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