Parkinson's meds

  1. Levadopa, Carbidopa, Sinamet
    • -Levadopa is a precursor to dopamine, standard tx since 1967
    • -no "right" dose of Lepadova, titrated to pt's response and s/e
    • -"end of dose symptoms:" pt. may freeze up or "turn off"
    • -s/e: N/V, orthostatic hypotension, arrythmias, dyskinesias, vivid dreams, hallucinations
    • -Carbidopa delays the conversion of levodopa to dopamine until it reaches the brain, reducing the amount of Levadopa needed.
    • -Sinamet is the only combo drug avil. in the US
  2. Bromocriptine (Parlodel)
    Pergolide (Permax)
    Pramipexole (Mirapex)
    Ropinirole (Requip)
    Dopamine Agonists
    • -mimic the role of dopamine in the brain, synergize levodopa (help receptor cells take up dopamine in the brain)
    • -s/e: nausea, constipation, dizziness, somnolence, dyskinesia, "wearing off" phenomenon
  3. Amanadine (Symmetrel)
    • -enhances release of incr. amounts of dopamine in the brain
    • -first-line med early in dx
  4. Benztropin (Cogentin)
    Trihexphenidyl (Artane)
    • -block some of the excitatory effects of ACH which contribute to tremors, also incr. HR and decr. gastric and oral secretions
    • -can also be used to prevent oculogyric crisis (when eyes are fixed in a lateral upward gaze)
    • -s/e: dry mouth, blurred vision, mydriasis, urinary retention
  5. Selegiline (Eldepryl)
    MAO-A inhibitor (monoamine oxidase-A)
    • -inhibits enzyme that breaks down lepadova in the brain, and so synergizes lepodova
    • -s/e: insomnia, orthostatic hypotension, arrhythmias, nausea
    • -MAO's have many drug interactions! and when taken w/ foods high in thiamine such as chianti and aged cheeses can cause HTN
  6. Tolcapone (Tasmar)
    Entcapone (Comtin)
    COMT inhibitors (catechol-O-methyl transferase)
    • -incr. bioavailability of levodopa by inhibiting enzyme that reduces it to a less active form (so it must be given w/ levodopa)
    • -s/e: liver toxicity (monitor LFTs q2-4 wks at start of tx and stop drug if not therapeutic effect in 3 wks), dyskinesia, hyperkinesia, nausea, diarrhea, brownish-orange discoloration of urine
Card Set
Parkinson's meds
exam 3 PD meds