PHRM 211 Lecture Notes - Lecture 24: Gastroparesis, Comt Inhibitor, Dopamine Agonist
Document Summary
Up to 50% of patients after 5 years of l-dopa therapy will develop: motor fluctuations wearing off , on-off , freezing of gait , dyskinesias peak-dose dyskinesia, diphasic dyskinesia, off-period dystonia . End-of-dose wearing off of effectiveness, relieved by next dose. Periods of fluctuating response no obvious relationship with l-dopa timing; could be due to erratic l-dopa kinetics. Delayed or no on slow or failure to turn on after dose. Freezing of gait sudden, transient, episodic inability to move feet forward, despite intention to walk. Pulsatile stimulation of dopamine receptors due to intermittent dosing. Short l-dopa half life 50 min without carbidopa, 90 minutes plus carbidopa. Space l-dopa between meals with high dietary protein intake ( 1 hr before or 2 hr after ) Give smaller doses more frequently or simply increase frequency. Add adjunctive agent (reduce dose by 25% when adding to l-dopa) Change cr to ir l-dopa due to erratic absorption.
