Parkinsons & Alzheimers

Levodopa-Carbidopa

DOC for Parkinsons Disease

• particularly bradykinesia

Administered with a DOPA Decarboxylase inhibitor

Can cause on and off phenomena

Pyridoxine

Increases the levels of DOPA Decarboxylase

Enhances the metabolism of levodopa

Present in Vitamin B complex medicine

MAOa inhibitors

Moclobemide

Tranylcypromine

Phenelzine

Isocarboxacid

Causes hypertensive crisis

Prevents the degradation of NE, EPI, DA

DO NOT TAKE WITH TYRAMINE RICH FOODS (CHEESE)

Ergot derivatives

Bromocriptine

Pergolide

Cabergoline

Piribedil

Partial agonist at D2 receptor in brain

Inhibits prolactin release (for HYPERPROLACTINEMIA)

AE/SE

• Erythromelalgia

  • vasodilation —> reddening of hands and feet

• Pulmonary/Retroperitoneal fibrosis

  • fibrosis in lungs and retroperitoneum/abdomen tissues

Bromocriptine

Ergot alkaloid that causes peripheral vascular disease

Non-Ergot

Pramipexole

Ropinirole

Impulse control disorders due to excessive D2 receptor activation

Pramipexole -D3

Ropinirole -D2

Uncontrollable tendency to fall asleep

Opioid Dopamine Agonist

Apomorphine

Rescue treatment for PD

No addicting properties

Never given alone

Can cause insomnia

MAOb Inhibitors

Selegiline

Rasagiline

Inhibits degradation of Dopamine only

for WANING EFFECT TREATMENT to LEVODOPA

Can cause dyskenesia

DO NOT TAKE WITH due to serotonin syndrome

• Meperidine

• SSRIS - Fluoxetine

• TCA - Amitriptyline

COMT Inhibitors

Tolcapone

Entacapone

Blocks L-dopa metabolism by COMT peripherally

Causes orange urine

Tolcapone

COMT Inhibitor that acts on CNS

Hepatotoxic

Antiinfluenza

Amantadine

May potentiate dopaminergic function

Suicidal ideation

Livedo reticularis

• fishnet pattern

Anticholinergics

Benztropine

Biperiden

Trihexyphenidyl

Procyclidine

For EPS caused by antipsychotics

Atropine-like effects

Huntington’s Disease

Imbalance between GABA (low) and Dopamine (high) with cholinergic deficits

Reserpine

TX for Huntingtons disease

Blocks catecholamine storage

Haloperidol

Perphenazine

TX for Huntingtons disease

Blocks D2 receptors

Wilsons disease

excess copper in body

Penicillamine

Chelating agent

TX for wilsons disease

Menkes disease

copper deficiency

Alzheimer’s disease

Low ACh and excess glutamate activity

AChE inhibitors

Donepezil

Rivastigmine

Galantamine

reversible AChE inhibition

first line for mild to moderate AD

only delays AD not cure

Tacrine

Tx for AD but can cause hepatotoxicity