Beruflich Dokumente
Kultur Dokumente
Dr.Rathnakar U.P.
MD.DIH.PGDHM
Contents
Examples of antiparkinsonian drugs Adverse effects of levodopa Basis for combining levodopa with carbidopa Drugs used in drug-induced parkinsonism and their mechanism of action
PD
[Poverty of movements, tremors and rigidity]
Clinical features of PD
Parkinson's disease (PD) is the second commonest neurodegenerative disease, exceeded only by Alzheimer's disease (AD). 5 million persons in the world suffer from this disorder.
Pathophysiology of PD
"Dopaminergic" pathology Degeneration of dopaminergic neurons in SN [Deficiency of DA]
Non-dopaminergic" pathology Over activity cholinergic neurons,
DA and Ach in PD
DA
Antichlonergics
Ach
DA Ach
DA Ach
DA
Normal DA=Ach
Carbidopa Benserazide
Entacapone Tolcapone
0
Stupid
BBB
3 Selegiline Rasagiline Levodopa Tolcapone 3
BBB
DOPAC
MAOB
Dopamine COMT 6
3MT 5
Anticholinergics Trihexyphenidyl Procyclidine Biperiden Antihistaminics
DA agonists
D1 & D2 Receptors
DA facilitator Amantadine
Drugs for PD
I.Drugs affecting brain dopaminergic system II.Drugs affecting brain cholinergic system
1. DA precursor- Levodopa 2. DDC inhibitors-Carbidopa 3. DA agonistsBromocriptine 4. MAO-B inhibitorsSelegiline 5. COMT inhibitorsEntacapone 6. DA facilitator-Amantadine
Levodopa
Levodopa ADEs
At initiation of therapy Nausea & vomiting Postural hypotension Cardiac arrhythmias Exacerbation of angina Alteration of taste Prolonged therapy Abnormal movements [dyskinesia]-chorea, grimacing. Worsen with time Dose limiting Behavioral-Anxietydepression-psychosis End of dose effect On-off phenomenon
[worsening and improvement in a few minutes-progressive degeneration]