Parkinson's Pharmacotherapy: Difference between revisions
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== Introduction == | == Introduction == | ||
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects motor function. This disease has become an epidemic, affecting approximately 1 percent of individuals over the age of 65 years old <ref>Harris PE ,C. K. Prevalence of complementary and alternative medicine (CAM) used by the general population: a systematic review and update. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22994327</nowiki>. October, 2012. Accessed November 5, 2018.</ref>. It is caused by decreased dopamine production in the basal ganglia due to degeneration of dopamine-secreting neurons <ref name=":0">Chen JJ, Nelson MV, Swope DM. Parkinson’s disease. DiPiro JT, Et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: Mcgraw-Hill. 2011. </ref>,<ref>Parent M, Parent A. Substantia nigra and Parkinson's disease: a brief history of their long and intimate relationship. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/20481265</nowiki>. May, 2010. Accessed November 5, 2018.</ref> | Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects motor function. This disease has become an epidemic, affecting approximately 1 percent of individuals over the age of 65 years old <ref>Harris PE ,C. K. Prevalence of complementary and alternative medicine (CAM) used by the general population: a systematic review and update. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22994327</nowiki>. October, 2012. Accessed November 5, 2018.</ref>. It is caused by decreased dopamine production in the basal ganglia due to degeneration of dopamine-secreting neurons <ref name=":0">Chen JJ, Nelson MV, Swope DM. Parkinson’s disease. DiPiro JT, Et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: Mcgraw-Hill. 2011. </ref>,<ref>Parent M, Parent A. Substantia nigra and Parkinson's disease: a brief history of their long and intimate relationship. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/20481265</nowiki>. May, 2010. Accessed November 5, 2018.</ref>. | ||
= | Initially, PD sufferers may be asymptomatic with the first clinical symptoms appearing after 60% of the dopaminergic neurons have degenerated in the substantia nigra <ref>Lecht, S., Haroutiunian, S., Hoffman, A., & Lazarovici, P. Rasagiline – A Novel MAO B Inhibitor in Parkinson’s Disease Therapy. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386362/</nowiki>. June, 2007. Accessed November 5, 2018.</ref>. Cardinal symptoms of Parkinson disease include bradykinesia, akinesia, rigidity, and resting tremors <ref name=":0" />,<ref>Garcia Ruiz PJ, Catalan MJ, Fernandez Carril JM. Initial motor symptoms of Parkinson disease. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22045320</nowiki>. November 17, 2011. Accessed November 5, 2018.</ref>. The exact cause of PD is unknown; however, contributing factors to may include trauma, infection, cortical degeneration, antipsychotic drugs and cerebrovascular disease <ref>Gelabert-Gonzalez M, Serramito-Garcia R, Aran-Echabe E. Parkinsonism secondary to subdural haematoma. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22527627</nowiki>. July, 2012. Accessed November 5, 2018. </ref><ref>Gupta D Kuruvilla. Vascular parkinsonism: what makes it different? NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22121251</nowiki>. December, 2011. Accessed November 5, 2018. </ref><ref>Lopez-Sedon JL, Mena MA, de Yebenes JG. Drug-induced parkinsonism in the elderly: incidence, management and prevention. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/22250585</nowiki>. February, 2012. Accessed November 5, 2018.</ref><ref>Mazokopakis EE, Koutras A, Starakis I, Panos G. Pathogens and chronic or long-term neurologic disorders. NCBI. <nowiki>https://www.ncbi.nlm.nih.gov/pubmed/21446901</nowiki>. March, 2011. Accessed November 5, 2018.</ref>. If PD goes untreated, total incapacitation will occur due to uncontrolled motor problems. This is why it is extremely important for PD patients to be prescribed the proper drug regimen. | ||
== [[Levodopa in the treatment of Parkinson's Disease]] | The inter-dependency of healthcare professionals is significant in the management of Parkinson's. Specialists are encouraged to have the knowledge and understanding of the condition and its impact on the quality of life. Communication is a key and it should aim to empower individuals who suffer Parkinson's to develop effective self-management strategies with an optimistic and realistic approach. | ||
Parkinson's medications are most commonly administrated orally. Injections and subcutaneous medications are available but expensive. | |||
Medications | |||
== Dopaminergic Medications: == | |||
=== Levodopa === | |||
Levodopa (L-dopa) is a common drug administered during the progressive stages of PD. L-dopa is considered a prodrug, meaning it is not activated until after it crosses the blood brain barrier via active transport[[Levodopa in the treatment of Parkinson's Disease|[1]]]. The primary use of Levodopa is to restore depleted levels of dopamine at the presynaptic terminal of the substantia nigra, which restores functional movement[[Levodopa in the treatment of Parkinson's Disease|[2]]]. This replacement can relieve symptoms of PD, such as freezing and rigidity[[Levodopa in the treatment of Parkinson's Disease|[3]]]. If a tolerance is built up to L-dopa, or adverse motor effects become present with this drug alone, partner drugs Benserazide and Carbidopa (LD-CD) can be supplemented to prevent the further premature breakdown in the periphery[[Levodopa in the treatment of Parkinson's Disease|[4]]]. | |||
Optimal oral dosing of LD-CD is typically between 97.5 mg-390 mg for a single dose, and 25mg-100mg bi-daily/tri-daily for either sustained release or immediate release[[Levodopa in the treatment of Parkinson's Disease|[5]]]. The volume of distribution is typically around 28.5 L and the plasma half-life clearance is 1.8 hours. Therefore, frequent dosage is required. The renal clearance of L-dopa is approximately 72 ml/min[[Levodopa in the treatment of Parkinson's Disease|[2]]]. | |||
Many of the adverse effects that are present with Levodopa are due to the fact that it is not combined with a partner drug. Some of the most common adverse effects to be aware of during a physical therapy visit include gastrointestinal distress due to the enteral administration, cardiac difficulties, gait disturbances due to dyskinesias, end of dose akinesia, and a tolerance after around 3-4 years. Administering physical therapy treatment during the peak time of this drug helps to avoid these end of dose side effects.[[Levodopa in the treatment of Parkinson's Disease|[3]]] | |||
== [[Anticholinergic Drugs in the treatment of Parkinson's Disease]] == | == [[Anticholinergic Drugs in the treatment of Parkinson's Disease]] == | ||
Revision as of 00:41, 20 April 2019
Introduction[edit | edit source]
Parkinson’s Disease (PD) is a progressive neurodegenerative disorder that affects motor function. This disease has become an epidemic, affecting approximately 1 percent of individuals over the age of 65 years old [1]. It is caused by decreased dopamine production in the basal ganglia due to degeneration of dopamine-secreting neurons [2],[3].
Initially, PD sufferers may be asymptomatic with the first clinical symptoms appearing after 60% of the dopaminergic neurons have degenerated in the substantia nigra [4]. Cardinal symptoms of Parkinson disease include bradykinesia, akinesia, rigidity, and resting tremors [2],[5]. The exact cause of PD is unknown; however, contributing factors to may include trauma, infection, cortical degeneration, antipsychotic drugs and cerebrovascular disease [6][7][8][9]. If PD goes untreated, total incapacitation will occur due to uncontrolled motor problems. This is why it is extremely important for PD patients to be prescribed the proper drug regimen.
The inter-dependency of healthcare professionals is significant in the management of Parkinson's. Specialists are encouraged to have the knowledge and understanding of the condition and its impact on the quality of life. Communication is a key and it should aim to empower individuals who suffer Parkinson's to develop effective self-management strategies with an optimistic and realistic approach.
Parkinson's medications are most commonly administrated orally. Injections and subcutaneous medications are available but expensive.
Medications
Dopaminergic Medications:[edit | edit source]
Levodopa[edit | edit source]
Levodopa (L-dopa) is a common drug administered during the progressive stages of PD. L-dopa is considered a prodrug, meaning it is not activated until after it crosses the blood brain barrier via active transport[1]. The primary use of Levodopa is to restore depleted levels of dopamine at the presynaptic terminal of the substantia nigra, which restores functional movement[2]. This replacement can relieve symptoms of PD, such as freezing and rigidity[3]. If a tolerance is built up to L-dopa, or adverse motor effects become present with this drug alone, partner drugs Benserazide and Carbidopa (LD-CD) can be supplemented to prevent the further premature breakdown in the periphery[4].
Optimal oral dosing of LD-CD is typically between 97.5 mg-390 mg for a single dose, and 25mg-100mg bi-daily/tri-daily for either sustained release or immediate release[5]. The volume of distribution is typically around 28.5 L and the plasma half-life clearance is 1.8 hours. Therefore, frequent dosage is required. The renal clearance of L-dopa is approximately 72 ml/min[2].
Many of the adverse effects that are present with Levodopa are due to the fact that it is not combined with a partner drug. Some of the most common adverse effects to be aware of during a physical therapy visit include gastrointestinal distress due to the enteral administration, cardiac difficulties, gait disturbances due to dyskinesias, end of dose akinesia, and a tolerance after around 3-4 years. Administering physical therapy treatment during the peak time of this drug helps to avoid these end of dose side effects.[3]
Anticholinergic Drugs in the treatment of Parkinson's Disease[edit | edit source]
MAO-B inhibitors in the treatment of Parkinson's Disease[edit | edit source]
Dopamine Agonist Drugs in the treatment of Parkinson's Disease[edit | edit source]
Physical Therapy Implications for Parkinson's Disease Drugs[edit | edit source]
Conclusion[edit | edit source]
References
- ↑ Harris PE ,C. K. Prevalence of complementary and alternative medicine (CAM) used by the general population: a systematic review and update. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/22994327. October, 2012. Accessed November 5, 2018.
- ↑ 2.0 2.1 Chen JJ, Nelson MV, Swope DM. Parkinson’s disease. DiPiro JT, Et al, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. New York: Mcgraw-Hill. 2011.
- ↑ Parent M, Parent A. Substantia nigra and Parkinson's disease: a brief history of their long and intimate relationship. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/20481265. May, 2010. Accessed November 5, 2018.
- ↑ Lecht, S., Haroutiunian, S., Hoffman, A., & Lazarovici, P. Rasagiline – A Novel MAO B Inhibitor in Parkinson’s Disease Therapy. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386362/. June, 2007. Accessed November 5, 2018.
- ↑ Garcia Ruiz PJ, Catalan MJ, Fernandez Carril JM. Initial motor symptoms of Parkinson disease. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/22045320. November 17, 2011. Accessed November 5, 2018.
- ↑ Gelabert-Gonzalez M, Serramito-Garcia R, Aran-Echabe E. Parkinsonism secondary to subdural haematoma. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/22527627. July, 2012. Accessed November 5, 2018.
- ↑ Gupta D Kuruvilla. Vascular parkinsonism: what makes it different? NCBI. https://www.ncbi.nlm.nih.gov/pubmed/22121251. December, 2011. Accessed November 5, 2018.
- ↑ Lopez-Sedon JL, Mena MA, de Yebenes JG. Drug-induced parkinsonism in the elderly: incidence, management and prevention. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/22250585. February, 2012. Accessed November 5, 2018.
- ↑ Mazokopakis EE, Koutras A, Starakis I, Panos G. Pathogens and chronic or long-term neurologic disorders. NCBI. https://www.ncbi.nlm.nih.gov/pubmed/21446901. March, 2011. Accessed November 5, 2018.
