ANTI-PARKINSON

MACP 2113

Disediakan oleh:
Pn. Nirmala Devi Tailan
Pengajar U41
Kolej Pembantu Perubatan, Ulu Kinta
 OBJEKTIF
1. Memberikan definisi ubatan anti-
parkinson.
2. Menyatakan tujuan/ indikasi ubat.
3. Menyatakan dos dan contoh ubat.
4. Menyatakan kaedah pemberian
ubat.
5. Menyatakan tindakan ubat.
6. Menerangkan kesan sampingan
dan kontraindikasi ubat.
7. Memberikan nasihat spesifik
dalam pengambilan ubat.
Parkinson’s Disease
• Degenerative disorder of the CNS.
• Disebabkan oleh:
– Kekurangan dopamine
– Kelebihan acetylcholine
• Parkinson’s disease menganggu
bahagian otak yang mengawal
pergerakan otot.
• Symptoms:
– Tremor
– Difficulty in walking
– Problems in balance
• No cure for Parkinson disease, but
the symptoms can be relieved by
using anti-parkinson drugs.
 Anti-Parkinson
• Ubat yang digunakan untuk
mengurangkan tanda-tanda
parkinsonism.
• Mengimbangkan semula paras
dopamine dan acetylcholine dalam
CNS.
 Jenis Anti-Parkinson
• Bergantung pada tindakannya,
Anti-Parkinson boleh dibahagi
kepada:
– Dopaminergic Agent
– Anticholinergic Agent
Dopaminergic
Agent
 Tindakan
• Meningkatkan penghasilan
dopamine.
• Membantu mengaktifkan
reseptor dopamine.
• Dengan ini paras dopamine
akan bertambah.
• Levodopa akan ditukar kepada
dopamine di dalam otak.
 Contoh Ubat

• Levadopa (Larodopa)
• Levadopa, Benserazide
(Madopar)
• Carbidopa, L-dopa (Sinemet)
• Selegiline HCl (Jumex)
• Amantidine HCl (Symmetrel)
 1. Levadopa (Larodopa)
Category: B

Dose
• 250-1000mg tab od PO
(divided dose)
• Given with food
 Kesan Sampingan
• Choreiform movement
(Involuntary muscle twitching)
• Dystonic movement (Muscular
spasms)
• Nausea (mual)
• Dizzy (pening)
• Anorexia
• Hypotension
• Sweating (perpeluhan)
• Levodopa-induced
changes in synaptic
dopamine levels increase
with progression of
Parkinson’s disease:
implications for dyskinesias
2. Levadopa, Benserazide
(Madopar 250mg)
Category: B
 Dose
• Madopar 250mg (50mg
levodopa/ 200mg benserazide)
• Initial: 125mg bid PO (after
meal)
• Increase at weekly intervals
until 1000mg (divided dose)
 Kesan Sampingan

• Sama seperti
Levodopa/Larodopa
3. Carbidopa, L-dopa
(Sinemet 275mg/ 125mg)

Category: B
 Dose

• Sinemet 275mg (25mg

carbidopa/ 250mg levadopa)
• Initial: ½ tab tid-qid PO
• Increase by ½ tab daily
• Not more than 8 tabs/day
• Sinemet 125mg (25mg
carbidopa/ 100mg levadopa)
• Initial: 1 tab tid PO
• Increase in small increment
to maximum of 8 tabs/day
• If necessary substitute with
Sinemet 275mg
Kesan Sampingan

• Sama seperti
Levodopa
 4. Selegiline HCl
(Jumex 5mg )
Category: A*

Dose
• 5-10mg (1-2 tabs) od PO
 Kesan Sampingan

• Nausea (mual)
• Hypertension
• Confusion (keliru)
• Agitation vigorous movement
• Hallucinations
 5. Amantidine HCL
(Symmetrel)
Category: B

Dose
• 100mg cap bid/ tid PO
 Kesan Sampingan

• Insomnia
• Nausea (mual)
• Edema
• Skin discolouration
• Orthostatic hypotension
 Contraindication

• Allergic to Dopaminergic
agents
• Glaucoma
• Lactation
 Drug Interaction
• MAOIs
– Increase therapeutic effects
– Possible hypertensive crisis
• Pyridoxin (Vit B6), Phenytoin, TCAs
– Decrease Efficacy
• Anti-histamine, Phenothiazine,
Alcohol
– Increase adverse reaction of
amantidine
Anticholinergic
Agent
 Tindakan
• Mengurangkan penghasilan
acetylcholine.
• Menghalang pengaktifan
reseptor acetylcholine.
• Dengan ini paras
acetylcholine akan
berkurang.
 Contoh Ubat

• Benzhexol (Artane)
• Benzotropine Mesylate
(Cogentin)
1. Benzhexol (Artane 2mg)
Category: B

Dose
• Initial: 1mg on 1st day
• 2mg on the 2nd day
• Then increase by 2mg daily
up to 6-10mg/day tid or qid
(after meal)
• For drug induced
parkinsonism:
– Initial: 1mg on 1st day
– Then increase to 5-15mg/day
 Kesan Sampingan

• Dry mouth
• Blurred vision (gangguan
visual)
• Nausea (mual)
2. Benzotropine Mesylate
(Cogentin)
Category: B

Dose
• 5 - 15mg tab od
(divided dose)
 Kesan Sampingan

• Dry mouth
• Blurred vision (gangguan
visual)
• Nausea (mual)
 Contraindication
• Drug allergic
• Glaucoma
• Pyloric/duodenal obstruction
• Peptic ulcer
• Myasthenia gravis
• Achalasia (failure of lower
esophageal muscle)
 Drug Interaction
• Phenothizines, TCAs
– Paralytic ileus
– Sometimes fatal
– Additive adverse CNS effects (toxic
pyschosis)
• Phenothiazines, Halopeidol
– Decreased therapeutic efficacy of
anti-psychotic drugs
 Nasihat

• Ubat ini boleh menyebabkan

mengantuk.
• Pesakit tidak dibenarkan
untuk mengendalikan mesin
atau memandu selepas
mengambil ubat tersebut.
 Soalan
1. Beri definisi ubat Anti-Parkinson?
2. Terangkan cara tindakan
Dopaminergic & Anti-cholinergic
agent?
3. Senaraikan contoh dopaminergic
dan anticholinergic agent?
4. Nyatakan kesan sampingan &
kontraindikasi dopaminergic dan
anticholinergic agent?