TRAP

Tremor (resting)

Rigidity

Akinesia

Postural (stooped)

MECH: Converted peripherally to Dopamine by Aromatic Amino Acid Decarboxylase (AAD). Dopamine cannot cross BBB, but L-Dopa can.

USE: Parkinson's.

AE: Nausea, GI distress, hypotension (vascular DA receptor effect), dizziness, hallucinations (psychosis/compulsive behavior), cardiac arrythmia (DA action on alpha/beta receptors). Neuroleptic malignant syndrome - can be fatal.

CONTRA: MAO-A inhibitors! Caution with Tricyclic antidepressants (TCA) and SSRIs.

MECH: Inhibitor of AAD. Administered with L-Dopa to increase the penetrance of L-Dopa through BBB by reducing its peripheral conversion to Dopamine. Carbidopa cannot cross BBB.

USE: In combination for Parkinson's. L-Dopa + Carbidopa = SINEMET.

-After 2-5 years: higher doses required; duration of effect decreases.

-After 5-8 years: Dyskinesias develop.

-"On-Off" Phenomenon: frequent oscillations between no motor relief (off) and dyskinesias (on).

Ergot Derivative

MECH: Dopamine receptor agonist. D2 Agonist; D1 Antagonist.

USE: Parkinson's.

AE: Acute hypotension (titrate slowly). Peripheral DA-like side effects. Also pleural effusion, cough, SOB, pulmonary fibrosis.

Synthetic (non-ergot) DA receptor agonist.

MECH: Selective D2 agonist (no D1 activity).

USE: Parkinson's. Effective early monotherapy or in combo.

AE: Fewer motor complications. Can be titrated faster than Bromocriptine. More acute psychosis and compulsive behavior attributed to limbic D3 receptor activation. Somnolence.

Synthetic DA receptor agonist.

MECH: Selective D2 receptor agonist.

USE: Parkinson's and Restless leg syndrome.

Synthetic (non-ergot) DA receptor agonist.

AE: Fewer motor complications. Can be titrated faster than Bromocriptine. Somnolence--sudden daytime sleep attacks.

Synthetic DA receptor agonist.

MECH: DA receptor agonist

USE: Rescue for "off" episodes (severe immobility).

AE: Usual peripheral DA side effects (psychosis, drowsiness, hypersexuality (erections). Also Emesis--use trimethobenzamide or domiperidone.

CONTRA: Seratonin receptor antagonists (ondansetron)

MECH: MAO-B (converts DA into DOPAC in presynaptic terminal) inhibitor.

USE: Monotherapy treatment of mild, early onset Parkinson's in order to delay use of L-Dopa.

AE: With L-Dopa (not approved for this) this drug increases GI disress, hypotension, n + v, dyskinesia, psychosis.

CONTRA: Decongestants (ephedrine, phenylephrine, amphetamines), Dextromethorphan, St. John's wort, Analgesics (mepiridine, methadone, tramadol, propoxyphene), use MAO-A inhibitors, TCAs and SSRIs with caution.

MECH: MAO-B (converts DA into DOPAC in presynaptic terminal) inhibitor.

USE: Monotherapy treatment of mild, early onset Parkinson's in order to delay use of L-Dopa.

AE: With L-Dopa (approved for this) this drug increases GI disress, hypotension, n + v, dyskinesia, psychosis.

CONTRA: Decongestants (ephedrine, phenylephrine, amphetamines), Dextromethorphan, St. John's wort, Analgesics (mepiridine, methadone, tramadol, propoxyphene), use MAO-A inhibitors, TCAs and SSRIs with caution.

Influenza A antiviral drug.

MECH: Unknown, but has dopaminergic, anticholinergic and anti-NMDA activity.

USE: Modest effects as monotherapy for mild tremor. BEST as adjunct to levodopa/carbidopa because it reduces dyskinesias related to L-Dopa--only adjunct to do this.

AE: Nausea, dizziness, hallucinations, confusion, insomnia, peripheral edema, psychosis, NMS (neuroleptic malignant syndrome) on withdrawal.

CONTRA: Elderly with dementia. Renally dose.

of subthalamic nucleus.

USE: In patients who still respond to levadopa/carbidopa. Long-lasting effects aid in reducing L-dopa dose.

AE: Fatal intracerebral hemorrhage, cognitive impairment.