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4 selective serotonin reuptake inhibitors (antidepressants)
- Fluoxetine (Prozac)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
- Citalopram (Celexa)
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Fluoxetine is what?
selective serotonin uptake inhibitor - antidepressant
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sertraline is what?
selective serotonin uptake inhibitor - antidepressant
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paroxetine is what
selective serotonin uptake inhibitor - antidepressant
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citalopram is what
selective serotonin uptake inhibitor - antidepressant
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celexa is what
selective serotonin uptake inhibitor - antidepressant
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akathesia
bradykinesia
akinesia
freezing
- invol movements
- slow
- loss
- can't initiate mvmnt
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neurotransmitter changes seen in PD
- less: dopamine, serotonin, GABA, norepinephrine
- more: acetylcholine (relatively speaking)
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sinemet
combo of levodopa and carbidopa
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levodopa does what? taken with what
- converts to dopamine
- taken with carbidopa which helps levodopa reach the BBB without breaking down (so the pt can take lower doses of levodopa and avoid the NV side effects of larger doses)
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MAO inhibitors -- mechanism
monoamine oxidase (MAO) catabolizes catacholamines (dopamine, norepinephrine, epinephrine, serotonin) so MAO inhibitors blocks this
target MAO B bc that's in the brain, while MAO A is intestinal
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best known MAO
selegiline
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selegine - what is it? how is it used?
- MAO inhibitor
- served w levodopa/carbidopa (sinemet) so you won't have to take as much l/c
also, its metabolites (amphetamine and methamphetamine) enhance release of norepinephrine, dopamine, serotonin
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3 names for MAO inhibitors
- selegiline
- eldepryl
- juprenil
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COMT inhibitors -- catechol o-methyltransferase does what?
help levodopa reach brain more safely (slows its breakdown) and limit the "off" periods
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COMT inhibitor names
- tolcapone (tasmar)
- entacapone (comtan)
- stalevo -- combo of levadopa, carbidopa, and entacapone
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tolcapone/tasmar - type of drug? side effects?
- COMT inhibitor
- liver failure
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stalevo
combo of leva/carbidopa and entacapone
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amantadine does what
augments dopamine release from presynaptic neurons and inhibits reuptake into storage granules
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amantadine - useful for what symptoms
stiffness, slowness, rigidity, bradykinesia
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amantadine side effects
- GI - N/V dry mouth, diarrhea
- CNS - depression, hallucinations, confusion, insomnia, irritability
- CV - edema, orthostatic hypotension
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dopamine agonists - name
- ropinirole (requip)
- pramipexole (mirapex)
- bromocriptine
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how do dopamine agonists work?
they act like dopamine and stim their receptors
can be used indep in early stages of PD (to delay the need for levodopa), used w levodopa in advanced PD
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when to add dopamine agonists to levodopa?
- levodopa can't control symptoms and increasing the dose would be reckless
- severe motor fluctuations
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side effects of dopamine agonists
all the usual bad stuff
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anticholinergic meds
Maintain balance of dopamine and acetylcholine by breaking down ACh.
Main role is to diminish tremor. Also helps with muscle rigidity.
Not so effective w bradykinesia and postural disturbances
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anticholinergic side effects
- PNS - dry mouth, blurred vision, constipation, urinary retention, increased intraocular pressure
- CNS - confusion, mem impairment, hallucinations, delusions
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deep brain stim for PD stims what?
- subthalamic nucleus
- this jams//blocks abnormal circuitry to minimize the disabling symptoms
- used for pts who can't be managed by meds
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ropinirole/requip is what
dopamine agonist
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pramipexole / mirapex is what
dopamine agonist
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bromocriptine is what?
dopamine agonist
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