CNS 6 Flashcards by Ofonmbuk Urom

What are motor neurone disease

Neurodegenerative condition which affects the brain and spinal cord

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State the non drug tx for motor neurone disease

Nutrition, psychological support , physio, exercise , use of mobility aids and special equipment

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What is the first line tx for managing muscular symptoms such as muscle cramp

Quinine (Unlicensed)

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What is the second line tx for muscle cramp

Baclofen

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State the other unlicensed tx for muscle cramp?

Tizanidine, dantrolene sodium or gabapentine( all.unlicensed used

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What’s the tx for muscle stiffness?

Baclofen, tizanidine, gabapentine, dantrolene

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What’s the tx for saliva problems

Antimuscarinic drugs( unlicensed)
Glycopyrronium bromide For pt with cognitive impairment if ineffective, specialist referral for botulinum toxin type A

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Tx for thick tenacious saliva

Humidification, nebulizer or carbocysteine

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Tx for respiratory symptoms

Breathlessness ( opiods) or benzodiazapine if symptoms Exacerbated by anxiety

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Tx for amyotrophic lateral sclerosis aka motor neurone disease

Riluzole used as tx to extend life

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What is Parkinson’s disease

Progressive neurodegenerative condition results from the death of dopamine cells of substantia nigra in the brain

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What are eg of motor symptoms of PD

Hypokinesia( small movement)
Bradykinesia( slow movement)
Rigidity
Rest tremor
Postural instability

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Non motor symptoms of PD

Dementia
Depression
Sleep disturbance
Bladder and bowel dysfunction
Speech and language changes
Swallowing problems
Weight loss

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Inform DVLA and car insurers once diagnosis of PD confirmed . T/false?

True

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Refer a pt with PD to a specialist and review every 6-12 months T/ F

True

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Non- drug tx for PD

Physiotherapy
SLT
Occupational therapy
Dietitian

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Eg of drugs used in PD

See photo Fav.

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List the two main drug classes used to tx PD

Antimuscarinic and DA drugs

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List eg of Antimuscarinic drugs used to tx PD

Procyclidine
Trihexyphenyl
Orphenadrine

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DA drugs used in PD

Catechol-o- methyltransferase inhibitors eg Entacapone, opicapone, tolcapone)

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List eg of Dopamine precursors used in PD

Co- beneldopa, co- careldopa) - more neurone complications

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List eg of Dopamine receptor agonist used in PD

Amantadine, apomorphine, bromocriprine , carbergoline, pergolide, pramipexole , ropinirole and rotigotine

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List eg of Monamine - Oxidase B Inhibitor used in PD

Rasagaline, selegiline , safinamide

What’s the first line tx of motor symptoms of PD that affect QOL

Levodopa + carbidopa ( co-careldopa)
Or Benserazide( co-beneldopa)

Management of motor symptoms of PD that does not affect QOL

Levodopa or Non ergot derived dopamine receptor agonist eg Pramipexole, ropinirole or rotigotine Rasagaline or selegline- Monoamine Oxidase B inhibitor

Can you abruptly withdrawal Antiparkinson drugs?

Nope to avoid side effects

Pt and carer advice on Antipakison's drug

Inform pt of risk of adverse reactions including psychotic symptoms

Which antiparkinson drug causes sudden onset of sleep as an ADR

Dopamine agonist such as Pramipexole, ropinirole or rotigotine and co-careldopa

Which antiparkinson drug is associated with more motor Complication eg Dyskinesia

Levodopa

State what to offer pts who develop Dyskinesia or motor fluctuations despite optimal levodopa

Offer a choice of non-ergotic DA agonist such as Pramipexole or Ropinirole, rotigotine or Rasagiline or Selegiline or COMT inhibitor entacapone or tolcapone as adjunct

State when to use an ergot derived Dopamine agonist as an adjunct therapy to tx dyskinesia

Only use if non ergot DA agonist are not adequate

Amantadine is indicatied for?

Used if dyskinesia is still not adequately managed by modifying existing therapy

State what drug is used to manage excessive day time sleepiness and sudden onset of sleep in PD

Modafinil Review tx every 12months Inform DVLA Advise pt not to drive

State what to use in the management of Nocturnal akinesia

Levodopa or oral dopamine receptor agonist(1st line) Rotigotine(2nd line)

What is nocturnal akinesia

Inability to turn in bed or rise to pass urine at night

What drug is used to tx postural hypotension in PD?

Midodrine HCL( ist line) Fludrocortisone (alternative)

What drug is used to tx psychotic symptoms?

Hallucinations and Delusion- no tx is needed if well tolerated

State when Quetiapine or Clozapine is used in tx psychotic symptoms in PD

It is used in pt with no cognitive impairment

What Antisychotics used in tx non motor symptoms of PD worsen the motor symptoms of Parkinson’s

Phenothiazines or butyrophenones

State the drug used to tx rapid eye movement sleep behaviour disorder in PD

Clonazepam or melatonin

Drug used to tx drooling saliva in PD

Only use if SALT is not available or Non effective Ist line- Glycopyrronium bromide (ist line) Botulinum toxin type A (2nd line)

Drug management of Parkinson’s disease dementia

Offer a cholinesterase inhibitor to pt with mild- moderate PD Offer Memantine if C.I is contraindicated

What's the drug management for advanced PD?

Offer apomorphine HCl injection or infusions Give Domperidone to counter N and V side effects from Apomorphine

Impulse control disorder can develop in Parkinson’s pt on Dopaminergic therapy. T/false

True

State how to manage impulse control disorder

Reduce dose of DA receptor agonist gradually and monitor withdrawal symptoms Offer CBT if dose reduction not effective

Important Safety advice for anti parkinsons drugs

Fibrotic runs Monitor for dyspnoea ( laboured breathing) ,persistent cough, chest pain, cardiac failure and abdominal pain (Bromocriptine, carbegoline ,pergolide) Impulse control disorder

Stopping parkinsons drug abruptly causes what ...

NMS - neuroleptic malignant syndrome; high fever, confusion, rigid muscle, sweating, fast Heart rate]

What is the drug of choice to tx N and V in PD?

Domperidone

State why Metoclopramide isn't used to tx N and V in PD

Increases EPSE, exacerbations PD and antagonises effect of Antiparkinson drug

State the appropriate time to tx n and V caused by apormorphine in PD

2 days before apormorphine tx and discontinue ASAP

Domperidone increases risk of QT prolongation when given with what drug?

Apomorphine It can cause serious Arrhythmia. Monitor ECG and cardiac risk factor

State the indication of COMT inhibitors

Use as adjunct to levodopa eg Tolcapone and Entacapone

What's the patient carer advice for Tolcapone?

Liver toxicity

Signs of liver toxicity for pts on Tolcapone

Anorexia, N and V, Fatigue, Abdominal pain, dark Urine or Pruritus develop

Pt and carer advise for Entacapone

May colour urine [ Reddish brown) label 14