CHAPTER 4: CNS: Parkinson's Disease Flashcards
Which neurotransmitter is deficient in Parksinson’s Disease?
Dopamine
Does drug therapy prevent disease progression?
No - improves quality of life
Who should patient with suspected Parksinson’s Disease be referred to?
A specialist to confirm the diagnosis
How often should patients with Parksinson’s Disease be reviewed?
Every 6-12 months
What percentage of people with Parksinson’s Disease will respond poorly to treatment?
5-10%
Which classes of drug are initially used to treat Parksinson’s Disease? (3)
- Dopamine agonists (non-ergot)
- Levodopa
- MAOB inhbitors
Give 3 examples of dopamine agonists
- Pramipexol
- Ropinirole
- Rotigotine
Why are the ergot-derived dopamine agonists (bromocriptine, carbegoline and pergolide) now rarely used?
Risk of fibrotic reactions
Dopamine agonists cause fewer what than levodopa?
Motor complications
Dopamine agonists cause more what compared with levodopa?
Psychiatric side effects
Which dopamine agonist is used in advanced disease for patients experiencing unpredictable “off” periods with levodopa?
Apomorphine
Can a GP initiate apomorphine?
No - specialist initiation only
How is the threshold for apomorphine determined?
After an overnight period without antiparkinson’s medicines to induce an “off” episode
How is apomorphine admnistered?
Via subcutaneous injection in the lower abdomen or outer thigh
What is levodopa always given with?
An extracerebral dopa-decarboxylate inhibitor
A dopa-decarboxylate inhibitor is used to prevent symptoms of peripheral conversion of the administered levodopa to dopamine to prevent which side effects? (3)
- Nausea
- Vomiting
- Cardiovascular
Which 2 peripheral dopa-decarboxylate inhibitors are given with levodopa?
- Carbidopa
2. Benserazide
How should levodopa be introduced to patients?
At low doses then titrated up in small steps
Which antiemetic can be given to control side effects of nausea and vomiting?
Domeperidone
Which complications can occur with treatment with levodopa?
Motor
What occurs during the “on” period with levodopa treatment?
Normal function
What occurs during the “off” period with levodopa treatment?
Weakness and restricted mobility
On and off symptoms of levodopa are associated with response fluctuations and what do they eventually lead to?
End of dose fading with progressively shorter duration of benefit
Give 2 examples of MAOB inhibitor
- Selegiline
2. Rasagiline
Which antimuscarinic drug can be used to treat parkinson side effects of antipsychotics?
Procyclidine
What side effect of both dopamine agonists and levodopa should patients and carers be counselled on?
Impulse control disorders
As well as impulse control disorders, what else should patients be counselled on with dopamine agonist? (2)
- Sudden onset of sleep
2. Hypotensive reactions
