CNS drugs are limited to - ANS ✓lipid soluble drugs
protein bound or highly ionized drugs cannot pass blood brain barrier
Parkinson's results from - ANS ✓imbalance of dopamine and acetylcholine that
results from degeneration of the neurons that supply dopamine to the striatum
Parkinsons causes - ANS ✓Dykinesias
(tremors at rest, rigidity, postural instability, bradykinesia)
parkinsons patients will have - ANS ✓loss of smell, excessive salivation,
clumsiness, tremor, slow gait, reduced voice volume
Carbidopa/Levodopa - ANS ✓efficacy decreases over time
patients have "cog wheel" rigidity
most effective therapy for PD.
Carbidopa allows more levodopa to ender the system.
Cabidopa/L-DOPA - ANS ✓L-dopa is a precursor to dopamine, carbidopa
increases the l-dopa at peripheral nerve sites
Dopamine receptor agonists - ANS ✓pramipexole and ropinirole
NURS 5334
, 2
NUR
stimulate D3 receptors in the CNS
increases risk taking behavior
COMT inhibitors - ANS ✓entacopone, tolcapone
inhibit COMT in the PNS to increase levels of l-dopa that reach CNS
given as adjunct to carbidopa/l-dopa
anticholinergics - ANS ✓benztropine used to decrease the cholinergic effects the
peripheral dopamine receptor activation
MAOB - ANS ✓selegiline & rasagiline
used to selectively inhibit MAO-B in the CNS
care should be taken to prevent serotonin syndrome by administering
concurrently with TCAs/Is etc.
Can be used first line for mild parkinson
Amantadine - ANS ✓help with dyskinesias in later stages of PD
Off times in PD can be helped by - ANS ✓dopamine agonsists
COMT inhibitors
MAO-B inhibitors
Depression in PD treated with - ANS ✓Amitriptlyne
SSRI will cause psychosis
NURS 5334
, 3
NUR
Alzheimers - ANS ✓ACH levels 90% below normal
Drugs in alzheimers - ANS ✓slow loss of memory and cognition and prolong
independent function
Cholinesterase inhibitors (drugs for Alzheimers) - ANS ✓Donepezil
galantamine
rivastigmine
memantine
(only 4 drugs approved for alzheimers treatment)
Drugs for muscle spasms - ANS ✓Diazepam
Cyclobenzaprine
Tizanidine
Metaxalone (least sedating)
Chlorzoxazone
phenytoin - ANS ✓partial and tonic-clonic seizures
gingival hyperplasia corrected with folic acid .5 mg/day and good dental hygiene
decreases effects of oral contraceptives, warfarin, and glucocorticoids
increases levels of diazepam, isoniazid, cimetidine, alcohols, and valproic acid
fosphenytoin - ANS ✓prodrug of phenytoin
converts to phenytoin when metabolized
carbamazepine - ANS ✓pharmacogenomics is used
major CYP 3A4 inhibitor
used for bipolar and seizures
decreases effect of OCP
bone marrow suppression, leukopenia, anemia, throbocytopenia
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