Antiparkinson agents

1. Antiparkinson agents Broyles: chapter 31

2. Terms • Parkinson’s symptoms: • Mask like face, fine tremors, • Intention tremor, slurred speech, shuffling gait, mask like face

3. Medications • Use: treatment of parkinsion’s disease.. Relieve the symptoms and increase the movement • Parkinsons disease=has decreased dopamine and increased acetylcholine • Action= levodopa crosses the blood brain barrier and is converted into dopamine to replace body dopamine

4. Dopaminergic • Medication: levodopa • Adverse: nausea, vomiting, orthostatic hypotednsion dystonic movements, anorexia, dysphagia, chorieform movements, • On off effect= long term use of the drug may have an irregulr response to the drug….. • Reduce the maintanence dose and substitute another anti parkinson’s drug

5. Dopaminergic • Food high in b 6 reverse effect of dopamine ( increases the breakdown)=fish, chicken, organ meat, oats, potatoes, egg yolk • Take multivitamins without b6=larobec • No alcohol

6. Carbidopa/levodopa • Sinemet (mg of carbidopa/mg of levadopa) • Used in combination, less levodopa can be used • Prevents breakdown in peripheral circulation, more levodopa for entry into brain (pg 699) • Carbidopa (lodosyn) is available without levodopa

7. Dopaminergic agents • Meds: symmetrel/amantadine • Action-medication given with levodopa causes more dopamine to reach the brain • Adverse: depression, orthostatic hypotension, insomnia • Parlodel/bromocriptine= stimulates dopamine receptors in brain • Adverse: drowsiness, sedation, epigastric distress

8. Eldepyl/seligiline • With levodopa=allows less to be used to achieve similar effects to larger doses of levodopa • Adverse: hallucinations, confusion, loss of balance, • Dyskinesia • Risk of hypertension when given in doses over 10 mg and tyramine foods as beer, wine, • Aged cheese…..

9. Comt inhibitors • Action: prolong effect of levodopa by blocking enzyme • That eliminates levodopa • (Catecho-0-methytransferease) • Not given with monoamine oxidase inhibitors • Meds: tasmar/tolcapone • Adverse: orthostatic hypotension, insomnia, dystonia, anorexia,confusion, disorientation liver damage/liver failure

10. Apomorphine/apokyn • Dopaminergic agonist • Can be used for undermedicated state • Used by injection and subcut med lasts 45-60 min • Gives rapid results (4-8 min)

11. Non-ergot dopamine receptor agonist • Action: not known • Med: mirapex/pramipexole • Adverse: nausea, vomiting, postural hypotension, hallucinations syncope, dyspepsia • Requip/ropinorole hcl • Adverse: syncope, constipation, dry mouth, urinary frequency • Do not use with monoamine oxidase inhibitors

12. Anticholinergic • Action: inhibits acetycholine Meds: cogentin artane benedryl Side effect: (antichloinergic effects) dry mouth, palpitations, urinary retention, constipation, blurred vision

13. Anticholinergic • Cogentin/artane.. • Do not use with peptic ulcer, myesthenia gravis, prostatic hypertrophy

14. Nsg • Use sips of water or hard candy for dry mouth • Liver function q 2 weeks for 1 year and if exceeds normal limit or liver failure develops stop the medication… esp tasmar/comtan • Do not rush pt. • Effectiveness of drug is based on pts ability to speak, ambulate, provide self care.