CNS 6 Flashcards
What are motor neurone disease
Neurodegenerative condition which affects the brain and spinal cord
State the non drug tx for motor neurone disease
Nutrition, psychological support , physio, exercise , use of mobility aids and special equipment
What is the first line tx for managing muscular symptoms such as muscle cramp
Quinine (Unlicensed)
What is the second line tx for muscle cramp
Baclofen
State the other unlicensed tx for muscle cramp?
Tizanidine, dantrolene sodium or gabapentine( all.unlicensed used
What’s the tx for muscle stiffness?
Baclofen, tizanidine, gabapentine, dantrolene
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
Tx for thick tenacious saliva
Humidification, nebulizer or carbocysteine
Tx for respiratory symptoms
Breathlessness ( opiods) or benzodiazapine if symptoms Exacerbated by anxiety
Tx for amyotrophic lateral sclerosis aka motor neurone disease
Riluzole used as tx to extend life
What is Parkinson’s disease
Progressive neurodegenerative condition results from the death of dopamine cells of substantia nigra in the brain
What are eg of motor symptoms of PD
Hypokinesia( small movement)
Bradykinesia( slow movement)
Rigidity
Rest tremor
Postural instability
Non motor symptoms of PD
Dementia
Depression
Sleep disturbance
Bladder and bowel dysfunction
Speech and language changes
Swallowing problems
Weight loss
Inform DVLA and car insurers once diagnosis of PD confirmed . T/false?
True
Refer a pt with PD to a specialist and review every 6-12 months T/ F
True
Non- drug tx for PD
Physiotherapy
SLT
Occupational therapy
Dietitian
Eg of drugs used in PD
See photo Fav.
List the two main drug classes used to tx PD
Antimuscarinic and DA drugs
List eg of Antimuscarinic drugs used to tx PD
Procyclidine
Trihexyphenyl
Orphenadrine
DA drugs used in PD
Catechol-o- methyltransferase inhibitors eg Entacapone, opicapone, tolcapone)
List eg of Dopamine precursors used in PD
Co- beneldopa, co- careldopa) - more neurone complications
List eg of Dopamine receptor agonist used in PD
Amantadine, apomorphine, bromocriprine , carbergoline, pergolide, pramipexole , ropinirole and rotigotine
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
