Parkinson's, alzheimers, immine mod

"Levodopa/Carbidopa Brand"

"Sinemet"

"Levodopa Mechanism of Action"

"Dopamine precursor converted to dopamine in the substantia nigra after crossing the blood-brain barrier."

"Carbidopa Mechanism of Action"

"Inhibits DOPA decarboxylase

"Levodopa/Carbidopa Adverse Effects"

"Dyskinesias

"Levodopa/Carbidopa Behavioral Effects"

"May cause behavioral changes and pathological gambling."

"Levodopa Wearing-Off Phenomenon"

"Often occurs after approximately 5 years of levodopa therapy due to progressive loss of neuronal dopamine stores."

"Levodopa Wearing-Off Management"

"May require decreasing the dosing interval by 30–60 minutes or adding a COMT inhibitor."

"Levodopa/Carbidopa Counseling"

"Start low and go slow."

"Crexont Drug Class"

"Extended-release carbidopa/levodopa formulation."

"Crexont Main Points"

"New extended-release formulation with label-specified titration; may be considered to help mitigate wearing-off."

"Crexont Adverse Effects"

"Same adverse effects as levodopa/carbidopa."

"Vyalev Drug Class"

"Foscarbidopa/foslevodopa."

"Vyalev Route and Administration"

"Subcutaneous continuous infusion of levodopa for advanced Parkinson disease with motor fluctuations."

"Vyalev Counseling"

"Requires consideration of pump therapy

"Amantadine Mechanism of Action"

"Appears to increase dopamine release from the striatum

"Amantadine Adverse Effects"

"Hallucinations

"Amantadine Livedo Reticularis"

"Purple mottling of the skin."

"Istradefylline Brand"

"Nourianz."

"Istradefylline Mechanism of Action"

"Unknown; believed to antagonize adenosine receptors."

"Istradefylline Use"

"Scheduled adjunct to levodopa/carbidopa for OFF episodes; not an immediate rescue medication."

"Istradefylline Usual Dose"

"20 mg/day."

"Istradefylline Maximum Dose"

"40 mg/day."

"Istradefylline Smoking Consideration"

"Patients who smoke approximately one pack per day may require 40 mg because tobacco decreases steady-state concentration by 38–50%."

"Istradefylline Metabolism"

"CYP3A4 substrate."

"Istradefylline Drug Interactions"

"CYP3A4 inhibitors limit dosing to 20 mg daily; avoid strong CYP3A4 inducers because the medication may not work."

"Istradefylline Adverse Effects"

"Multiple drug interactions and dyskinesia."

"Dopamine Agonists Mechanism of Action"

"Activate dopamine D1 and/or D2 receptors."

"Dopamine Agonists Timing"

"Starting dopamine agonists before levodopa may help delay dyskinesias and on/off periods."

"Dopamine Agonists Initial Treatment"

"When used alone as initial treatment they eventually lose effectiveness and levodopa may need to be started."

"Dopamine Agonists Treatment Consideration"

"If one dopamine agonist does not work try another

"Bromocriptine Brand"

"Parlodel."

"Pramipexole Brand"

"Mirapex."

"Ropinirole Brand"

"Requip."

"Apomorphine Brand"

"Apomorphine."

"Rotigotine Brand"

"Rotigotine."

"Dopamine Agonists Adverse Effects"

"Orthostatic hypotension nightmares, hallucinations, impulse-control disorders, vomiting, sedation, and confusion."

"COMT Inhibitors Mechanism of Action"

Block catechol-O-methyltransferase, an enzyme responsible for metabolism of levodopa and dopamine."

"COMT Inhibitors Use"

"Used as adjuncts to levodopa; they are not stand-alone treatments."

"COMT Inhibitors Main Effect"

"Prolong the half-life of levodopa/carbidopa and may allow a decrease in the daily levodopa dose."

"Tolcapone Brand"

"Tasmar."

"Entacapone Brand"

"Comtan."

"Opicapone Brand"

"Ongentys."

"Tolcapone Adverse Effects"

"Not specified in the lecture table."

"MAO-B Inhibitors Mechanism of Action"

Inhibit monoamine oxidase B, decreasing dopamine metabolism and increasing dopamine concentrations."

"MAO-B Inhibitors Use"

"Generally given to younger patients or patients with early-stage Parkinson disease in combination with levodopa."

"Selegiline Brand"

"Eldepryl."

"Rasagiline Brand"

"Azilect."

"Safinamide Brand"

"Xadago."

"MAO-B Inhibitors Serotonergic Drug Interactions"

Dextromethorphan, meperidine, tramadol, methadone, and linezolid."

"Anticholinergics Mechanism of Action"

Block acetylcholine actions, decreasing cholinergic activity and helping balance the acetylcholine-to-dopamine ratio."
"Anticholinergics Use in Parkinson Disease","Reduce tremor and muscular rigidity."

"Anticholinergics Use in Parkinson Disease"

"Reduce tremor and muscular rigidity."

"Benztropine Brand"

"Cogentin."

"Trihexyphenidyl Brand"

"Artane."

"Anticholinergics Age Consideration"

"Should not be used in patients older than 65 years."

"Anticholinergics Discontinuation"

"Gradual discontinuation is important."

"Anticholinergics Adverse Effects Mnemonic"

Can't see, can't spit, can't piss, can't shit."

"Cholinesterase Inhibitors Mechanism of Action"

"Increase and prolong acetylcholine concentrations at the synapse."

"Cholinesterase Inhibitors Benefits"

Produce modest but sustainable improvement in cognition, activities of daily living, and behavior."

"Donepezil Brand"

"Aricept."

"Rivastigmine Brand"

"Exelon."

"Galantamine Brand"

"Razadyne."

"Donepezil and Rivastigmine Formulation"

"Both are available as patches approved for Alzheimer disease."

"Cholinesterase Inhibitors Adverse Effects"

Nausea, vomiting, diarrhea, bradycardia, syncope, and urinary incontinence."

"Donepezil Specific Adverse Effect"

"Vivid dreams."

"Anti-Amyloid Monoclonal Antibodies Mechanism of Action"

"Target amyloid plaques."

"Lecanemab Brand"

"Leqembi."

"Lecanemab Indication"

"For patients with early symptomatic Alzheimer disease and confirmed amyloid pathology."

"Lecanemab Administration"

"One-hour IV infusion every 2 weeks or subcutaneous administration."

"Donanemab Brand"

"Kisunla."

"Donanemab Administration"

"IV administration."

"Anti-Amyloid Monoclonal Antibodies Serious Adverse Effects"

"Cerebral edema and hemorrhage

"Anti-Amyloid Monoclonal Antibodies Before Treatment"

"Obtain MRI assessment and perform APOE E4 testing with counseling about associated risks."

"Anti-Amyloid Monoclonal Antibodies Monitoring"

"Follow the product-specific MRI and symptom assessment plan."

"Memantine Brand"

"Namenda."

"Memantine Mechanism of Action"

"Reduces glutamatergic overstimulation at the NMDA receptor."

"Memantine Benefits"

Produces modest but sustainable improvement in cognition, activities of daily living, and behavior."

"Memantine Combination Therapy"

"Can be used along with donepezil."

"Memantine Adverse Effects"

Dizziness, confusion, insomnia, hallucinations, and delusions."

"Brexpiprazole Brand"

"Rexulti."

"Brexpiprazole Drug Class"

"Atypical antipsychotic."

"Brexpiprazole Indication"

"Approved for dementia-associated agitation."

"Brexpiprazole Boxed Warning"

"Increased mortality in older adults with dementia-related psychosis."

"Brexpiprazole Monitoring"

"Monitor sedation

"Dextromethorphan/Bupropion Brand"

"Auvelity."

"Dextromethorphan/Bupropion Use"

"Non-antipsychotic option for Alzheimer-related agitation."

"Dextromethorphan/Bupropion Screening"

"Screen for seizure risk, elevated blood pressure, and bipolar disorder."

"Dextromethorphan/Bupropion Contraindications and Interactions"

"Contraindicated with MAOIs; review serotonergic medications, CYP2D6 interactions, and duplicate bupropion or dextromethorphan products."

"Dextromethorphan/Bupropion Administration"

"Not a PRN medication."

"Glucocorticoids Mechanism of Action"

Cause lysis and redistribution of lymphocytes, reducing total blood lymphocyte numbers."

"Glucocorticoids Mechanism of Action Additional"

"Increase lymphocyte apoptosis by curtailing NF-kB activation."

"Glucocorticoids Anti-Inflammatory Action"

"Inhibit synthesis of pro-inflammatory cytokines."

"Methylprednisolone Brand"

"Medrol."

"Prednisone Brand"

"Deltasone."

"Dexamethasone Brand"

"Decadron."

"Glucocorticoids Indications"

"Prevent and treat transplant rejection, treat autoimmune disorders such as rheumatoid arthritis and IBD, and manage allergic reactions to other immunosuppressive agents."

"Glucocorticoids Adrenal Suppression"

"Risk depends on dose and duration of treatment."

"Glucocorticoids Infection Risk"

"Increased risk of infection with 20 mg or more of prednisone or equivalent daily for 2 or more weeks."

"Glucocorticoids Adverse Effects"

Slowed wound healing, cataracts, hyperglycemia, ulcers, hypernatremia, hypokalemia, psychosis, Cushingoid appearance, and increased osteoporosis risk."

"Calcineurin Inhibitors Mechanism of Action"

"Suppress T-cell activity by inhibiting calcineurin-dependent signaling and IL-2 production."

"Tacrolimus Brand"

"Prograf."