3. OTHER DRUGS - Amantidine , MAO inhibitors and COMT inhibitors

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Amantidine is an antiviral used for the treatment of

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Influenza A , herpes simplex and varicella zoster

has modest anti parkinsonian activity

Given orally and is well tolerated

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MOA of Amantidine as an anti parkinsonian drug

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acts by releasing dopamine from intact dopaminergic neurons - increases levels in the synpases

also decreases dopamine reuptake in CNS

Only a few benefits and tolerance develops with time.

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15 Terms

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Amantidine is an antiviral used for the treatment of

Influenza A , herpes simplex and varicella zoster

has modest anti parkinsonian activity

Given orally and is well tolerated

2
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MOA of Amantidine as an anti parkinsonian drug

acts by releasing dopamine from intact dopaminergic neurons - increases levels in the synpases

also decreases dopamine reuptake in CNS

Only a few benefits and tolerance develops with time.

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ADRS of Amantidine

nightmares

insomnia

Hallucinations

Delirium

dizziness

GIT disturbances

skin discoloration

dry mouth

peripheral edema

rarely - leukopenia

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DOPAMINE METABOLISM INHIBITORS

MAOb inhibitors - selegiline , rosagiline

COMT inhibitors - entacapone and tolcapone

dopamine is metabolised by MAO (mono amine oxidase) and COMT (catechol-o-methyl transferase)

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Does Entacapone act centrally or peripherally

peripherally

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Does Tolcapone act centrally or peripherally

both centrally and peripherally

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Entacapone is useful in

end dose of motor flactuations as an adjunct to L dopa - carbidopa combinations.

use of dopamine decarboxylase inhibitors is associated with the rise in 3-o methyldopa

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ADRS of entacapone

increased L DOPA associated dyskinesias , nausea and confusion

diarrhea

abdominal pain

orthostatic hypotension

sleep disturbances

orange discolouration in urine.

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ADRs of tolcapone

Hepatotoxic effects - hepatotoxicity with cases of acute hepatic failure rarely reported.

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SELEGELINE

MAO B inhibitor. In high doses inhibits MAO A.

• Used in conjunction with L-dopa in severe disease to reduce end of dose deterioration.

Early use may delay need for L-dopa therapy and slow down progression of disease.

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DOSAGE OF SELEGINE

• Given orally.

• Dose 10MG OD in the morning, or 5mg at breakfast and 5 mg at midday.

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ADRS OF SELEGELINE

• Nausea, vomiting

• Hypotension

• Confusion

• Agitation

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DIs OF SELEGELINE

• Should not be taken with:

Meperidine

• TCAs

• Serotonin reuptake inhibitors- may cause acute toxic reaction of serotonin syndrome

Adverse effects of levodopa may be increased by selegeline.

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Rasagiline

• MAO B inhibitor

• Pharmacology like selegeline, but pore potent in preventing MPTP induced Parkinsonism.

Used as a neuroprotective agent and for early treatment.

• Preps - 0.5mg, 1mg

• Dose - standard dose 0.5 mg /d

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Other movement disorders

• Tremors

• Chorea

• Huntington's disease

• Ballismus

• Athetosis and dystonia

• Tics

• Drug induced dyskinesias

• Restless leg syndrome

• Wilson's disease