- dec. Dopamine-----(Viz. DA = grease for movement)
- Cholinergic dominates
Symptoms (triad) = dz of motion
- tremor (resting)
- rigidity
- bradykinesia
Tx mech.:
- inc. Dopamine
- block cholinergic
Drug therapy:
1 - DA
2 - DA agonist: Bromocriptine & Pex got pin (Pramipexole, Rotigotine & Ropinirole)
3 - MAO-I
4 - COMT-I
5 - Amantadine
6 - Anti-Cholinergic
Drug name therapy:
1 - DA ----(dopey dean)
- Carbidopa/Levodopa (Lazy dean and his car)
Mech.: metabolized to DA (Lazy dean becaomes Dopey dean when he gets out of his car)
Use:
- Most effective
- >75y/o
- COMT/MAOI = longer effects
Side effects:
- Hallucinations --------(too much DA grease)
- Dyskinesia -------------(too much DA grease ---> weird movements)
- Arrythmias ------------(too much DA grease----> heart beats too werid too fast too much)
- GI upset ---------------(too much DA grease - greasy foods = GI upset)
- on-off & wearing off phenomenon
2 - DA agonist ---- supporters of the dean
- bromocriptine ------ (a bra for the dean)
- pramipexole----------(p-cRAMming-PEcho viz: pecho=breast, cramming breast to make it less cumbersome -> supporting DA's pecho) ==> too tight can cause back pain which is similar to renal problems
- ropinirole -------------(ROPE-IN-a-ROLE => the dean always brings a rope with her to act in her role so that she can make sure things go greasy.)--- several drug-drug interactions (bc of corporal punishment from the rope => it creates a lot of controversies (drugdrug interactions)
- rotigotine
Use:
- monotherapy for mild dz (just a supporter, not the real dean but enuf to have effects)
- or with DA
- Side effects similar to DA BUT bc it's just a supporter, it's quickly prohibited in ppl with psychotic illness or active peptic ulcer (GI upset) while the DA dean can still create these side effects but NOT prohibited
3 - MAO-I
- Selegiline ----the sledgehammer (he smashes the MAOI bouncer when the bouncer tries to take the dopey dean out of the university
- rasagiline --- more potent than selegiline (raSAW-dze^`-lie^`n- more powerful to scare the bouncer who's trying to take the dopey dean out of the university
 |
| rasagiline = very horror = very potent |
Mech.:
- inhibitor of the DA uptake pump => slows the uptake of DA
Use:
- adjunct only ====> too horrific to be relied upon all the time.
inhibits MOA, slows/prevents the breakdown of
dopamine
4 - COMT-I (Catechol-O-methyltransferase Inhibitor) (These COMPton guys actually the DA's bodyguards because they keep the DA from going to those peripheral neighborhood (periphery)). And, thus, DA is more present at the University.
- entacapone----enta-CAPONE---(Enrique al Capone)
- tolcapone------tol-CAPONE-----(Lev Tolstoy al Capone) --Liver toxic => pt to sign consent
- entacapone combined with levodopa/carbidopa ----Stalevo
Mech.: Diminishes Levodopa levels in peripheral metabolism
Mnmonics:
5 - Amantadine ---(A cowboy riding a mantis)
Mech.: potentiates DA actions by some unclear mech.
Mnemonics: the cowboy threatens to let the Mantis dine on the dopey dean DA to make him work hard.
- => Levodopa is prolonged
- reduces levodopa by 30%
- adjunct w/ levodopa
Mnmonics:
- al-CAPONE used to work as the bodyguard for the dean DA in the DA's neighborhood in COMPton.
- Al Capone is actually the DA's leader's of all of the body guards.
- Therefore, all of body guards such as Enrique & lev Tolstoy takes over Al Capone last name. Therefore, they are called Tolcapone and Encapone.
- Lev Tolstoy comes from a communist country, therefore he risks being put in jail (liver) if he comes over to help the dean
 |
| Lev Tolstoy => Tol-Capone |
5 - Amantadine ---(A cowboy riding a mantis)
Mech.: potentiates DA actions by some unclear mech.
Mnemonics: the cowboy threatens to let the Mantis dine on the dopey dean DA to make him work hard.
6 - Anti-Cholinergic:
- benztropine ----(Park parks the Benz)
- biperiden ------ bismuth periodic den scares the 3 musketeer cubs away because they can't deal with stuff requiring lots of concentration like that.
- diphenhydramine
- trihexyphenidyl ------ (3 hexes: the witch of three hexes. The 3 witches (hexes) put 3 hexes on the 3 musketeer cubs and restores the dopey dean DA to power => the three musketeer cubs (cholinergic) can't do anything with the 3 hexes on them)
Use:
- improve tremor & rigidity----(musketeers cubs are gone making the dean less flustered (tremors) and rigid (displine, by the book). That's the way the dean is--- she has to be rigid and flustered around children)
- littl effect on bradykinesia ----(muscketeers cubs are gone but the dean is still old . So, it doesn't matter. She's still slow.)
- titrate up until symptoms improve
- taper slowly
 |
| tri-hex-y-phenidyl = tri-hex = 3 hexes) |
 |
| bi-peri-den = BIsmuth Peri den |
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