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Introduction
1817: James Parkinson describes the disease clinically.
• Late 1800s: Jean-Martin Charcot differentiates Parkinson’s and introduces anticholinergic drugs.
• Early 1900s: Discovery that the substantia nigra is the key brain region affected.
• 1910-1921: Dopamine and L-dopa discovered, laying the foundation for treatment.
• 1960: Parkinson’s linked to dopamine deficiency in the brain.
• 1961: Trials with levodopa (L-dopa) show significant symptom improvement.
• 1960s-1970s: Carbidopa added to levodopa, reducing side effects and improving treatment efficacy.
• Later: New drug classes like dopamine agonists, MAO-B inhibitors, and COMT inhibitors developed.
MOA
1. Dopaminergic Agents:
• Levodopa: Converts to dopamine.
• Carbidopa: Prevents levodopa breakdown.
• Dopamine Agonists: Stimulate dopamine receptors.
2. MAO-B Inhibitors:
• Increase dopamine levels by blocking its breakdown.
3. COMT Inhibitors:
• Prolong levodopa’s effect.
4. Anticholinergics:
• Control tremors by blocking acetylcholine.
5. Amantadine:
• Increases dopamine release and reduces dyskinesia.
6. Adenosine A2A Antagonists:
• Improve motor control when used with dopaminergic therapy.
Examples of medication Brand names
Brand name of levodopa
Brand name of Pramipexole
Brand name of Ropinirole
Brand name of Selegiline
Brand name of Rasagiline
Brand name of Amantadine
indications
1. Age of Onset: Usually after 50; rarely earlier.
1. Age of Onset: Usually after 50; rarely earlier.
2. Motor Symptoms: Resting tremors, bradykinesia, rigidity, and postural instability.
2. Motor Symptoms: Resting tremors, bradykinesia, rigidity, and postural instability.
3. Non-Motor Symptoms: Sleep issues, cognitive decline, mood disorders, autonomic dysfunction, and loss of smell.
3. Non-Motor Symptoms: Sleep issues, cognitive decline, mood disorders, autonomic dysfunction, and loss of smell.
4. Medication Response: Positive response to dopaminergic drugs like Levodopa supports diagnosis.
4. Medication Response: Positive response to dopaminergic drugs like Levodopa supports diagnosis.
5. Genetic Factors: Family history increases risk.
5. Genetic Factors: Family history increases risk.
6. Environmental Factors: Exposure to toxins (e.g., pesticides, heavy metals) may contribute.
6. Environmental Factors: Exposure to toxins (e.g., pesticides, heavy metals) may contribute.
Side effect
Side Effects of Parkinson’s Disease
• Motor Symptoms: Tremors, slowness of movement, muscle stiffness, balance issues, shuffling gait.
• Non-Motor Symptoms: Depression, anxiety, sleep problems, memory issues, constipation, loss of smell.
• Speech/Facial Changes: Reduced facial expressions, weak speech, difficulty speaking.
• Psychological Issues: Hallucinations, impulse control problems.
• Fatigue: Constant tiredness.
precautions
1. Levodopa:
Caution in heart, lung, psych, endocrine issues. Avoid abrupt stop. May cause drowsiness.
2. Dopamine Agonists:
Risk of confusion, hallucinations, sudden sleep, low BP. Echo before ergot types.
3. MAO-B Inhibitors:
Avoid sudden stop. Interact with antidepressants. May cause hallucinations with Levodopa.
4. COMT Inhibitors:
Don’t stop suddenly. Adjust Levodopa dose. Avoid in liver issues, tumors, muscle disorders.
5. Antimuscarinics:
Caution in elderly, heart issues, BPH, glaucoma. Avoid in myasthenia or GI obstruction.
6. Amantadine:
Avoid abrupt withdrawal. Caution in elderly, heart/liver issues. Not for pregnancy. May cause drowsiness.
Contraindications
Contraindications for anti-Parkinsonism drugs include:
Contraindications for anti-Parkinsonism drugs include:
1. Dopamine Precursors (e.g., L-Dopa): Glaucoma, psychiatric disorders, liver/kidney problems.
1. Dopamine Precursors (e.g., L-Dopa): Glaucoma, psychiatric disorders, liver/kidney problems.
2. Dopamine Agonists (e.g., Pramipexole): Heart issues, mental disorders, liver/kidney dysfunction.
2. Dopamine Agonists (e.g., Pramipexole): Heart issues, mental disorders, liver/kidney dysfunction.
3. MAO-B Inhibitors (e.g., Selegiline): Interactions with antidepressants, hypertension with tyramine-rich foods.
3. MAO-B Inhibitors (e.g., Selegiline): Interactions with antidepressants, hypertension with tyramine-rich foods.
4. COMT Inhibitors (e.g., Entacapone): Liver disease.
4. COMT Inhibitors (e.g., Entacapone): Liver disease.
Monographs
Activity pharma (2)_250424_141758.pdfDrug%20monograph.pdfRopinirole دواء .pdf.pdfRawan Elsaeed.pdfShahd Yasser Mohamed Abd -ElRazik Mady.pdfDrug monograph.pdfReference
Ziad nagy Elshinawy
Sama Ismail Ahmad
Rinad Wael Fathy
Shahd Yasser Mohamed
Reham Ahmad belal
Rawan Elsaeed Mohamed
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