Drugs Used for Treatment Parkinson Disease
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Transcript of Drugs Used for Treatment Parkinson Disease
DRUGS USED FOR TREATMENT PARKINSON DISEASE
MEDICAL FACULTYUNIVERSITY OF LAMPUNG
ISWANDI DARWIS, MD
PARKINSON DISEASE
TRAP
REMOR
IGIDITY
KINESIA
OSTURALINSTABILITY
Groups ExampleDopamine AgonistLevodopa (L-dopa)CarbidopaBromoriptine
Levodopa, Benserazide (Madopar)
Bromocriptine mesylate (Parlodel)
Indirect Dopamine Agonist (Dopamino-antikolinergik)DeprenylAmantadine
Selegilline (Jumex)
Antimuscarinic AgentBenztropineBiperideneOrphenadrineTrihexyphenidyl
Benzhexol HCl (Artane)
Trihexyphenidyl, Neostigmine metylsulfate, Prostigmine
Inhibitor MAO-BCNS Stimulant (Amphetamine)Tricyclic antidepressants(Amitryptiline)
Levodopa Karbidopa
•Intermediate compounds of cathecolamine synthesis•Trough Blood Brain Barrier and changed by L- decarboxylate aromatic amino acid (dopa-decarboxylate) into dopamin•T ½ 1-3 hour•> 90% metabolized by peripherydepo decarboxylate (CNS outside) into dopamine•The levels to the brain <2%•More effective to reduce rigidity and bradichynesia than reduce tremors
•CNS : Dyskinesia, behavioral changes•GIT : Nausea dan Vomitus•Liver Function Test : slightly increased•Cardiovascular : arythmia, postural hypotensi, hypertensi (high dose)
Advers Effect
•Pyridoxin increase metabolism levodopa•Reserfin (decrease dopamine depo) and neuroleptic (blocking dopamine reseptor) exacerbate parkinsonism•Anticholinergic, tryciclic antidepresan, phenytoin and benzodyazepin decrease effect of levodopa
Drugs Interact
ion
Bromocriptine
•Ergote alkaloids derivate•Agonist of dopamine reseptor•T ½ 8-12 hour•Treatment effect prolonged for several month•Indication : Parkinsonism & Hyperprolactinemia
Toxicity•Involuntary movement, behavioral changes•Nausea and vomite•Arytmia and postural hypotensi•Livedo retikularis
Contraindication
•Myocardium infarction•Mental disorders
•Work by releasing dopamine from presinaptic vesicle•Urine excretion with intact form warning for patient with renal failure•Indication : Parkinson disease, type A influenza infection•Advers effect / toxicity•Behavioral changes•Livedo retikularis•Congestive hearth failure
Amantadine
• Deprenile• Mono Amin Oxidase Inhibitor (MAOI)
• Amantadine• Antiviral drugs• Work by releasing cathecolamine from place of
storage
Indirect dopamin
ergic agent
•Inhibiting competitively muscarinic reseptor in the brain•Effective for reducing tremor but less effective for bradikinesia•Indication•Mild Parkinsonism single dose•Parkinsonism severe relatively combination with dopaminergic agent•Most effective for tremor•Adverse effect same with atropine : confusion, hallucinations, dry mouth, constipation, urine retention
Benztropine and
trihexilphenidin
e
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