Author/Editor		Locatelli, Igor; Mrhar, Aleš
Title		Odmerjanje zdravil za zdravljenje Alzheimerjeve in Parkinsonove bolezni
Translated title		Dosage regimens of drugs used in the treatment of Alzheimer's and Parkinson's disease
Type		članek
Source		2331505
Publication year		2008
Volume		str. 79-85
Language		slv
Abstract		Zdravljenje Alzheimerjeve bolezni (AB) in Parkinsonove bolezni (PB) z zdravilije simptomatsko. Uvajanje terapije s temi zdravili je postopno, kar pomeni, da se terapija prične z najmanjšim odmerkom, ki se ga nato postopoma zvišuje, dokler ni dosežen zadosten klinični učinek. Zdravila prvega izbora za zdravljenje zmerne AB so zaviralci holinesteraz (donepezil, galantamin, rivastigmin), medtem ko je za zdravljenje hude oblike AB indiciran memantin, antagonist NMDA receptorjev. Zdravila prvega izbora za zdravljenje PB so dopaminergiki, od katerih je levodopa najbolj učinkovita. Starejšim bolnikom se prednostno odmerja levodopa, mlajšim bolnikom pa agoniste dopaminskih receptorjev (pramipeksol in ropinirol). Odmerjanje levodope pri napredovani PBje zahtevno, saj se za radi nadaljnjega propada nevronov terapevtsko okno levodope zoži, kar povzroči, da se že pri majhnih nihanjih plazemskih koncentracij levodope pojavijo motorični zapleti. Trenutni način, kako motorične zaplete omiliti, je razvoj novih farmacevtskih oblik, ki omogočajo t.i.dopaminergično stimulacijo.Pharmacotherapy of Alzheimer's (AD) and Parkinson's disease (PD) is stillinergic drugs that can provide continuous dopaminergic stimulation symptomatic. In the initiation phase of the pharmacotherapy the dose of the majority of these drugs is kept low and it should be gradually increased until the optimal clinical effect is reached. Cholinesterase inhibitors such asdonepezil, galantamine, and rivastigmine represent the first class of drugs approved for the treatment of mild to moderate AD, while memantine, a NMDA receptor antagonist, is recommended for the treatment of severe AD. Dopaminergic drugs, amongst which levodopa is the most effective, are the first class drugs approved for the treatment of PD. The treatment with levodopa is recommended for older patients, while the dopamine agonists such as pramipexol and ropinirol are used for younger patients. Progressive neurodegeneration results in narrower therapeutic window of levodopa. Consequently, even minor fluctuations in levodopa plasma concentrations can berelated to the occurrence of motor complications. Motor complications can bereduced by using new delivery systems of dopaminergic drugs that can providecontinuous dopaminergic stimulation.
Keywords		Alzheimerjeva bolezen Parkinsonova bolezen odmerjanje zdravil odmerjanje rivastigmina