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WEEK 1 PARKINSONS DISEASE ABD MOVEMENT DISORDERS

PARKINSON

DOPAMINERGIC

CO-CARELDOPA
Levodopa +
carbidopa

MECHANISM OF ACTIONS
Levodopa is converted to dopamine via DOPA
decarboxylase. This occurs both in the peripheral
circulation and in the central nervous system after
levodopa has crossed the blood brain barrier.
Activation of peripheral dopamine receptors
causes nausea and vomiting.
For this reason levodopa is usually administered in
combination with a DOPA decarboxylase inhibitor
(DDCI), in this case carbidopa. It cannot cross the
blood brain barrier and diminished peripheral
conversion of levodopa to dopamine hence,
reduces the unwanted peripheral side effects of
levodopa.
Use of carbidopa also increases availability of
levodopa to the CNS

Bromocriptine

Dopamine receptor agonists.


]
A potent agonist at dopamine D2 receptors and
various serotonin receptors. It also inhibits the
release of glutamate, by reversing the glutamate
GLT1 transporter

Selegiline

Selectively inhibits monoamine oxidase type B. Hence


decreasing the metabolism of dopamine.
When administered in conjunction with dopaminergic
agents such as L-DOPA, entacapone prevents COMT
from metabolizing L-DOPA into 3-methoxy-4-hydroxyL-phenylalanine (3-OMD) in the periphery, which does

Entacapone

not easily cross BBB. Leads to decreased plasma


concentrations of 3-OMD, increased central uptake of
levodopa, and greater concentrations of brain
dopamine.

INDICATIONS

Parkinson

Effective in pt exhibiting
fluctuations in their response to
levodopa.
Less risk of developing dyskinesia
and motor fluctuations as initial
therapy compared to levodopa
Little potential to cause hypertensive
crisis.

ADVERSE EFFECTS
Peripheral effects
- Anorexia, nausea and vomiting
- Tachycardia and ventricular extrasystoles
- Hypotension
- Saliva and urine are a brownish color
(melanin pigment produced from
catecholamine oxidation)
CNS effects
- Visual and auditory hallucinations
- Dyskinesia
- Mood changes, depression, psychosis,
anxiety

Hallucinations, confusion, delirium, nausea,


and orthostatic hypotension.
Worsen mental illness
Pt with MI may develop serious cardiac
problem
Insomnia
Peripheral effects
- Anorexia, nausea and vomiting
- Tachycardia and ventricular extrasystoles
- Hypotension
- Saliva and urine are a brownish color
(melanin pigment produced from
catecholamine oxidation)
CNS effects
- Visual and auditory hallucinations
- Dyskinesia
- Mood changes, depression, psychosis,
anxiety

A.MUSCA
RINIC

WEEK 1 PARKINSONS DISEASE ABD MOVEMENT DISORDERS

Procyclidine

Anti-muscarinic agent

Adjuvant therapy

Pupillary dilatation, confusion, hallucination,


tachycardia, urinary retention, constipation
and dry mouth.