Drugs for Parkinsons disease

Direct Acting dopaminergic agent(park)
Non-ergot
almost entirely renal excretion
S/E- hypotension, dyskinesias, hallucinations

Direct acting dopaminergic agent(P)
New non-ergot- sub-q
Indicated only for immobility induced by acute "off" episodes of PD
Effects w/in 10-20 min, lasts 1 hr
Nor more than 3 doses/day
S/E- quite common: injection site reactions, hallucinations, yawning, drowsiness, dyskinesias, N/V, penile erection

Brand new non-ergot DA-ergic agent (PD)
administered 1/day as transdermal patch

COMT inhibitor (PD)
-used only in combination w/ levodopa
-prevents peripheral destruction of l-dopa by COMT
-preferred to tolcapone due to possibility of serious hepatotoxicity of tolcapone
S/E- mostly attributable to higher peripheral levels of l-dopa. N?V, hypotension, sleep disturbances, hallucinations, dyskinesias

MAO-B inhibitor (PD)
-usually 2nd or 3rd line agent due to modest effects
-side effects partly produced by increasing CNS levels of dopamine-may be reduced by l-dopa dose reduction
-S/E of CNS stimulation contributed to by amphetamine-like metabolites

MAO-B inhibitor
-very new anti-Parkinson agent
-indicated alone or in combination w/ levodopa
-specific anti-Parkinson mechanism of action is not known
-liver metabolized
-fairly well tolerated-not metabolized to amphetamine-like substances
-no comparisons w/ selegiline

DA release (PD)
-originally develped as antiviral
-increases release of DA from surviving neurons in striatu,
-may also block DA reuptake
-rapid onset of benefits, but often short-lived

S/E- CNS- confusion, anxiety, somnolence, sleep disturbances, HA, especially in elderly or renally impaired
-antimuscarinic effects