PARKINSON’S DISEASE
SYMPTOMS
CHRONIC PROGRESSIVE MOTOR DISORDER
tremor at rest
rigidity - difficult to initiate movement
advanced "frozen" state
SECONDARY SIGNS
slurred speech, stooped posture, shuffling gait, pill rolling motion, depressed,apathetic
ETIOLOGY
UNKNOWN
VIRAL THEORIES
CEREBRAL HYPOXIA (atherosclerosis)
EXTRAPYRAMIDAL SIDE EFFECTS FROM ANTIPSYCHOTIC AGENTS
PHYSIOLOGIC CAUSE
DYSFUNCTION OF BASAL GANGLIA OF BRAIN (controls EPS)
REDUCTION OF NUMBER OF DOPAMINE TERMINALS IN SUBSTANTIA NIGRA
IMBALANCE OF NEUROTRANSMITTERS DOPAMINE AND ACETYLCHOLINE
TREATMENT CHOICES
ANTIHISTAMINES
ANTICHOLINERGICS
DOPA
DOPA/CARBIDOPA
DOPAMINE RECEPTOR STIMULANTS
ANTICHOLINERGICS
Therapeutic Use
Minimal symptoms, adjunct therapy
Drug induced Parkinson’s (EPS)
Mechanism of Action
Blocks acetylcholine receptors
Side Effects
dry mouth, blurred vision, constipation, urinary retention
ANTIHISTAMINES
Therapeutic Use
Elderly male
Drug induced Parkinson’s (EPS)
Mechanism of Action
anticholinergic properties
DOPA PHARMACOKINETICS
DOPA can cross blood brain barrier
Dopamine cannot cross BBB
95% of DOPA dose is metabolized to dopamine prior to crossing BBB
Vitamin B6 induces decarboxylase enzyme
Carbidopa blocks decarboxylase enzyme
DOPA EFFECTS
THERAPEUTIC
Relieves rigidity, decreases tremor, enhances mood
No effect on drug induced Parkinson’s
SIDE EFFECTS/ADVERSE REACTION
orthostatic hypotension, arrhythmogenic, nausea/vomiting, psych disturbance, on/off
limit dose decreases side effects
DOPA CONTRAINDICATIONS
NARROW ANGLE GLAUCOMA
AMANTADINE
STIMULATES DOPA RECEPTOR
ANTIVIRAL PROPERTIES
Influenza Type A
SIDE EFFECTS
insomnia, depression, orthostatis hypotension