Parkinson's Drugs Flashcards
Parkinson’s Dse is also known as
paralysis agitans
PD is caused by
degeneration of dopaminergic neurons in substantia nigra
PD Triad
Bradykinesia, Resting Tremors, Dystonia
Manifestations of PD
It’s a TRAP.
Tremor
Rigidity
Akinesia
Postural Instability
Pathological Hallmark of PD
loss if pigmented, dopaminergic neurons of the substantia nigra pars compacta
with the appearance of intracellular inclusions known as LEWY BODIES
Principal component of Lewy Bodies
aggregated alpha-synuclein
Drug Induced Parkisonism
Typical antipsychotics (Dopamine antagonists) Reserpine (depletes catecholamine stores) MPTP (protoxin damaging dopaminergic neurons)
alternating periods of improved mobility and akinesia during treatment that is UNRELATED to timing of doses
ON-OFF PHENOMENA
alternating periods of improved mobility and akinesia during treatment that is RELATED to timing of doses
WEARING-OFF PHENOMENA
Drugs causing Livedo Reticularis
A man reads FHM and GQ
Amantadine Hydroxyurea Minocycline Gemcitabine Quinidine
Drugs for Huntington Disease
TETRABENAZINE, RESERPINE
depletes amine transmitters (Dopamine) from nerve endings by reversibly inhibiting human vesicular monoamine transporter type 2 (VMAT2) resulting to decrease uptake of monoamines
Drugs for Tourette’s Syndrome
Haloperidol, Pimozide
Blocks central D2 receptora, reduce vocal and motor tic frequency and severity
dopamine precursor
Levodopa-Carbidopa
DOC for PD
Levodopa-Carbidopa
should not be given to patients taking L-dopa
Phenothiazine
AE of L-dopa + Carbidopa
On-Off phenomena, Wearing-off phenomena
ERGOT DOPAMINE AGONIS
Bromicriptine
Pergolide
Cabergoline
Piribedil
MOA: DOPAMINE AGONIST ERGOT
partial agonist at D2 receptors in brain
Piribedil - acts as a D3 agonist and A2 antagonist
USE: DOPAMIN AGONIST ERGOT
PD, LEVODOPA INTOLERANCE, HYPERPROLACTINEMIA
AE OF BROMOCRIPTINE
erythromelalgia and pulmonary infiltrate
DOPAMINE AGONIST NON ERGOT
PRAMIPEXOLE, ROPINIROLE
MOA: DOPAMINE AGONIST NON ERGOT
Partial agonist at D2 (pramipexole) and D3 (ropinirole)
USE: NON ERGOT
PD, RESTLESS LEGS SYNDROME, ON-OFF PHENOMENON
OPIOID DOPAMINE AGONIS
APOMORPHINE
MOA: APOMORPHINE
agonist at D2
antagonist at 5HT and alpha adrenoceptors
USE: APOMORPHINE
rescue tx for off-periods of PD, Alcoholism, opiate addiction, erectile dysfunction, alzheimer’s
Premedicate with ______ before taking Apomorphine
TRIMETHOBENZAMIDE
SELECTIVE MAO B inhibitors
SELEGILINE
RASAGILINE
no cheese effect
COMT INHIBITORS
ENTACAPONE, TOLCAPONE
ANTICHOLINERICS FOR PD
BENZTROPINE
BIPERIDEN
TRIHEXYPHENIDYL
PROCYCLIDINE
COMT inhibitor in the brain
Tolcapone
COMT inhibitor at periphery
Entecapone, Tolcapone
Notable side effect of COMTi
Orange urine
Hepatotoxicity - Tolcapone only
Drug that potentiates dopaminergic function by influencing the synthesis, release or reuptake of dopamine and is also used for influenza.
AMANTADINE
Drug class that decreseas the excitatory actions of cholinergic neurons on cells in the striatum by blocking muscarinic receptors.
ANTICHOLINERGICS
AE: Anticholinergics
Atropine-like effects (urinary retention, constipation, dry mouth)
Acute Dystonia
Diphenhydramine
Parkinsonism and Rabbit Syndrome
Benztropine
Akathisia
Diphenhydramine
