Parkinson’s and Multiple Sclerosis Drugs

Parkinson’s Disease

Dopamine deficiency, causing tremor, rigidity, and slow movement

• Imbalance of dopamine and ACh (dopamine is low, ACh is high), causing motor control loss​

• Caused by neuron loss in substantia nigra

• Symptoms: tremor, rigidity, bradykinesia, shuffling gait, postural instability

Parkinson’s Drug Classes

• Anticholinergics

  • Benztropine

• Dopaminergics

  • Levadopa/Carbadopa

• Dopamine Agonists

  • Pramipexole​

• AO-B Inhibitors

  • Selegiline

• COMT Inhibitors

  • Entacapone

• Dopamine Antagonists

  • Amantadine

Benztropine

Centrally acting cholinergic blocker (anticholinergic)

• MoA: Blocks ACh to reduce tremor and drooling

• Indication: Parkinson’s, extrapyramidal disorders (except tardive dyskinesia)

• Contraindication: Children ≤3 years of age

• Adverse Effects:

  • Confusion/agitation

  • dry mouth

  • tachycardia

  • N/V

  • Anhidrosis

Levadopa/Carbadopa - MoA, Indication, Contraindication, Nursing Considerations

Dopaminergic

• MoA: Get converted into dopamine and replaces dopamine

• Indication: Reduce Parkinson’s symptoms

• Contraindication: Foods high in protein

• Monitor gait, fall risk​

• Avoid high protein foods with levadopa – it interferes with absorption (consistency is key, don’t want low protein, but don’t want high protein)​

• Do not stop abruptly, can cause neuroleptic malignant like syndrome​

• Best given before meals to help tremors before eating​

Adverse Effects of Levadopa/Carbadopa

• On-off phenomenon (sudden, unpredictable fluctuation in motor function)

• Dyskinesia

• Orthostatic hypotension

• Nausea / Vomiting

• Tachycardia/dysrhythmias

Pramipexole

Dopamine agonist

• MoA: Binds to dopamine receptors and mimics dopamine

• Indication: Parkinson’s

• Adverse Effects:

  • Nausea/vomiting/constipation

  • Hallucinations

  • Hyperhidrosis

  • Sleep attacks/daytime sleepiness

  • Orthostatic hypotension/bradycardia

  • Dyskinesias

Amantadine

Dopamine Antagonist

• MoA: Increases release of dopamine from vesicles in the presynaptic neurons

• Indications: Reduction of PD symptoms, Management of levodopa-induced dyskinesia

• Adverse Effects:

  • Severe allergic reaction

  • Suicidal thoughts

  • Seizures

  • Orthostatic hypotension

  • Tachypnea

  • Anxiety/irritability/nervousness

  • NMS

Multiple Sclerosis (MS)

Autoimmune demyelination, causing nerve signal loss

• Symptoms: fatigue, weakness, spasticity, vision issues.​

  • Fatigue is biggest complaint with MS​

• Often relapsing-remitting pattern.

• Unpredictable progression, some can live for long, some can have quick progression and death​

MS Drugs

• Interferons

• Immunomodulators

  • Glatiramer, Teriflunomide

• Muscle Relaxants

  • Baclofen, Dantrolene

• Ocrelizumab

Interferons

• MoA: Lower inflammation by reducing cytokine production

• Indication: MS

• Contraindication: Immunosuppressed clients, liver disease

• Adverse Effects

  • Flu-like symptoms (fever, chills, headache, myalgia)

  • Injection site reactions

  • Infection

  • Anaphylaxis

• Can cause liver toxicity – monitor liver function (LFTs)​

• Infection risk​

Immunomodulators

Glatiramer, Teriflunomide

• Used for MS

• decrease inflammation

• Can cause liver toxicity – monitor liver function (LFTs)​

• Infection risk​

Baclofen

Muscle Relaxant

• MoA: Reduce spasticity by inhibiting GABA receptors in the spinal cord and resrticting calcium influx

• Indications: for reversible muscle spasticity from MS

• Contraindications: Caution with pregnancy and breastfeeding

• Interactions: CNS depressants, Anticholinergic agents

• Encourage mobility with rest periods​ (with any MS drug)

• Promote stress management and adherence​

Adverse Effects of Baclofen

• Weakness/drowsiness/fatigue

• Confusion/headache/insomnia

• Nausea/vomiting/constipation

• Urinary retention

• Hypotension

• Arrhythmias

GABA structural analogs

For neuropathic pain​ with MS