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L-DOPA
BROMOCRIPTINE
It is a Dopamine agonist reserved for patients taking L-dopa and who have end of
dose akinesia, On-Off effect or who are refractory to treatment. This is due to its
rapid absorption, long half-life and smoother effects compared with L-dopa.
SELEGILINE
Selective MAO-B inhibitor
It delays the breakdown of Dopamine.
It is used with L-dopa for the treatment of end of dose akinesia.
No risk of hypertensive crisis due to selectivity.
AKATHESIA: -
Features: - Motor restlessness
Mechanism: - Blockade of D2 receptors in the basal ganglia (e.g. by Antipsychotics).
Treatment: - Anticholinergic drugs (e.g. Benzhexol and Benztropine).
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DYSTONIA: -
Features: - Muscle spasm
Mechanism: - Blockade of D2 receptors in the basal ganglia
Treatment: - Anticholinergic drugs.
TARDIVE DYSKINESIA: -
Features: - Abnormal involuntary movements (e.g. Chewing, Sucking, Tongue
protrusion).
Mechanism: - Supersensitivity of Dopamine receptors following chronic blockade.
Prevension:
- Use the least possible dose of Antipsychotic
- Minimal duration
- Avoid the routine use of anticholinergic drugs
- Switch to atypical antipsychotics.