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Drugs that can cause Parkinson (Antipsychotics)
- chlorpromazine
- thioridazine
- fluphenazine
- loxapine
- haloperidol
- olanzapine
- risperidone
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Drugs that can cause Parkinson (Antiemetics)
- metoclopramide
- prochlorperazine
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Risk factors that increase risk for Parkinson
- genetics
- male
- pesticide exposure
- well water (rural areas)
- head injury
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Protective factors reduce risk of Parkinson
- coffee
- cigarette smoking
- NSAIDS
- estrogen replacement post menopause
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Medications associated with tremors
- lithium
- valporic acid
- albuterol
- theophylline
- cyclosporine
- caffeine
- other stimulants
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Treatment for action and essential tremors
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Non motor PD symptoms and treatments
- Bladder incontinence: oxybutyin, tolterodine
- Constipation: incrrease water, dietary fiber, polyethylene glycol
- Olfactory dysfunction (hyposmia): N/A
- REM sleep behavior disorder: clonazepam, melatonin, dopaminergic medications
- Depression: TCAs, SSRI
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Rasagiline (MAO-B inhibitor) drug-drug interactions
- CYP1A2 inhibitor: decreases clearance of rasagiline
- cipro
- fluvoxamine
- cimetidine
- CYP1A2 inducer: increases clearance of rasagiline
- omeprazole
- smoking
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MAO-B drug-drug interactions
- MAO-B with tyramine: MAO-B loses its selectivity
- Serotonin syndrome: interactions w/
- SSRI
- SNRI
- meperidine
- dextromethorphan
- decongestants (sympathomimetic meds)
- non-selective MAO inhibitors
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Levodopa drug-drug interactions
- reduced efficacy of levodopa: interactions w/
- D2 recptor antagonists (phenothiazines, risperidone, antipsychotics)
- metoclopramide (antiemetic D2 antagonist
- phenytoin)
- Hypertensive crisis: interactions w/ phenelzine, tranycypromine
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Pramipexole drug-drug interactions
- reduced clearance that inhibit cationic tubular secretion: interactions w/
- cimetidine
- diltiazem
- probenecid
- ranitidine
- triamterene
- verapamil
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Ropinirole drug-drug interactions
- clearance is reduced: when estrogen therapy is started
- CYP1A2 inhibitor: decreases clearance of ropinirole
- cipro
- fluvoxamine
- cimetidine
- CYP1A2 inducer: increases clearance of ropinirole
- omeprazole
- smoking
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Apomorphine drug-drug interactions
- ondansetron: can cause severe hypotension and loss of consciousness and is contraindicated
- trimethobenzamide: can be used to treat the nasuea/severe emesis associated with apomorphine
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Anticholinergic drug-drug interactions
- may increase the risk of paralytic ileus, hyperthermia, or heat tolerance: interacting w/
- phenothiazines
- haloperidol
- TCAs
- potassium chloride: this interaction slows the gastric motility delaying the passage of potassium chloride resulting in lesions and ulcerations
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Amantadine drug-drug interactions
- reduces the renal clearance: interacting w/
- quinine
- quinidine
- potassium chloride: this interaction slows the gastric motility delaying the passage of potassium chloride resulting in lesions and ulcerations
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Nausea caused by levodopa
- if currently on levodopa/carbidopa: treat w/
- carbidopa 25mg addition
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Nausea caused by dopamine agonist
- treat w/:
- ondansetron
- trimethobenzamide
- dronabinol
- avoid: prochlorperazine, metoclopramide
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Neuroleptic Malignant Syndrome (NMS)
- Caused by the abrupt cessation of levodopa and dopamine agonists
- NMS symptoms include:
- elevated temperature (100.4)
- alter level of consciousness, confusion, tachycardia, diaphoresis, urinary or fecal continence
- piplike rigidity
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