a while to work
Sleep attacks
same side effects of levodopa including compulsive behavior

Question 14

Ropinirole

Answer 14

Used early alone and later with levodopa
Don’t use when pregnant
Same side effects as levodopa –> compulsive behavior

Question 15

Rotigotine

Answer 15

Used throughout PD treatment
good for restless leg syndrome
dose-related hallucination and dyskinesia

Question 16

Apomorphine

Answer 16

Treats hypomobility during off episodes
DONT GIVE PO
Only use acutely

Question 17

Bromocriptine and Cabergoline

Answer 17

Bromo: approved for PD
-directly activates dopamine receptors
-used early alone and later with levodopa
-reduces dyskinesias and allows for lower levodopa dose
-adverse effects of fibrosis and Raynaud stuff

Cabergoline: not approved
-maybe effective during off times

Question 18

COMT inhibitors

Answer 18

-stop peripheral metabolism of levodopa

Entacapone
- side effects = yellow/orang urine and GI issues
- keeps levodopa working longer

Tolcapone
- not as safe
-keeps levodopa working better and longer at lower doses w/o motor function issues
LIVER FAILURE

Question 19

Lev/Carb/Entacapone

Answer 19

-available in 3 strengths in immediate dose tablets

Question 20

MAO-B inhibitors

Answer 20

1st line drugs with modest benefits
combo with levodopa

Selegiline
-by itself or with levodopa
-improves motor funcs and helps lev work better
-good for 1-2 yrs

Rasagiline
-Can cause insonmnia, ortho hypo, mouth issue, htn
-bad with levodopa, meperidine, and SSRIs

Question 21

Amantadine

Answer 21

-was an antiviral first
-response w/in 3 days
-Not first line or very effective, but can help with dyskinesias from levodopa
-dries you up and blurs vision and fucks up skin color

Question 22

Centrally acting anticholinergic drugs

Answer 22

Benztropine
-helps reduce tremors
-2nd line therapy
-Bad for old ppl bc of sedative and psych effects
- GI issues, peeing, ortho hypo, sleep issues, depression, dementia, psychosis

Question 23

Depression when taking PD meds

Answer 23

only take amitriptyline

Tricyclic antidepressants
-anticholinergic effects exacerbate dementia
-antiadrenergic effects exacerbate hypotension