Term
| CHOLINESTERASE INHIBITORS |
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Definition
AD drug Keeps ACH levels ^
^ or stabilizes cognitive decline, not cure or reverse Delays worsening of sx 6-12mon in 50% ppl DONEPEZIL (ARICEPT)- daily RIVASTIGMINE (EXELON)- bid GALANTAMINE (RAZADYNE)- bid TACRINE (COGNEX)- 4x/day, 1st in class, hepatotoxic Common side FX: N/V/D If MMSE score <12, these are of little value
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AD drug MEMANTINE (NAMENDA)- newer class (2004), for use in mod-severe AD, blocks excitotoxic FX of glutamate Adverse FX: dizziness, HA, fatigue, constipation
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PD drug Decreases ACH activity Antihistatmines w/ anticholinergics or B-adrenergic blockers SIDE FX: dry mouth, constipation, urinary retention, blurred near vision; can cause confusion & psychosis, especially visual hallucinations NOTORIOUSLY TOXIC IN ELDERS Best reserved for use in young onset PD
Effective for rest tremor
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Definition
PD drug Precursor to dopamine Least likely to cause cognitive side FX Nausea is the only usual side effect; + carbidopa decreases side effect LEVODOPA+CARBIDOPA (SINEMET)- GOLD STANDARD, crosses blood-brain barrier, changed to dopamine in basal ganglia, carbidopa inhibits enzyme that breaks down levodopa before it reaches the brain
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PD drug/antiviral Typically effective for sx r/t akinesia as well as tremor
SIDE FX: edema, mottling of skin Necessitates dose reduction or D/C Most effective adjunctive therapy for dyskinesias induced by dopaminergic meds
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PD drug Synthetic, binds to dopamine receptors and imitates action of dopamine Helps control tremors, rigidity & nighttime leg cramping ROPINIROLE (REQUIP) PRAMIPEXOLE (MIRAPEX) APOMORPHINE (APOKYN) SIDE FX: cognitive side FX, severe sedation, edema, impulse control disorder (gambling, hypersexuality, etc)
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PD drug Blocks enzymes that cause that cause premature breakdown of levodopa Primarily used for tx of motor fluctuations May delay need for levodopa RASAGILINE (AZILECT) SELEGILINE (ELDEPRYL) MANY drug interactions, food interactions SIDE FX: H/A, indigestion, vivid dreams, +levodopa side FX: dyskinesia, nausea, dizziness, orthostatic hypotension
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PD drug Must be taken +carbidopa/levodopa By itself, no anti-PD effects Prolongs effects of Sinemet blocks enzyme that breaks down levodopa in peripheral circulation ENTACAPONE (COMTAN) TOLCAPONE (TASMAR)- more potent but associated w/ rare but potentially fatal liver dx & therefore requires routine liver testing
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Can be thalamotomy, pallidotomy or subthalamic nucleotomy Used in PD pts >50 yrs w some ^ of sx Recently replaced w Deep Brain Stimulation (DBS)
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Term
| DEEP BRAIN STIMULATION (PD pts) |
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Definition
Approved 1997 Procedure done in stages over approx three weeks Involves implanting electrode in thalamus, globus pallidus, or subthalamic nucleus & is connected to generator on upper chest Device programmed to deliver certain current to targeted brain location BEST SX CONTROL SIDE FX: Dysarthria, paresthesia, visual disturbances, lightheadedness, involuntary movements RISKS: Intracerebral bleeding, infection, seizure activity, tolerance to effect of electrodes SAFETY: Electromagnetic interference (EMI) from airport/MRI can turn device on/off, MRI EMI can heat implanted hardware, ultrasound/diathermy causes heating of tissue along lead
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