Pharm Week 11

what causes Parkinson’s?

not enough dopamine and too much acetylcholine

PD symptoms

• rigidity

• tremors

• gait disturbance

• bradykinesia

benztropine category

anticholinergic (PD)

why give anticholinergic for PD?

• theres too much acetylcholine - reduce then acetylcholine → increased effects of dopamine in the brain

levodopa category

dopaminergic (PD)

levodopa mechanism of action

replaces dopamine in the brain

carbidopa category

dopaminergic

carbidopa mechanism of action

stops enzyme that breaks down levodopa → more reaches brain

carbidopa/levodopa side effects

• orthostatic BP

• tachycardia

• N/V

• dyskinesia

• psychotic behavior

• urine and sweat discoloration (darken)

carbidopa/levodopa food consideration

taking with food can help with N/V, but food needs to be low protein

levodopa/carbidopa pt education

• take at regular intervals, never stop abruptly (won’t move)

• takes 2-6 weeks to be effective

• started low then gradually increased

inhaled levodopa

dopamine agonist mechanism of action

mimic dopamine

dopamine agonist safety concern

sleep attacks

bromocriptine category

bopamine agonist (PD)

apomorphine category

dopamin agonist (PD)

pramipexole category

dopamine agonist (PD)

ropinirole category

dopamine agonist (PD)

what must be monitored with apomorphine?

BP and HR - given under close supervision of HCP

pramipexole/ropinirole consideration

cardiac (up/down BP and HR)

additional use for pramipexole/ropinirole

restless leg syndrome

monoamine oxidase b inhibitor mechanism of action

stops enzyme that breaks down dopamine

monoamine oxidase b inhibitor used with what?

levodopa/carbidopa

monoamine oxidase b inhibitor requires lower intake of what? why?

tyramine - can lead to hypertensive crisis

selegiline category

monoamine oxidase b inhibitor

COMT inhibitors common ending

-capone

COMT inhibitor mechanism of action

increases levodopa in brain - used alongside it

entacapone category

COMT inhibitor

tolcapone category

COMT inhibitor

tolcapone can cause what?

fatal hepatotoxicity

stopping COMT inhibitor suddenly can lead to what?

NMS, confusion

COMT inhibitor side effects

GI, darkened urine

amantadine category

dopamine receptor antagonist

dopamine receptor antagonist mechanism of action

acts on dopamine receptors → increases effects of dopamine in brain

what causes alzheimer disease

• not enough acetylcholine → cognition and memory issues

acetyhcholinesterase (AChE) inhibitor mechanism of action

acetylcholinesterase is what breaks down acetylcholine - inhibit that → more acetylcholine (alzheimer)

donepezil category

acetyhcholinesterase (AChE) inhibitor (alzheimer)

galantamine category

acetyhcholinesterase (AChE) inhibitor(alzheimer)

revastigmine category

acetyhcholinesterase (AChE) inhibitor(alzheimer)

when is donepezil given

bedtime

acetyhcholinesterase (AChE) inhibitor side effects

• GI upset

• muscle spasms

• bradycardia!!!

• dizziness, syncope → safety!!!

• increasing secretions

revastigmine patch considerations

• new patch every 24 hours

• but, these patients are cognitively impaired so might not be a great idea

n-methyl-d-aspartate (NMDA) receptor antagonist mechanism of action

calms things down in the brain (alzheimer’s)

memantine category

n-methyl-d-aspartate (NMDA) receptor antagonist (alzheimer)

n-methyl-d-aspartate (NMDA) receptor antagonist side effects

• dizziness - safety!!

• consitpation

IgG1 monoclonal antibody mechanism of action

decreases plaque formation (alzheimer)

aducanumab category

IgG1 monoclonal antibody

how is aducanumab given?

IV/infusion center

aducanumab considerations

brain bleed, brain swelling