Final pharm exam (1).docx

Strict timing long acting formulation only by

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– Strict timing (long-acting formulation only by neurologist) – Not taken with food (one hour before or after meals) • Overshoot – Dystonia – Dyskinesia – Psychosis • Undershoot – Tremor – Rigidity – Bradykinesia – Gait/balance Dopamine Agonists • Typically used early for motor symptoms (especially in younger patients with PD) – Pramipexole – Ropinirole • Improve tremor/bradykinesia • Possible benefit decrease in apathy/poor motivation and some improvement in mood Dopaminergic Agent ADEs • More ADEs (N/V, edema, confusion, somnolence) • Disinhibition and pleasure seeking • Gambling • Promiscuity – Need to counsel patients and family to avoid potentially damaging effects of any impulsive or disinhibited pleasure-seeking behaviors • Dopaminergic dysregulation syndrome: compulsive use of dopaminergic drugs develops in a small number of patients with PD and has been termed the dopaminergic dysregulation syndrome (DDS) • Valvular heart disease: appears to increase relative to the cumulative dose of pergolide or cabergoline. The mechanism is probably related to pergolide and cabergoline activation of serotonin (5-HT 2B type) receptors expressed on heart valves, which in turn leads to valvular overgrowth. • Dopamine agonist withdrawal syndrome: symptoms resemble those of cocaine withdrawal and include anxiety, panic attacks, depression, sweating, nausea, pain, fatigue, dizziness, and drug craving. These symptoms are refractory to other antiparkinsonian medications, including levodopa, and only responded to resuming the DA. MAO-B Inhibitors and Catechol-O- Methyltransferase (COMT) Inhibitors • Primarily extend the effects of individual doses of CD • Decrease the “on-off” phenomena • Prolong the action of CD • MAO-B inhibitors – Some hypertension and tyramine food effects (but much less than MAO inhibitors) – Serotonin syndrome • Use only at recommended doses • Special care when using with SSRIs • Care in tapering off – Selegaline – Resagline • COMT inhibitors (increased dopaminergic stimulation and include dyskinesia, hallucinations, confusion, nausea, and orthostatic hypotension) – Entecapone – Tolcapone Other Agents – NMDA-receptor antagonist- AMANTINE • Potentiates dopaminergic response • One of the agents that may be used early in the disease • May also be used as an adjunct to decrease carbidopa- levodopa doses • Anticholinergic agents – May be used early specifically for tremor • Benztropine
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Decrease Parkinson’s medications in the following order; start with least potent: – Anticholinergics,amantadine,MAO-Binhibitors,COMTinhibitors, dopamine agonists, levodopa – Avoidmedicationsthatsignificantlyblockdopamine(haloperidol) – Useatypicalantipsychoticagentswithlowestinhibitionofdopamine • Atypical antipsychotics – Quetiapine, clozapine, pimavanserin (low antidopaminergic activity) – Do not use haloperidol ALZHEIMERS Pharmacologic Agents (Slow progression but do not improve cognitive functioning)
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  • Summer '17
  • Selective serotonin reuptake inhibitor, Serotonin Syndrome, cimetidine, griseofulvin

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