Medicamente dopaminergice in parkinsonism

Boala Parkinson este o boala cronica degenerativa a sistemului nervos, caracterizata de degenerarea progresiva a structurilor creierului care coordoneaza functiile motorii (ganglionii bazali) si de pierderea progresiva a substantei numite dopamina jogos casino online.

Precursori de dopamina Tratamentul electiv al maladiei parkinson idiopatice e reprezentat de levodopa in asociere cu un inhibitor de dopa-decarboxilaza. Levodopa, un precursor al dopaminei, amelioreaza bradikinezia si rigiditatea.

Exercita, de asemenea, un efect minor asupra tremorului. Acest medicament trebuie asociat cu un inhibitor al dopa-decarboxilazei (benserazida si carbidopa) pentru a evita degradarea la nivel periferic. Acesti inhibitori nu pot penetra bariera hemato-encefalica.

Terapia trebuie initiata cu dozaje scazute, cresterea lor fiind graduala la intervale de 2-3 zile. Doza optima de levodona este aceea care permite cresterea mobilitatii pacientului si este bine tolerata de acesta. Majoritatea efectelelor secundare care impun limitarea dozei sunt miscarile involuntare si complicatiile psihiatrice.

Tratamentul cu levodopa poate provoca initial (primele 6-18 luni) o ameliorare lenta a patologiei, iar principalele efecte secundare ale administrari acestui medicamnent sunt anorexia, insomnia, agitatia, vertij, hipotensiune posturala, tahicardie, aritmie Bonus Fara Depunere

Agonistii receptorilor dopaminergici

Agonistii receptorilor dopaminergici derivati din ergot (bromocriptin, cabergolina, pergolide) nu prezinta avantaje fata de levodopa. Aceste medicamente trebuie administrate pacientilor care nu tolereaza levodopa sau care prezinta riposte inadecvate.

Agonistii receptorilor de dopamina sunt utili in reducerea perioadelor de off si in ameliorarea fluctuatiilor din ultimul stadiu al maladiei, dar administrarea lor este limitata de efecte indezirabile.

Adesea se observa, cand agonistii sunt asociati cu levedopa, aparitia de miscari involuntare anormale si stari confuzionale. Derivatii de ergot pot provoca efecte neuropsihiatrice.

Clasa angonistilor receptorilor dopaminergici cuprinde si ropinirolul si pramipexol. Primul este folosit in monoterapie, la pacientii mai tineri care au risc de diskinezie la terapia de lunga durata pe baza de levodopa.

Inibitori selectivi de monoaminoxidaza B

Selegilina in dozaje mici (<10 mg/zi) este un inhibitor selectiv al enzimei monoaminoxidaza B (MAO-B). Aceasta izoenzima este principala responsabila de metabolismul oxidant al dopaminei, la nivelul muschiului striat.

Selegilina nu inhiba metabolismul periferic al catecolaminei.

Inibitori de catecol-O-metiltransferaza (COMT)

Entacapon este un inhibitor al catecol-O-metiltransferaza, o enzima responsabila de catabolismul dopaminei si al levodopei. Acesta reduce simptomele clinice de "wearing - off", la pacientii tratati cu levodopa.

Bibliografie:
Ghidul folosirii medicamentelor, 2003
Goodman & Gilman's

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