Learning Objectives

• Manage patients with Parkinson's disease.

• Manage patients with Alzheimer's disease.

• Manage patients with depression.

• Manage patients with schizophrenia.

• Manage patients with epilepsy

Anti Parkinsonism
 Anti Parkinsonism

Definition :

• Neurodegenerative Disease
• Associated With Loss Of Dopamine Neuron
• Characterized By Disorder Of Movement
Tremor , Rigidity , Bradykinesia
I.E. slowing initiating & carrying out of voluntary movement
• Most cases involve people over the age of 65
 Anti Parkinsonism

Anticholinergic
EX. Cogentin , Parkinol

Anti
Parkinsonism
Dopaminergic
Ex. Stalevo, Sifrol ,
Sinemet
 Anti Parkinsonism
Dopaminergic & Other Mechanism Drugs
Ex. Sinemet (Carbidopa : Levodopa) (1 : 10 )
• Levodopa : Is Immediate Precursor Of Neurotransmitter Of
Dopamine But It Is Rapidly Decarboxylated & Become Inactive
Before Enter The Brain

• Carbidopa : Decarboxylase Inhibitor

• Levodopa should be taken on an empty stomach, typically 30

minutes before a meal
• Side effect : nausea , vomiting , Saliva and urine are a brownish ,
Visual and auditory hallucinations and abnormal involuntary
movements (dyskinesia)
 Anti Parkinsonism

Dopaminergic & Other Mechanism Drugs

Ex. (Entacapon )
• Selective , Reversible Peripheral Inhibitor Of Catechol-O-
methyl Transferase (COMT)

• An Enzyme Involved In Metabolism Of Dopamine & Levodopa

 Anti Parkinsonism

Dopaminergic & Other Mechanism Drugs

Ex. Stalevo (Carbidopa , Levodopa , Entacapon )

• Side Effect :
Nausea , Vomiting , Constipation Or Diarrhea , Dry Mouth
 Anti Parkinsonism

Dopaminergic & Other Mechanism Drugs

Ex. Parlodel ( Bromcriptine )
Ex. Dopergin (Lisuride )

• Dopamine Agonist Associated With Dopamine Depletion

• Side Effect :
GIT ( Nausea , Vomiting & Constipation )
CVS (Postural Hypotension)
CNS (Confusion & Hallucination)
 Anti Parkinsonism

Dopaminergic & Other Mechanism Drugs

Ex. Sifrol (Pramipexole )
Ex. PK-Merz ( Amantadine )

• Dopamine agonist with action similar to those of

bromocriptine
 Patient Education
Constipation
• People With Parkinson's Disease, Constipation May Occur Due To The Improper Functioning Of The Autonomic Nervous
System.
keep the balance
• slowly When Change The Position , When Arising From The Bed Wait Some Time, Stand With Support Cane Has Large
Rubber Tip, Also When Stand The Feet Slight Apart
Decrease the reflexes
• Decrease The Stimulation & Decrease The Attention , Destruction
Plan periods of rest
In Walking
• Not Carry Objection In Hands & Arm For Kept Balance
Driving a Car
• Significantly Impair Driving Skills, Cause Safety Concerns, And Force Many People With The Condition To Stop Driving A
Car
Exercise
• Use Yoga
Diet
• Protein Food Decrease Absorption Of Levodopa , Advice To Take Fiber Food
Anti Alzheimer Drugs
 Anti Alzheimer Drugs

Definition :

• Neurodegenerative Disease Is Characterized By Loss Of Cholinergic Neuron Then,

Loss Of Memory

• Degenerative brain process that produce dementia may be due to accumulation of

type of protein (beta amyloid protein ) lead to degeneration

• Alzheimer is type of dementia , causes problems with memory , thinking , behavior

& symptoms develop slowly & get worse overtime
Anti Alzheimer Drugs

ACHE
Inhibitors

Anti NMDA
Alzheimer Receptor
Drugs Antagonist

Others
 Anti Alzheimer Drugs

ACETYLCHOLINESTERASE INHIBITORS
(ACHE Inhibitors)

• Treatment Mild To Moderate Dementia

• Ex. Exelon (Rivastigmine 1.5 , 3, 4.5 mg Tab, Patch)

• Ex. Dementile (Donepezil )

 Anti Alzheimer Drugs

ACHE Inhibitors

• Ex. Reminyl (Galantamine )

Side Effect Of ACHE Inhibitor

• Diarrhea
• Insomnia
• Abdominal Pain
• Sweating
• Tremors
 Anti Alzheimer Drugs

NMDA Receptor Antagonist :

• N-Methyl-D-Aspartate Receptor Antagonist

• One of glutamate receptor , stimulation these receptor has critical role

in the memory

• But over stimulation of the glutamate receptors specially NMDA lead

to neuro degenerative effect
 Anti Alzheimer Drugs

NMDA Receptor Antagonist :

• Ex. Ebixa (Memantine )

• Ebixa used in moderate & severe Alzheimer
Side Effect
• Constipation
• Headache
• Somnolence
 Anti Alzheimer Drugs

Other Drugs
• Support drugs prescribed to increase the
memory
• Ex. Gincobiloba As Memorex
• Ex. Folic Acid
• Ex. L . Carnitine
 Patient Education ( Patient Family )

Create Save Environment

• Prevent falls
• Use locks on dangerous materials , medicine , dangerous tools
• Take care with water temperature
• Take fire safety precaution
• Smoking with supervision
Patient Education ( Patient Family )
Reduce The Frustration
• Give His Time
• Limited Choice
• Reduce All Destructions As Different Voice , Television , ..

Be Flexible With Him

Simple Tips For Daily Task

Advice To Take Supplement

Anti Depressant Drugs
 Anti Depressant Drugs
Tri Cyclic Anti
Depressant

Selective
Serotonin & Anti
Atypical
Norepinephrine Depressant antidepressant
Reuptake
Inhibitors Drugs

Selective
Serotonin
Reuptake
Inhibitors
 Anti Depressant Drugs

Selective Serotonin Reuptake Inhibitors (SSRI)

• Ex. Escitalopram (Cipralex)
• Ex. Fluoxetine (Prozac)
• Ex. Paroxetine (Seroxat)
• Ex. sertraline (LUSTRAL®).
 Anti Depressant Drugs

Selective Serotonin & Norepinephrine Reuptake Inhibitors ( SSNRI)

• Ex. Effexor (Venlafaxine )
• Ex. Prestiq (Desvenlafaxine )
• Ex. Cymbalta (Duloxatine )
 Anti Depressant Drugs

Atypical Antidepressant
• Ex. Mirtazipin (Remeron , Mirzagen)
• It is sedating because of its potent antihistaminic activity
• Increased appetite and weight gain frequently occur.
• Ex. Bupropion (Welbutrin®)
 Anti Depressant Drugs

Tri Cyclic Anti Depressant TCA

Ex. Imipramine (Tofranil )
EX. Clomipramine (Anafranil )
EX. Amitriptyline (Tryptizole )
Adverse Effects
• Blockade of muscarinic receptors leads to blurred vision,
xerostomia (dry mouth), urinary retention, tachycardia,
constipation, and aggravation of angle-closure glaucoma.
• Weight gain is a common adverse effect of the TCAs
 Anti Depressant Drugs

Other Antidepressant
Ex. Herbal antidepressant as St. John 'Worts

Ex. Drugs has an other main indication as Tegretol , Depakine there

main indication is anti epilepsy
 Anti Depressant Drugs

Complementary Treatment
Folic Acid
• Folic acid orally with conventional antidepressants seems to improve
treatment response in patients with major depressive disorder
• 500mcg to 1000mcg is used daily for 8 weeks with antidepressants
Zinc
• Improve depression scores in patients diagnosed with major depression
• 25 mg daily for 12 weeks with antidepressants
Fish Oil
• One cap of 500 mg fish oil twice daily for 16 weeks
 Anti Depressant Drugs

Adverse Effects
• Sleep Disturbances
 Paroxetine generally more sedating

• Sexual Dysfunction
Anti Depressant Drugs
Migraine As
Prophylactic
Ex.Tryptizole Neuropathic
Anxiolytic Effect Pain
As In Aspastic
Colon Ex. Cymbalta &
Tryptizole
Other Uses Of
Antidepressant

Bulimia Nervosa
P.M.S ex. Fluoxetine
Premature
Ejaculation
Ex. Lejam ,
Cipralex
Antipsychotic Drugs = Major Tranquilizer Drugs

Schizophrenia is a type of chronic psychosis

characterized by delusions, hallucinations (often in the
form of voices), and thinking or speech disturbances.
Antipsychotic Drugs used in psychotic states & sever
behavioral disorders they induce state of calm without
causing sleeping
• Atypical antipsychotics
 Olanzapine ( Zyprexa )
 Quetiapine ( Seroquel )
 Aripiprazole (Abilify)
 Resperidone (Respirdal,redon, )
 Clozapine (Leponex )
Antipsychotic Drugs = Major Tranquilizer Drugs

Mechanism Of Action
1. Dopamine Antagonism
2. Serotonin Receptor–blocking Activity
Therapeutic Uses
1. Treatment Of Schizophrenia
2. Prevention Of Nausea And Vomiting
3. Many antipsychotic agents are approved for the management of the
manic and mixed symptoms associated with bipolar disorder
Antipsychotic Drugs = Major Tranquilizer Drugs

Adverse Effects
1. Extrapyramidal effects
2. Tardive dyskinesia
3. Drowsiness occurs due to CNS depression and antihistaminic effects.
4. The antipsychotics depress the hypothalamus, affecting
thermoregulation and causing amenorrhea, galactorrhea,
gynecomastia, infertility, and erectile dysfunction
Antipsychotic Drugs = Major Tranquilizer Drugs

Antipsychotic drugs used in other indication

Sedating & Neuroleptics Effect
• Ex. Sulpride (Dogmatil )
• Ex. Amisulpride ( Solian )
Anti Epilepsy Drugs
 Anti Epilepsy Drugs

Epilepsy Definition :

• Medical condition that produce seizures that affect mental & physical function
when person has two or more seizures considered epilepsy & produced by
abnormal electrical charge in the brain

• An Abnormal electrical activity lead to loss of consciousness & abnormal

movement & may be genetic epilepsy , structural/metabolic epilepsy
 Anti Epilepsy Drugs

Epilepsy Seizures

Partial (Focal )Seizures Generalized Seizure

 Anti Epilepsy Drugs

Partial Seizures
Only Portion Of The Brain , only one lobe &
symptoms depend on site of neuronal discharge

Simple Partial Seizures Complex Partial Seizures

1- Group Of Electrical Discharge Does Not
Spread
2- Patient Does Not Loss Consciousness
3- Abnormal Activity In Single Limb , Group
Of Muscles
4- Occur In All Ages
1- Loss Of Consciousness
2- Motor Dysfunction May Involve
( Chewing , Diarrhea , Urination )
3- Occur In All Ages
 Anti Epilepsy Drugs
Mechanism Of Action Of Ant epilepsy
• Block of voltage – gated channel (Na Or Ca )
• Suppress seizures but do not cure or prevent the epilepsy

Antiepileptic Oral Drugs given for long periods ( long term therapy ) can be
arranged in 2 generation as following :

• 1st Generation : Phenytoin , Valproic Acid , Carbamazipine , Phenobarbital

Derivatives , …

• 2nd Generation: Gabapentin , Lamotrigin , Topiramate , Oxycarbimazipine ,

Leveteracetam (Keppra ) ,…
 Anti Epilepsy Drugs

Phenytoin
• Block Na , Ca
• Treatment Status Epileptics
• Bounded With Plasma Protein (Albumin(
• Liver Inducing Enzyme
• Side Effect Of Long Term Application :
Peripheral Neuropathy , Osteoporosis , Gingival Hyperplasia , Diplopia
 Anti Epilepsy Drugs

Topiramate
• Several Action (Broad Spectrum ) Ant seizures
• Application In Partial & Primary Generalized Epilepsy ,
Migraine
• It Is Liver Inhibited Enzyme
• Lamictal With Topiramate Increase Concentration Of
Topiramate
• Side Effect:
Aggressiveness , Somnolence , Weight Loss , Renal Stone
 Anti Epilepsy Drugs

Carbamazepin
• Blocks sodium channels
• Application In Partial Seizures & Secondary Generalized Seizures , Bipolar Disease

• Liver Inducer Enzyme

• Side effect : Diplopia , Epigastric Pain , Ataxia

 Anti Epilepsy Drugs

Gabapentin
• Gabapentin is an analog of GABA.

• Application …. Partial Seizures , Post Herpetic Neuralgia

• It is tolerated specially by elderly population with partial seizures

 Anti Epilepsy Drugs

Lamotrigin
• Block Na Channel , Ca Channel

• Application effective in all types of seizures also bipolar

disorder

• It is tolerated specially by elderly with partial seizures

• Side Effect : Diplopia, Ataxia

 Anti Epilepsy Drugs

Levetiracetam
• Is Unknown Mechanism

• Application is approved for adjunct therapy of partial onset

seizures , myoclonic seizures , primary tonic – clonic (grand mal )
in adult & children

• Side Effect : Dizness , Sleep Disturbance , Headache , Weakness

 Anti Epilepsy Drugs

Valproic Acid (DEPAKINE ®)

• Mechanisms of action include sodium channel
blockade, blockade of GABA

• Effective for the treatment of focal and

primary generalized epilepsies
 Anti Epilepsy Drugs

Oxcarbazepine
• Prodrug Is Na Channel Blocker
• Application partial seizures , absence seizures
• Used in adult & children
• Less Effective On Metabolic Enzyme
• Side Effect :Nausea , Vomiting , Headache , Visual Disturbance

Broad spectrum Ant Epilepsy

Topiramate , Lamotrigine , Levetiracetam
 Anti Epilepsy Drugs
Neuropathic
Pain
EX. Tegretol
,Neurontin
Digitalis
Induced
Arrhythmia Migraine EX.
( Phenytoin ) Topamax

Other Uses Of
Anti Epilepsy

Bipolar Muscle
Disorder Relaxant
Ex. Lamictal EX. Lioresal

Hiccup Ex.
Lioresal
Patient Education (First Aid )
 ‫‪Patient‬‬
‫‪Patient‬‬ ‫‪Education‬‬
‫‪Education‬‬ ‫) ‪(First) Aid‬‬
‫‪(First Aid‬‬
‫ال تحاول وقف حركته‬ ‫•‬
‫فك كل األشياء حول الرقبة‬ ‫•‬
‫ضع شيء مبطط وخفيف وناعم تحت الرأس وكذلك بالفم لو أستعطعت ولكن ليس‬ ‫•‬
‫بالقوة‬
‫تضع الشخص في إتجاه واحد حتي تسمح له بالتنفس الطبيعي‬ ‫•‬
‫ال تحاول فتح الفم بأشياء حادة‬ ‫•‬
‫ال تجعل الشخص يبلع لسانه بمعني ال تدخل اللسان بالقوة‬ ‫•‬
‫ال تحاول أن تعطيه تنفس صناعي أثناء التشنج إال الذي أنتهي من التشنج وكان لديه‬ ‫•‬
‫مشكلة في التنفس‬
‫الحظ فترة حدوث التشنج حيث غالبا ً تستغرق من بعض ثواني الي بعض دقائق ال‬ ‫•‬
‫تزيد عن ‪ 5‬دقائق‬
‫ال يوجد بجوار الشخص أي أشياء صلبة أو حادة‬ ‫•‬