Pharm - Neuro; Parkinson's, Alzheimers, Epilepsy

levodopa; use + MOA

parkinson's disease

MOA: converted to dopamine to help restore proper balance between dopamine and acetylcholine

levodopa; classification

dopamine replacement

levodopa; dose + route

PO

only given with carbidopa or entacapone

levodopa; adverse effects

most troubling adverse effect: dyskinesia

dark urine/sweat, insomnia, nightmares, dysrhythmias

early s/sx: N/V, postural hypotension

D/C drug if psychosis occurs

levodopa; rx interactions

carbidopa + entacapone: INCR effects

first gen antipsychotics: DECR effects

MAO inhibitors incr toxicity, risk for HTN crisis

levodopa; contraindications

Given w/out carbidopa

Caution in renal failure

AVOID in narrow angle glaucoma

levodopa; education

-avoid super high proteins

-drug may wear off between doses

-takes a few weeks to start working

-give w/ food

carbidopa; class + use + MOA

class: dopamine agonist

use: parkinson's, combined w levodopa to incr. therapeutic effects

MOA: inhibits decarboxylation of levodopa in intestines and peripheral tissues

carbidopa; dose + route

PO, max dose is 8 tablets per day

carbidopa; adverse effects

none; ae come from levodopa

carbidopa; education

-avoid super high protein

-may wear off between doses

-take w levodopa

pramipexole; class + use + MOA

• class: nonergot dopamine receptor agonist

• use: early stages of parkinsons, provides motor improvement, reduce motor control fluctuations, also used for restless leg syndrome

• MOA: binds to dopamine D2 and D3, activating dopamine receptors, blocks serotonergic and alpha adrenergic receptors

pramipexole; dose + route

PO

pramipexole; adverse effects

• when used alone: nausea, dizziness, daytime somnolence, insomnia, constipation, weakness

• weird side effects: sleep attacks, impulse control disorders, hallucinations

• in combo w levodopa: hypotension, dyskinesias, hallucinations

pramipexole; D/I + contraindications + education

Cimetidine

do not take if renal impairment or compulsive behavior

may take weeks to work, monitor BUN

entacapone; class + use + MOA

class: COMT inhibitor

use: parkinson's, prolongs half life of levodopa to prevent "wearing off"

MOA: selectively inhibits COMT, resulting in decreased effectiveness of levodopa

entacapone; dose + route

PO w levodopa/carbidopa

entacapone; adverse effects

most common: vomiting, diarrhea, constipation, yellow/orange urine

with levodopa: dyskinesias, orthostatic hypotension, nausea, hallucinations, sleep disturbance, impulse control issues

selegiline; class + use + MOA

class: MAO-B inhibitor

use: parkinson's, improves motor function, may delay neurodegeneration, can prolong effects of levodopa

MOA: selectively and irreversibly inhibits MAO-B, (the enzyme that inactivates dopamine)

selegiline; dose + route + when to take

PO, take before food, wait 5 mins before eating/drinking

selgiline; adverse effects

principal adverse effect when used alone: INSOMNIA

orthostatic hypotension, dizziness, GI s/sx

high doses + tyramine foods: hypertensive crisis buccaneers mucosa irritation if taking ODT

selegiline; interactions

tyramine foods

sympathomimetics

intensifies effects of levodopa

Meperidine (contraindicated)

SSRIs (contraindicated)

selegiline; contraindications

meperidine

SSRIs

selegiline; pt education

-benefits may decline after 12-24mos

-administer last dose before noon to avoid insomnia

-avoid tyramine foods

-monitor BP

2 alzheimers drugs

memantine

donepezil

memantine; class + use + MOA

class: NMDA receptor antagonist

use: MODERATE to SEVERE alzheimers

MOA: regulate calcium uptake into cells, preventing toxic levels of calcium from blocking memory formation

memantine; adverse effects

dizziness, headache, confusion, constipation, diarrhea, HTN, hypotension

memantine; rx interactions + contraindications

• D/I: other NMDA antagonists (amantadine, ketamine, sodium bicarb

• C/I:

  • drugs that alkalinize urine

  • caution w hepatic/renal impairment

what do you need to monitor with memantine?

BUN, creatinine

donepezil (aricept); class + use + MOA

class: cholinesterase inhibitor

use: MILD and mod/severe alzheimers

MOA: inhibits breakdown of acetylcholine by increasing acetylcholine available at cholinergic synapses

donepezil; adverse effects

Most common: headache, dizziness, vertigo, insomnia, N/V/D

Most serious: bronchoconstriction, bradycardia, sick sinus syndrome

donepezil; rx interactions

first gen antihistamines

tricylcic antidepressants

antipsychotics

donepezil; contraindications

asthma

COPD

liver disease

heart disease

donepezil; pt education

does not cure alzheimers, only slows progression

takes 1-3mos to see results

take med with food

give low + slow

epilepsy meds

levetiracetam ,

phenytoin

valproic acid

carbamazepine

gabapentin

phenobarbital

levetiracem; class + use + MOA

class: antiepileptic drug

use: myoclonic seizures, partial-onset seizures, primary generalized tonic-clonic seizures

MOA: unknown

levetiracem; adverse effects

drowsiness

weakness

suicidal ideation

levetiracem; contraindications + monitoring

pregnancy category C risk

screen for suicide risk

BUN + creat

phenytoin; class + use + MOA

class: anti-epileptic drug

use: partial seizures, generalized tonic-clonic seizures, dysrhythmias

MOA: blocks sodium entry into neurons decreases activity of neurons that produce seizures

phenytoin; adverse effects

Nystagmus (w/ high doses)

sedation

ataxia

diplopia

cognitive impairment, gingival hyperplasia, measles like rash,

bleeding tendencies in newborns

dysrhythmias and hypotension with IV

phenytoin; rx interactions

oral contraceptives

warfarin

glucocorticoids

diazepam

isoniazid

cimetidine

alcohol (sedates pt)

valproic acid (DO NOT overload it)

carbamezipine

Phenorbital

phenytoin; contraindications

HLA-B*1502 genetic mutation, Pregnancy Risk Category D

phenytoin; education

avoid alcohol and other CNS depressants

take 0.5mg folic acid daily

good oral hygience

phenytoin; nursing monitoring

LFTs

screen for suicide risk

should not exceed 20mcg/ml in body

Phenytoin implications

• Educate on good oral hygiene (d/t gum hyperplasia)

• Take 0.5 mg of folic acid DAILY

• Birth control

• AVOID alcohol & other CNS depressants

valproic acid; class + use + MOA

class: traditional anti-epileptic drug

use: seizures, bipolar, migraines

MOA: suppresses high frequency neurons targeting sodium channels, prevents calcium from entering calcium channels, may enhance inhibitory influence of GABA

valproic acid; contraindications

Preg Risk Cat D

AVOID combos in childer < 2 yr

Preexisting liver dysfunction

valproic acid; adverse effects

GI effects are MOST COMMON: N/V, indigestion

hepatotoxicity + pancreatitis or hyperammonemia

rash, weight gain, hair loss, tremors, blood dyscrasias

valproic acid; pt education

category D pregnancy risk

take w food

take folic acid for women in childbearing age

DO NOT chew or crush tab/caps

carbamezipine; class + use + MOA

class: traditional anti-epileptic drug

use: DOC for partial & tonic-clinic seizures

MOA: suppress high frequency neuronal discharge in and around seizure focus

carbamezipine; adverse effects

minimal effects on cognitive function

nystagmus, blurred vision, diplopia

ataxia, vertigo, unsteadiness, HA

bone marrow suppression

3 Mia’s: Leuko, anemia, thrombocytopenia

SJS

hypo-osmolalrity and hyponatremia

carbamezipine; contraindications + interactions

-hematologic abnormalities

-pregnancy risk D

-screen asian pts for HLA-B1502

oral contraceptives, warfarin, phenytoin, phenobarbitol, grapefruit juice

carbamezipine monitoring

suicide risk

LFTs

CBC

BMP

gabapentin; class + use + MOA

class: newer anti-epileptic

use: adjunct therapy for partial seizures, post-herpetic neuralgia

MOA: May enhance GABA release, a bit unknown

gabapentin; adverse effects

somnolence, dizziness, ataxia, fatigue, nystagmus, peripheral edema

gabapentin; conraindications

reduce dose in renal impairment

pregnancy risk category C

gabapentin; nursing monitoring

suicide risk

BUN

creat

phenobarbitol; class + use + MOA

class: anticonvulsant barbituate

use: partial and general tonic-clonic seizures

IV form can treat status epilepticus

MOA: binds to GABA receptors

phenobarbitol; dose + route

IV, IM, PO

phenobarbitol; adverse effects

drowsiness & lethargy is most common

sedation, rickets, osteomalacia

in children: hyperactivity, irritability

in elderly: agitation + confusion

porphyria

bleeding tendencies in newborns

Dependence

phenobarbitol toxicity s/sx

nystagmus

ataxia

respiratory depression

phenobarbitol; rx interactions

oral contraceptives

warfarin

CNS deppressants

alcohol

valproic acid

phenobarbitol; contraindications

hx of porphyria

suicidal tendencies

pregnancy risk D

phenobarbitol; pt education

-will not cause addiction

-as tolerance builds, drowsiness will subside

-limit or avoid alcohol

-do not d/c abrubtly