anti parkinson Flashcards
presentation of PKD in later stage
- motor fluctuation
- dyskinesia
- falls, postural instability
- postural hypotension
- confusiom, dementia
- suboptimal nutrition
- speech disorder
- sleep disorder
4 cardinal features of PKD
- tremour “pill rolling” at rest
- bradykinesia
- rigidity
- postural imstability, gait disturbances
levodopa
SE
Short term: N/V, postural hypotension
Long term:
dyskinesia (10%/yr), motor fluctuation
What is (Carbidopa/levodopa)? carbidopa moa
carbidopa moa is dopa decarboxylase inhibitor.
levodopa -> dopamine by dopa decarboxylase.
carbidopa dont padd through BBB, so it will lower dopamine level in the peripheral, lowering SE.
what is entacapone,
tolcapone? MOA and SE
MOA: COMT inhibitor, so more levodopa can enter the brain. must pair with levodopa.
SE:
- dyskinesia (lesser than levo)
- n/d, urinary discoloration
- visual hallucination
- daytime drowsiness, sleep disturbances
- TOLCAPONE: liver dysfunction
what is selegiline, rasagiline
SE
mao-b I.
- heartburn
- loss of appetite
- anxiety
- palpitation
- insomnia, nightmares
- visual hallucination
(maoi: postural hypotension, insomnia, restlessness)
Which stage of PKD should which drug be used for
- MAOBI: mild PKD as symptomatic monotherapy, used to delay use of levodopa
- D R agonist: adjunct or monotherapy
- amantadine: adjunct or monotherapy and anti-dykinesia
- trihexyphenidyl: adjunct or symptomatic monotherapy for tremour and stiffness and drooling
severe: levodopa, COMT I
name 3 dopamine receptor agonist
bromocriptline
pergolide
ropinirole
bro, mo i am cripple, dont pergo like this leh, roll pi ni men
SE of dopamine r agonist
- fibrosis
- pedal edema
- pergolide- restrictive vulvular heart disease
- ropinirole sleepy
trihexyphenidyl
SE
anti cholinergic
sedation
delirium, hallucination, confusion
amantadine
SE
- cognitive (inability to conc)
- hallucination
- insomnia, nightmare
- livedo reticularis
weird weird SE
amantadine- livedo reticularis
pergolide - restrictive valvular heart disease
Ropinirole -somnolence
Tolcapone- liver dysfunction
Sleep disturbance
sedation
- comt inhibitor: daytime sleepy, night time sleep disturbance
- MAOBI
- amantadine
•trihexyphenidyl
-ropinirole
non-pharm mod
physio, exercise (stretching, balance, posture)
diet
knowledge abt this disease more
social support
