Drugs for Parkinson’s Disease & Psychotherapeutics NSG 106 Pharmacotherapeutics

Terms to Know Anticholinergics COMPT inhibitors Dopaminergics Adjunct Therapy Antihistamines Antipsychotics Anxiolytics GABA MAOI’s Monotherapy SSRI’s Tricyclic Benzodiazepines

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Parkinson’s Disease Chronic, progressive, CNS degeneration that affects the production of dopamine. Dopamine deficiency = excess acetylcholine (a cholinergic), this manifests as: tremor, bradykinesia, rigidity, shuffling gait, & mental degeneration in late stages.

Parkinson’s Treatment Strategies Increase the dopamine exogenously, or enhance the dopamine producing cells in the body. Inhibit the MAO’s which breakdown dopamine. Give anticholinergics to block the S&S of Parkinson’s (caused by too much acetylcholine).

Dopaminergics Sinemet (levodopa- carbidopa) gold standard treatment –Facilitates the replacement dopamine to cross the brain barrier –Cardiovascular, and CNS side effects Dopamine agonists –Stimulate brain dopaminergic receptors –Less sides –Delay/decrease need for levadopa administration –Mono or adjunct therapy

Other Anti-Parkinson’s MAOI’s –Slow progression of Parkinson’s –Severe HTN with food (tyramine) interactions –Prevent the breakdown of dopamine = more dopamine COMT inhibitors –Prevents the breakdown of dopamine Anticholinergics –Blocks acetylcholine to treat muscle tremors and rigidity –Side effects

Psychotherapeutics Antipsychotics –Phenothiazines Dopamine antagonists = block messages Extrapyramidal side effects (Fig 25-1, pg 377) agranulocytosis –Atypical antipsychotics Block dopamine & serotonin Antidepressants –Tricyclics 6-8 wks optimal effect –Monoamine Oxydase Inhibitors (MAOI’s) Food interactions –tyramine –Selective Serotonin Reuptake Inhibitors Sexual disfunction –New Others Seizure risk

Psychotherapeutics AntiMania Medication –Lithium Long term prophylaxis Serum levels Fluid/lytes sodium –Anticonvulsants Bipolar Monitor liver & agranulocytosis Anxiolytics & Sedative-Hypnotics –Benzodiazepines Potentiates GABA No antacids etc –Benzo antagonists flumazenil (Romazicon) –Barbiturates –Others Bind to serotonin & dopamine