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PR3136 > Antiparkinsons' > Flashcards

Antiparkinsons' Flashcards

1
Q

The main pathophysiology of Antiparkinsons

A
  • Substantia nigra has dopaminergic projections to basal ganglia (striatum, to control thalamus), which is important to control movement
  • Degeneration of dopaminergic neurons with Lewy Body inclusions in Substantia Nigra cause it to be unable to send dopaminergic signals to the striatum to control movements
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2
Q

The 3 cardinal features of PD (IMPORTANT!!)

A
  • Rest Tremors
  • Rigidity
  • Bradykinesia (slowness of movement)
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3
Q

What are some non-motor manifestations of PD and when are they the most prominent? Can they be treated with dopaminergic agents?

A

Autonomic, neuropsychiatric, olfactory, sensory

  • More prominent in later stages of PD and are resistant to dopaminergic agents
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4
Q

Main principle of drugs usage in PD

A

Go slow, start low

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5
Q

Treatment of PD has to be individualised according to what factors?

A
  1. Age
  2. Stage of disease
  3. Level of Activity
  4. Associated Psychological factors
  5. Associated medical conditions
  6. Other patient factors
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6
Q

When PD is diagnosed in a patient, but patient does not shows signs and symptoms, should treatment be started?

A

No. Oral meds not required if patient is coping well, even with mild symptoms

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7
Q

Some non-pharmaco therapy for PD

A
  1. Physiotherapy and exercise regime (e.g. stretching, balance, posture)
  2. Healthy and balacned diet
  3. Social support
  4. Knowledge on PD
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8
Q

Classes of oral medications for PD

A
  1. Anticholinergics
  2. MAO-B/COM-T inhibitors
  3. Dopamine agonists
  4. Levodopa
  • Levodopa is gold standard for PD
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9
Q

Mechanism of Levodopa in PD

A

Dopamine precursor (analogue of L-dopa). Converted to dopamine in the neurons = more dopamine = more control of movements

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10
Q

Levodopa (dopamine precursors) usually comes as “2-in-1” preparation with peripheral decarboxylase inhibitors. Why is this so?

A
  • Levodopa can be converted in peripheral to dopamine
  • Levodopa can cross BBB, but Dopamine cannot
  • Inhibitors minimise levodopa’s conversion in peripheral, allow more to cross BBB
  • Hence lower dose of levodopa required for same effect
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11
Q

Main concern of long-term usage of Levodopa

A

Cumulative increased risk of motor fluctuations and dyskinesia (10%/yr). Chronic and irreversible, even if levodopa is withdrawn

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12
Q

Ways to minimise risk of dyskinesia from using Levodopa?

A
  • Use other meds adjunct with levodopa, allowing lower doses of levodopa to be used. Other meds can be used as monotherapy too
  • Use minimum effective dose
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13
Q

An example of anticholingergics used in PD

A

Trihexyphenidyl

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14
Q

Two advantages of Anticholinergics in PD?

A
  1. May be effective in controlling tremor

2. Peripherally acting agents useful in treating sialorrhea

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15
Q

Roles of anticholinergics in PD

A
  1. Symptomatic monotherapy OR

2. Adjunct to levodopa to treat tremors and stiffness

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16
Q

An example of MAO-B inhibitor used in PD

A

Selegiline

17
Q

Mechanism of action of MAO-B inhibitors. State its disease modifying effect

A
  • Inhibits MAO-B = decreased dopamine breakdown

- May have disease modifying effect –> Delay nigral brain cell degeneration

18
Q

Side effects of MAO-B inhibitors?

A

Many sympathetic CNS related side effects (think noradrenaline)

19
Q

Roles of MAO-B inhibitors in PD

A
  1. Symptomatic monotherapy, may be used in early stages of Parkinson’s disease
20
Q

Two examples of COMT inhibitors used in PD

A
  1. Entacapone

2. Tolcapone

21
Q

MoA of COMT inhibitors

A

Blocks COMT (Catechol-O-methyltransferase) and prevents it from converting levodopa into an inactive form, thus increasing the amount of levodopa available to enter the brain

22
Q

Role of COMT inhibitors in PD

A
  • Used with levodopa to increase duration of each dose of levodopa
  • Help treats “wearing off” response

note: NO effect if only itself is used

23
Q

One SE of Tolcapone

A

Liver dysfunction

24
Q

General SE of COMT inhibitors

A
  • Dyskinesia
  • Nausea, diarrhea
  • Urinary disclouration
  • Visual hallucinations
  • Daytime drowsiness, sleep disturbances
25
Q

Examples of Dopamine agonists used in PD

A
  1. Bromocriptine
  2. Pergolide
  3. Piribedil
  4. Ropinirole
  5. Pramipexole
26
Q

Role of Dopamine agonists in treating PD?

A
  1. Adjunct (to levodopa)
  2. Symptomatic Monotherapy
  3. Initial therapy in younger PD patients
27
Q

One benefit of dopamine agonist

A

Prevent or delay onset of motor complications

28
Q

Between dopamine agonist and levodopa, which is more effective in managing PD?

A

Levodopa. Hence Levodopa is still the gold standard

29
Q

Notable SE of ropinirole and pramipexole

A

Somnolence

30
Q

Notable SE of Pergolide

A

Restrictive valvular heart disease

31
Q

On top of SE that are similar to levodopa, what other SE does dopamine agonist have?

A
  1. Fibrosis

2. Pedal Edema

32
Q

MoA of Amantadine

A
  1. Enhance release of stored dopamine
  2. Dopamine receptor agonist
  3. Inhibit presynaptic uptake of catecholamine
  4. NMDA receptor antagonist
33
Q

Benefit of Amantadine

A

Reduce dyskinesia in patients with motor fluctuations (Antidyskinetic effect)

34
Q

Role of Amantadine in PD

A
  1. Adjunct to levodopa (can reduce risk of dyskinesia SE)

2. Monotherapy

35
Q

Can Amantadine be used in PD patients with seizures and psychiatric syndromes? Why or why not?

A

No. It can worsen seizure disorders and psychiatric symptoms, in Schizo or PD

36
Q

SEs of Amantadine

A
  1. Cognitive impairment (inability to concentrate)
  2. Hallucination
  3. Insomnia
  4. Nightmares
  5. Livedo reticularis (venule swelling due to thromboses, hence reticulated discoloration of limbs)

PR3136 (18 decks)

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