Parkinson's Disease Medication Overview PDF

o • • • • • General Information BRAND Sinemet Rytary Duopa BRAND Mirapex Requip Stelvo Eldepryl Zelapar Emsam Azilect Xadago Cogentin Northera MOA Levodopa DA Precursor Carbidopa inhibit Decarboxylase C/I C/I DRUG Tx: NOTES • Give 200mg w/ EACH dose of Carbidopa/Levodopa. •  Levodopa d...

o • • • • • General Information BRAND Sinemet Rytary Duopa BRAND Mirapex Requip Stelvo Eldepryl Zelapar Emsam Azilect Xadago Cogentin Northera MOA Levodopa DA Precursor Carbidopa inhibit Decarboxylase C/I C/I DRUG Tx: NOTES • Give 200mg w/ EACH dose of Carbidopa/Levodopa. •  Levodopa dose by10-30% when giving COMT inhibitor. CAUTION Dose written in mL NOT mg. 1. Apply QD same time each day. 2. Do NOT apply to same site for 14days. 3. No Heat source over patch. 4. Remove patch before MRI. 5. Avoid in SULFITE allergies. NOTES • Titrate Cautiously • CR-Tab may cut in ½ • Must separate from Iron products. NOTES MOST Effective = Levodopa = Prodrug • Give w/ Carbidopa to prevent peripheral metabolism of Levodopa. • Important to give RIGHT AMOUNT of Carbidopa = 70-100mg QD to block metabolism w/o causing excess S/E • ELDERLY: initial Tx should be Carbidopa/Levodopa • YOUNG: Usually give Dopamineagonists to limit "OFF" periods & dyskinesia. • Tremor dominant: Tx w/ Central-Acting Anti-Cholinergic • BEERS: Avoid in Elderly due to S/E. 5HT-3 Antagonist (Ondansetron due to hypotension) Livedo Reticularis cutaneous reddening skin rxn. C/I Toxic Delirium w/ Renal imp. BBW BBW Long-term use can lead to response fluctuations + dyskinesia BBW NOT Recommended: Bromocriptine Amantidine = Treat Tremors MAO-B inhibitors Catecholo-Methyltransferase (COMT) inhibitors • Also blocks Levodopa metabolism. • C/I with Dopamine drugs. 1st LINE = Replace DOPAMINE: 1. Give DA-Precursors 2. Give DA-Agonists 3. Other Rx to control Sx. (ex. Tremors) PARKINSON’S DISEASE Symptoms MOTOR Sx: "TRAP" Sx Bradykinesia (slow move) Akinesia (lack of move) Shaking/Tremors Leg/Trunk Rigidity Postural Instability Additional Sx: Small/Cramped Handwriting Bent over body Shuffling walk Muffled Speech or Drooling Depression/Anxiety ADRs Somnolence Daytime sleep attack Nausea/Dizziness Orthostasis Hallucinations Dyskinesia MOA Dopamine-Agonist Severe N/V Hypotension Dizziness Similar S/E to Levodopa ADRs DA INJECTION "Rescue" agent for "OFF" period MOA COMT inhibitor Inhibit COMT to prevent conversion of Levodopa. Block DA-Reuptake Xadago = Severe Hepatic Imp. Used primarily for Tremors MAO-B inhibitors  Anti-Cholinergic effects Used for Neurogenic Hypotension Other MAOi Linezolid Opioid/TCA SNRIs Anti-Cholinergic/Histamine Syncope/Headache Falls Serotonin Syndrome HTN CNS Depression Alpha+Beta agonist Patch: may cause Skin-site rxns ADRs Nausea/Dizziness Orthostasis Dyskinesias Dystonias Brown/Black/Dark urine, saliva, sweat Unusual Sexual urges Priapism Coombs Test: D/C due to Hemolysis Brain disorder where Substantia Nigra is damaged  Failure to produce Dopamine. Disease will continue to progress despite tx w/ extended "OFF" periods o Disease worsens before next dose. Depression - use Secondary Amines o ex. Desipramine or Nortriptyline ▪  Efficacy  S/E SSRIs: used but contribute to Tremor + Serotonin Syndrome Psychosis: use Quetiapine or Clozapine or Pimavanserin (Nuplazid) o New approved drug for hallucinations or delusions. Drugs that WORSEN Parkinson's Dx: Prochlorperazine, Phenothiazines, Haloperidol, Risperidone or SGAs, Metoclopramide GENERIC Carbidopa/Levodopa GENERIC Pramipexole Ropinirole Neupro Apokyn Rotigotine Apomorphine Tasmar BRAND Comtan GENERIC Entacapone Entacapone + Levodopa/Carbidopa Tolcapone Amantadine Selegeline Rasagiline Safinamide Benztropine Trihexphenidyl Droxidopa