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Medicatia antiparkinsoniana

medicina












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MEDICATIA ANTIPARKINSONIANA

Substantele medicamentoase folosite in tratamentul bolii Parkinson,care amelioreaza unele simptome ca:tremor,rigiditate,hipokinezie,

Clasificare;

1.in functie de mecanismul de actiune:



                         -antiparkinsoniene –anti-colinergice ex:-trihexifenidil

                                                                                             -benzatioprina

                                                                                             -biperiden

                                                                                             -prociclidina

                                                                                               

                         -antiparkinsoniene –care stimuleaza transmisia dopa-minergica

                      a)-influenteaza pozitiv metab.dopaminei

                               ex:-levo-dopa +inhibitorii –aromatil

                                                                            -L-amino-acid decarboxilaza

                                                                         (carbidopa,benserozid)

                      b)-agonisti dopa-minergici –ex der semisintetici si sintetici ai alcaloizilor din ergot(bromcriptina,pergolid,lergotril)

                                                                           -derivati piperazinici(peribedil)

Tratament si principii de tratament:

-tratamentul produce amelioarea la cca 60-80% din pacienti si se continua toata viata

-in formele incipiente se adm anticolinergice(trihexifenidol)sau stimulante ale eliberarii dopaminei(amantadina)

-in formele avansate se administreaza levo_dopa

-in Parkinson medicamentos se adm anticolinergice ,fiind excluse dopa minerg

-dozele sunt crescute treptat

-asocierile de antipark.sunt frecvente,pt a creste eficacitatea clinica

-intreruperea tratamentului se face treptat

Exemple de reprezentanti

TRIHEXIFENIDIL

-scade rigiditatea musculara ameliorand mersul si starea generala

-efect mai slab asupra bradikineziei si tremuraturilor

-mai active in Parkinson post-encefalic decat in cel atherosclerotic

Reactii adverse:-anorexie,greata,voma

                            -HTA ,tahicardii,aritmii

                            -agitatie,dezorientare

                            -trombocitopemie

                            -leucopemie

C.I-psihonevroze

      -ulcer gastro-duodenal

      -sarcina

      -infarct miocardic

      -leucopemie

      -insuficienta renala,hepatica,cardiaca

Administrare:-oral-initial 0,25 gr de 3x/zi ,doza se mareste cu 0,25 -0,5 gr la 4-7 zile (se adm dupa mancare)

                                -doza medie eficace este de 3-4 gr/zi

Specialitati farmaceutice:-ROMPARKIN-cpr 2 mg

                                      -la copii intre 2-3 ani doza este de 1mg de 3x/zi

                                      -la copii intre 3-10 ani 1mg de 3x/zi sau semareste doza in functie de nevoie

BIPERIDEN

-anticolinergic central si periferic

-slab antidepresiv

Indicatii:-boala si sindrom Parkinson

Reactii adverse:-hiposalivatie            

                          -tulb de acomodare

                          -tulb de mictiune

                          -constipatie

                          -ameteli

C.I.:-glaucom

        -hipertrofie a prostatei

        -stenoza digestiva

        -cardiopatii decompensate

Administrare:-oral-4-8 mg /zi in priza unica dimineata

Specialitati farm:-AKINETON-cpr 2 mg

LEVODOPA

-folosit ca medicatie de substitutie in parkinsonism prin trans in dopamine

-Reactii adverse:-la nuvel digestive,cardiac,hematologic

C.I.:-sarcina

        -infarct miocardic recent

        -insuficienta renala,hepatica si cardiaca

Administrare:-oral-e adm in combinatie cu inhibitori ai decarboxilazei

(carbidopa sau benserazid)

Specialitati farmaceutice:-au in comp levodopa +carbidopa

                                         -CARBIDOPA+LEVODOPA-compr de 100mg+25 mg sau compr de 250 mg+25 mg

                                          -CRETAMIN-cpr de 250 mg +25 mg

                                          -ISICOM-cpr 250mg+25 mg

                                          -NAKOM-cpr de 250 mg +25 mg

                                          -NAKOM _SINEMET-cpr 250 mg+25 mg

                                           -care au in compozitie levodopa+benserazid

                                          -MADOPAR-cpr 250 mg +50 mg

AMANTADINA

-derivat de adamantan

-stimuleaza receptorii dopaminergici

Indicatii:-insomnie,ameteli

               -ataxie

               -scaderea reflexivitatii

               -edeme

               -convulsii

               -confuzii

C.I.:-epilepsie

        -psihoze

        -insuf hepatica

        -insuf renala grava

Administrare:-oral-la mese

                        -doza medie 100mg dimineata si la amiaza si mai crescuta  pana la 500 mg/zi

Specialitati farmaceutice:-A-PARKIN-cpr 100mg

                                            -AMANTADINA-cps de 100 mg

                                            -VIREGYT-K-cps de 100 mg

       

BROMCRIPTINA

-agonist dopa-minergic

-in Parkinson are ef asemanatoare cu levo-dopa si in plus inhiba secretia de prolactina si reduce hiperprolactinemia(de origine fiziologica post-partum sau de origine patologica )

Indicatii:-hiperprolactinemia cu tulb de ciclu menstrual ,cu sau fara galactoree

                -sterilitate

                -galactoree ca atare

                -suprimarea lactatiei fiziologice

                -ginecomastie,impotenta

                -acromegalie moderata,asociata cu radioterapie

                -in Parkinson



Reactii adverse:-greata,voma

                           -edeme ale membrelor inferioare

                           -accentuarea ischemiei periferice

                           -reducerea atentiei

                           -uscarea mucoasei bucale

                           -constipatie

                           -HTA ortostatica

                           -confuzii

                           -excitatie psihomotorie pana la delir (in doze mari)

C.I.:-HTA

       -tulburari psihice dupa nastere

       -hipersensibilitate la alcaloizii din ergot

       -alcoolul scade toleranta

!!!prudenta la conducatori auto!!!

Administrare:-oral-7,5 mg pana la 100 mg/zi in Parkinson

                                 -2,5 mg/zi 2-3 zile

                                 -2,5 mg -2x/zi  14 zile pt suprimarea lactatiei

Specialitati farmaceutice:-BROMCRIPTINA-cpr 2,5 mg

                                           -MEDOCRIPTINE_DORO-cpr 5 si 10 mg

DIHIDRO-ERGOCRIPTINA

Indicatii:-boala Parkinson

                -tratament de intretinere in cefalee si migrena

               -hiperprolactemie

               -inhibarea lactatiei

Reactii adverse:-greata,voma,gastralgii

                           -dispepsie

                           -ameteli

                           -HTA ,tahicardie

                           -somnolenta

Administrare:-in Parkinson-initial-5 mg de 2x/zi pana la 10 mg de 2x/saptamana

                           -astenie,costipatie

Administrare:-oral-initial 0,125 mg de 3x/zi la mese sau in afara lor                                                -doza de intretinere -60 mg /zi

                          -in cefalee si migrena-numai ca tratament de intretinere

                                       -initial 10 mg/seara inainte de culcare timp de 2 saptam

                                       -tratament de intretinere -2x10 mg /dimineata si seara

                          -in hiperprolactinemie-initial-5 mg /de 2x/zi

                                                                 -de intretinere-10 sau 20 mg de 2x/zi

                          -inhibarea lactatiei-5 mg de 2x/zit imp de 5-10 zile

Specialitati farmaceutice:-DAVERIUM-cpr 20 mg s.a.

PRAMIPEXOL

-

Indicatii:-Parkinson ca monoterapie(in stadium initial)

                -asociat cu levo-dopa in stadiile mai avansate

Reactii adverse:-hTA-ortostatica

                           -ameteli,greata

                           -diskinezie

                           -insomnii sau somnolenta

                           -cefalee,halucinatii,confuzii

                                 -doza se creste apoi la 5-7 zile pana la ef therapeutic optim

                                 -doza de intretinere-1,5 -4,5 mg /zi in 3 prize

Specialitati farmaceutice:-MIRAPEXIN-cpr 0,25 mg sic pr 1mg s.a.

SELEGENINA

Indicatii:-Parkinson ca monoterapie sau asociat cu levo-dopa sau inhibitori ai dopa-decarboxilazei 

                -dementa Alzheimer si depresii

Reactii adverse:-dischinezie crescuta

                           -greturi

                           -hTA

                           -halucinatii

Administrare:-oral-initial 5 mg dimineata apoi pana la 10 mg

Specialitati farmaceutice:-JUMEX-cpr 5 mg si 10 mg

                                            -SELEGOS-cpr 5 mg

                                            -SELEGILINE-cpr 5 mg

ENTACAPON

-Indicatii:-Parkinson asociat cu levo-dopa si inhibitori ai dopadecarboxilazei

                 -efecte modeste cu prelungirea actiunii levo-dopala parkinsonieni cu fructuatii motorii

Reactii adverse:-creste efectele adverse ale levo-dopa

                           -diskinezie

                           -anorexie

                           -hTA ortostatica

                           -greata,voma,halucinatii

                           -sincopa ,diaree

Administrare:-oral-200mg  cu fiecare doza de levo-dopa,carbidopa pana la cel mult 8 doze /zi

!!!!NU ESTE HEPATO-TOXIC!!!!!

Specialitati farmaceutice:-COMTAM-cpr filmate 200 mg

 

 MEDICATIA ANTICONVULSIVANTA SAU ANTIEPILEPTICA

Sunt medicamente care :-suprima sau diminua intensitatea convulsiilor ,produse prin electro-socuri sau prin excitante ale SNC (pentetrazol sau stricnina)

                         -suprima sau diminua convulsiile din diverse stari patologice (ex:traumatisme,tumori,edem cerebral,tetanus,)

                                            -suprima si reduce intensitatea convulsiilor si a atacurilor de convulsii din boala epileptica

Clasificare:-1.In functie de structura chimica;

                         A)BARBITURICE-ex:-fenobarbital

                                                                -metil-fenobarbital

                          B)HIDANTOINE-ex:-fenitoina

       

                          C)PIRIMIDIN-DIONE-sau DEZOXIBARBITURICE

                                                             Ex:-primidona

                           D)OXAZOLIN_DIONE-ex:-trimetadiona




                            E)SUCCINIMIDE-ex:-etosucximida

                                                                  -fensuximida

                                                                  -molsuximida

                            F)ACIL-UREE-ex:-fenacemid

                            G)DIBENZAPINE sau IMINO-STILBEN-ex:-carbamazepina

                             H)BENZODIAZEPINE –ex:-diazepam

                                                                            -clonazepam

                             I)ALTE STRUCTURI:-ex:-acid valproic

                                                                           -vigabatrim

                                                                            -gabapentina

                                                                            -sulfamide inhibitoare(sultiam,

                                                       Acetazolamida)

                  2.In functie de criteriile farmacodinamice si farmacoterapeutice

                            A)-antiepileptice cu eficacitate predominanta in marele rau epileptic(de ex:-fenobarbital,fenitoina)

                          

                            B)-antiepileptice cu eficacitate in celelalte forme cu exceptia micului rau epileptic-ex:-primidona

                                          -carbamazepina si ac valproic

                           C-)antiepileptice in micul rau epileptic –ex:-trimetadiona

                                                                                                   -etosuximida

                                                                                                   -acetazolamida

                                                                                                   -acid valproic

                           D)-antiepileptice in starea de rau epileptic

                                    -ex:-benzodiazepinice adm iv lent-diazepam,clonazepam

                                          -anestezice locale

                           E)-antiepileptice in epilepsiile cu spectru larg ex:-fenacetina

                           F)-antiepileptice in epilepsia partiala,focala-ex:-sultiam

                                                                                                           -vigablastina

                                                                                                           -lamotrigina

Administrare:-principii de tratament

1.-individualizarea antiepilepticuli si a dozelor

2.-dozele mici incipiente sunt crescute treptat

3.-intervalul dintre doze este in functie de T1/2

4.-optimizarea posologiei prin monitorizarea conc plasmatice

5-monitorizarea efectelor adverse

6.-intreruperea trat se face prin reducerea treptata a dozelor

7.-calea de adm in status epilepticus este iv lent ,iar pt cazurule grave refractare la antiepileptice se recurge la anestezie generala

Reprezentanti

FENOBARBITAL

-absorbtie digestive buna

-conc plasmatica la 6-8 ore

-actiune intense in marele rau epileptic

Indicatii:-epilepsie majora

               -stare de rau epileptic

               -eclampsie

               -convulsii febrile si toxice               

Reactii adverse:--somnolenta

                            -eruptii alergice

C.I.-alergie la barbiturice

      -porfirie

      -insuf renala,hepatica si cardiaca

      -se adm cu precautii labatrani si in sarcina

Administrare:-adulti-oral-100 mg 1 sau de 2x/zi

                         -copii –oral-2-4 mg /kg corp/zi

                                    -iv-adulti-200 mg

                                         -copii 4-8 mg/kgcorp/zi

                        -in stare de rau epileptic iv lent –adulti 150-400 mg

                                                                              -copii 6mg/kgcorp/zi

Specialitati farmaceutice:-FENOBARBITAL-cpr 0,0015gr sau 1 gr sa

                                                                             -fiole 10%-fiole de 2 ml

                                                                             -fiole 4% -fiole de 1ml

FENITOINA

Indicatii:-epilepsie majora ,psihomotorie

               -status epilepticus

               -bulimie

               -sughit refractar persistent

               -adjuvant in durerile cronice persistente

C.I.-anemie

       -HTA

       -leucopenie

       -insuf renala,hepatica,cardiaca

Reactii adverse:-tulb de vedere ,icter

                           -hiperplazia gingiilor

                           -anemie megaloblastica

Administrare:-oral-1-2x/zi –adulti 0,2-0,4 g/zi

                                              -copii –sub 5 ani-50 mg/zi

                                                         -intre 5-8 ani-100mg/zi

                                                         -peste 8 ani-200 mg/zi

               -in sughit-iv-200 mg in 5 minute

                               -100 mg de 4x/zi (i.m.apoi oral pana la 10 zile

Specialitati farmaceutice:-FENITOIN –cpr de 100mg s.a.

CLONAZEPAM



Indicatii:-epilepsie minora

               -status epilepticus

               -nevralgie

               -convulsii mioclonice si akinetice

               -atac de panica

Reactii adeverse:-sedare

                             -ameteli

                             -hipersecretie salivara si bronsica

Administrare:-oral-1-2 prize /zi –la sugari-1-3 mg/zi

                                                       -copii mici-2-6 mg/zi

                                                       -scolari-3-6 mg/zi

                                                       -adulti-3-7 mg/zi

                        -in status epilepticus-iv lent -0,5 mg la copii si 1 mg la adulti

Specialitati farmaceutice:-RIVOTRIL-cpr 0,5 mg si 2 mg de s.a.

CARBAMAZEPINA

Indicatii:-epilepsia majora ,psihomotorie,temporala

                -sindrom depresiv influentat de litiu

                -in manie la persoanele care nu tolereaza litiul sau valproatul

                -in tulburari de stress post-traumatic

                -diabet insipid

                -nevralgie de trigemen

                -adjuvant in durerea cronica patrunzatoare

Reactii adverse:-somnolenta

                           -ameteli

                           -ataxie

                           -anorexie

                           -greata

                           -edeme

                           -anemie

C.I.-gravide

Administrare:-oral-2-3 prize /zi

                        -la adulti-0,8 -1,2 gr/zi

                  -in nevralgia de trigemen-initial-2x100 mg/zi apoi se creste la 12 ore cu 100mg pana la 1600 mg

                 -doza de intretinere 400-800 mg/zi in 2-4 prize

Specialitati farmaceutice:-CARBAMAZEPINA-cpr 200 mg s.a.

                                            -CARBAVIM –cpr 200 mg sa

                                            -CARBEPSIL-cpr 200,400 mg

                                            -FINLEPSIN-cpr 200 mg sic pr retard 400 mg sa

                                            -TAVER-cpr 200mg sa

                                            -TIMONIL-sirop de  uz pediatric

                                                               -compr retard 150,300,600 mg

ACIDUL VALPROIC

Indicatii:-epilepsie minora si majora

               -convulsii mioclonice la copii

               -manie asociata cu tulburari bipolare

C.I.-gravide

Reactii adverse:-toxic hepatic si pancreatic

                           -epistaxis

                           -fen de hiperexcitabilitate nervoasa centrala

                           -cefalee

                           -insomnie

                           -hirsutism

Administrare:-oral-2-3 prize/zi la mese

                                 -adulti-20-30 mg/kg corp /zi

                                 -copii-30-40 mg/kg corp/zi

                                 -sugari-30mg/kgcorp/zi

Specialitati farmaceutice:-CONVULEX-cps 150;300;500mg si sirop 50mg/ml

                                           -DEPAKINE –cpr film 200 mg si sirop 57mg/ml

                                           -DEPAKINE_CHRONO-300;600 mg compr retard

                                           -ORFIRIL-150;300 mg cps sau sirop 300mg/5 ml

TOPIRAMAT

Indicatii:-convulsii partiale

Reactii adverse:-diaree

                           -ameteli

                           -parestezii

                           -astenie

Administrare:-oral-200-300 mg /zi pana la 2x/zi si apoi se creste pana la 400 mg/zi

Specialitati farmaceutice:-TOPAMAX-cpr 25;50;100;200;300;400 mg sa

                                                                  -cps cu microsfere controlabile 15 mg

                  

                       

                          

                           

 

 












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