Parkinson’s Disease and Its Treatment

Overview

• Parkinson's involves motor symptoms due to low dopamine.
• Treatment includes medications to increase or mimic dopamine.

Levodopa

• Primary treatment for Parkinson's symptoms.
• Often used with other medications to delay the need for high doses.

MAO-B Inhibitors

• Some can be used with levodopa; others require caution.
• Monitor for drug interactions.

Amantadine

• Used with levodopa for additional symptom control.
• Caution in patients with seizures, liver issues, psychosis, or heart failure.

Adverse Effects

• Confusion, hallucinations, dizziness.
• Skin modeling; resolves after discontinuation.
• Hepatotoxicity, seizures, psychosis.

Drug Interactions

• Anticholinergics can worsen confusion.

Apomorphine

• A dopamine agonist for acute immobilization episodes in advanced Parkinson's.
• Requires anti-emetics like trimethobenzanide, not Zofran.

Adverse Effects

• Nausea, vomiting, orthostatic hypotension.
• Chorea, hallucinations, sleep attacks.

Drug Interactions

• Do not mix with serotonin antagonists or phenothiazines.

Pramipexole (Mirapex)

• Non-ergot dopamine agonist for early symptoms.
• Used alone or with levodopa.

Adverse Effects

• Nausea, sleep events, impulse control disorders.

Drug Interactions

• Diltiazem and others inhibit excretion, requiring dosage adjustment.

Ropinirole (Requip)

• Similar use and effects as Pramipexole.
• Gradual discontinuation required.

Rotigotine (Neupro)

• Patch used in early and late stages of Parkinson's.

Cautions

• Remove before MRI or cardioversion.
• Avoid heat sources.

Adverse Effects

• Skin reactions, nausea, compulsive behaviors.

COMT Inhibitors

• E.g., Entacapone, used with levodopa.
• Monitor liver function.

Adverse Effects

• Diarrhea, brownish-orange urine.

Drug Interactions

• Can amplify effects of levodopa.

Anticholinergics

• For tremor and drooling.
• Baseline assessments crucial.

Adverse Effects

• Dry mouth, constipation, urinary retention.

Drug Interactions

• May reduce levodopa effectiveness.

Alzheimer's Disease

Overview

• No cure, focus on cognitive improvement.
• Two classes: Acetylcholine esterase inhibitors and NMDA inhibitors.

Common Drugs

• Aricept, Exelon: Improve cognitive function.
• Memantine (NMDA inhibitor): Affects mental functioning.

Adverse Effects

• Nausea, dizziness, insomnia, restlessness.

Considerations

• Drug interactions can affect Alzheimer’s symptoms and treatments.