1WEEK 1 – PARKINSON’S DISEASE ABD MOVEMENT DISORDERS

PARKINSON MECHANISM OF ACTIONS INDICATIONS ADVERSE EFFECTSDO

PAM

INER

GIC

CO-CARELDOPALevodopa + carbidopa

Levodopa is converted to dopamine via DOPA decarboxylase. This occurs both in the peripheral circulation and in the central nervous system after levodopa has crossed the blood brain barrier. Activation of peripheral dopamine receptors causes nausea and vomiting.

For this reason levodopa is usually administered in combination with a DOPA decarboxylase inhibitor (DDCI), in this case carbidopa. It cannot cross the blood brain barrier and diminished peripheral conversion of levodopa to dopamine hence, reduces the unwanted peripheral side effects of levodopa.

Use of carbidopa also increases availability of levodopa to the CNS

Parkinson

Peripheral effects- Anorexia, nausea and vomiting - Tachycardia and ventricular

extrasystoles- Hypotension - Saliva and urine are a brownish color

(melanin pigment produced from catecholamine oxidation)

CNS effects- Visual and auditory hallucinations - Dyskinesia - Mood changes, depression,

psychosis, anxiety

Bromocriptine

Dopamine receptor agonists. A potent agonist at dopamine D2 receptors]

and various serotonin receptors. It also inhibits the release of glutamate, by reversing the glutamate GLT1 transporter

Effective in pt exhibiting fluctuations in their response to levodopa.

Less risk of developing dyskinesia and motor fluctuations as initial therapy compared to levodopa

Hallucinations, confusion, delirium, nausea, and orthostatic hypotension. Worsen mental illnessPt with MI may develop serious cardiac problem

Selegiline Selectively inhibits monoamine oxidase type B. Hence decreasing the metabolism of dopamine.

Little potential to cause hypertensive crisis. Insomnia

Entacapone

When administered in conjunction with dopaminergic agents such as L-DOPA, entacapone prevents COMT from metabolizing L-DOPA into 3-methoxy-4-hydroxy-L-phenylalanine (3-OMD) in the periphery, which does not easily cross BBB. Leads to decreased plasma concentrations of 3-OMD, increased central uptake of levodopa, and greater concentrations of brain dopamine.

Peripheral effects- Anorexia, nausea and vomiting - Tachycardia and ventricular

extrasystoles- Hypotension - Saliva and urine are a brownish color

(melanin pigment produced from catecholamine oxidation)

CNS effects- Visual and auditory hallucinations - Dyskinesia - Mood changes, depression,

psychosis, anxiety

2WEEK 1 – PARKINSON’S DISEASE ABD MOVEMENT DISORDERS

A.M

USC

ARIN

ICProcyclidine Anti-muscarinic agent Adjuvant therapy

Pupillary dilatation, confusion, hallucination, tachycardia, urinary retention, constipation and dry mouth.