Neuro Drugs - ALS, PD, Alzheimer's

what does vit D help with?

absorption of Ca and P

dose for vitamin D adult supplement

600-800 IU

what form of vit D is synthesized in the skin through sun exposure?

• deficient after winter

• fatty fish, eggs

cholecalciferol

vit D _____________ dementia, but does not ____________ it

prevents, reverse

list the order of vitamin D synthesis

1. 7 dehydrocholesterol

2. previtamin D

3. cholecalciferol

4. calcidiol

5. calcitriol

what type of vitamin D is used for supplements because of better potency, bioavailability, and duration?

calciferol D3

what type of vit D is given with liver disease?

calcidiol

what type of vit D is given with kidney pts?

calcitriol

what is usually LOW in RLS pts?

iron w

what should RLS pts avoid?

• alcohol

• obstructive sleep apnea

• antihistamines

• serotogenic

• antidopamine meds

what are the three first line medications for RLS? what should also be given?

1. gabapentin enacarbil

2. gabapentin

3. pregabalin

iron supplements!

second line for RLS

• ER oxy

• perineal nerve stimulation

• dipyridamole

what should you NOT give RLS pts?

dopamine agonists

what is low in PD pts?

dopamine

PD pts have problems in the __________ ________ of the brain

substantia nigra

what do you initially prescribe early PD pts?

IR levodopa, lowest dose

what are the two types of surgeries for PD pts?

deep brain stimulation

high focus ultrasound

vitamin D

MOA: converted to active form by kidneys and liver, boost Ca absorption

Use: vit D deficiency

Dose: 50,000 IU a day for 8 weeks → 1500-2000 afterward

SE: constipation, appetite loss, hypervitaminosis, polyuria, Ca nephrolithiasis

warning: fat soluble = potential toxicity, monitor levels :)

gabapentin enacarbil

renally adjusted

somnolence, dizziness

gabapentin

enhances gaba

used for seizures, RLS

renally adjusted

dizziness, ataxia

pregabalin

gaba analog

used for partial seizures, RLS

renal dosing

carbidopa levadopa

MOA: carb makes sure to LEAVE levo in the brain

dose: adjustment due to “wearing off”

SE: levadopa induced dyskinesias (LID), nausea, vomiting, vivid dreams, hallucinations, ICDs

drug rxns: MAO-I, linezolid (HTN → adjust with phenytoin, metoclopramide, antihypertensive

notes: take 1-2 hrs after protein for proper ab, it does wear off

delayed on

time for PD drug to take effect

peak dose dyskinesias

too much PD drug, physical effects

wearing off

re-emergence of PD symptoms after drug decreases

on-off

PD disease fluctuating symptoms

what do you give a pt for LID?

amantidine

dopamine agonists

MOA: stimulate dopamine

use: younger pts to delay levadopa use

types: promiprexole, ropinorole, rotigotine, apomorphine

SE: dizzy, sleep (NO DRIVING!!!), ICDs

hat does apomorphine do?

fixes a PD “freeze”

MAO-B inhibitors

MOA: limits dopamine breakdown

use: younger pts to avoid levodopa, or advanced pts to increase on time

types: rasagiline, safanimide (ADD ON ONLY)

SE: gambling behaviors

drug rxns: tyramine, serotonin syndrome, dont use with MAO-I

COMT inhibitor

MOA: block enzyme that breaks down levodopa

use: extends levadopa use, MUST be an add on

types: entacaprone, stalevo, opicaprone, tolcapone

SE: dyskinesia

Amantidine

MOA: helps with dopamine

Use: LID, mild early PD (not the best)

dose: start low and titrate

SE: peripheral edema, GT prolong

hallmark of alzheimers

amyloid beta plaques

decreased acetylcholine

low stimulation of NMDA receptors

amyloid PET/CT used for diagnosis, CSF testing helps too

B amyloid and Tau CSF biomarkers are abnormal

how do you treat moderate to severe alzheimers?

symptomatic treatment

donepezil

memantine

if you have moderate to severe alzheimers, what are you NOT eligible for?

disease modifying therapy —> monoclonal antibodies

scale used to stage dementia

clinical dementia rating

at what clinical dementia ratings are pts eligible for monoclonal antibodies?

if its over 2, they are NOT a candidate

0.5, 1

anti-amyloid monoclonal antibodies

MOA: target amyloid B and promote clearance via phagocytosis

Types: lecanemab (AB protofibrils), donanemab (AB epitopes, establish plaques)

use: MCI with confirmed B amyloid plaques

dose: lecanemab (SQ maintenence), donanemab (treat to clear)

SE: amyloid related imaging abnormalities (edema/effucion/microhemorrhage) → ARIA symptoms: HA, dizzy, confusion

contraindications: anticoagulants, higher ARIA rates, MRI exclusions, moderate to severe AD

acetylcholinesterase inhibitors

MOA: decreases AChE

use: mild-moderate AD

dose/type: donepezil

SE: diarrhea, nausea, vomiting

drug reactions: anticholinergics, ramelteon

monitor: symptoms, GI bleed

notes: take at bedtime

NMDA receptor agonist

MOA: NMDA agonist

use: moderate to severe AD

dose/type: memantine

SE: HTN, hypotension, dizzy, HA

drug reactions: urinary alkalizers

notes: memantine and donezapil can be taken together

for AD, what type of meds are first line? second line?

first line = acetylcholinesterase

second line = NMDA receptor agonist