Pharm for real

Parkinson’s Disease: destruction of DA neurons in the substantia nigra (part of extrapyramidal system).
Relative overactivity of Ach (that oppose the action of dopamine). Secondary Parkinson due to
tranquilizers and haloperidol thatblock dopamine.
-Most Parkinson drugs provide relief of symptoms, but they do not arrest/reverse the neuronal
degeneration caused by the disease.

Levodopa & carbidopa (dopamine hydroxylase inhibitor that does NOT cross the BBB): Dopamine
does NOT cross the BBB, but precursor levodopa does. Peripheral dopamine effects cause nausea,
vomiting, cardiac arrhythmias, and hypotension, and we can lessen these peripheral SEs with carbidopa
(however, central effects of agitation and anxiety will actually increase due to more dopamine in the
brain).
-Drug combo only works for the first few years of therapy. As more neurons degenerate, less effect is seen.
-“on-off” phenomenon.