CNS - Parkinsons Flashcards
Treatment target for Parkinson’s ?
Increase dopamine levels
If motor symptoms decrease quality of life what should be used?
Levodopa + Carbidopa/Benserazide
(Co-caridopa )
If a patient’s motor symptoms do not affect quality of life?
- Levodopa
- Non-ergot derived dopamine receptor
- Monoamine oxidase B inhibitors (MAO B inhibitors)
Why is carbidopa/benzerazide added with levodopa?
Prevents breakdown before it crosses Blood brain barrier
(Only 1% absorbed otherwise)
Levodopa side effects?
- Pathological Gambling
- Binge eating
- Hypersexuality
- sudden onset of sleep
What colour urine does levodopa cause?
Red urine
Sudden onset of sleep from levodopa can be treated with?
Modafinil
What are non ergot derived dopamine receptors?
Pramipexole
Ropinirole
Rotigotine
Which drugs cause the most impulse disorders?
Non ergot derived dopamine receptors
Non ergot derived dopamine receptor side effects?
Impulse disorders
Sudden onset of sleep
Hypotension
Which are Moniamine oxidase B inhibitors?
Rasagline or Selegline
Which drugs should not be given with MAO-b inhibitors ??
- Phenylephrine
- Pseudoephedrine
Why can’t you give pseudoephedrine with rasagline?
Hypertensive crisis can occur!
Which drugs are COMT inhibitors?
Entacapone
Tolcapone
Pt with dyskinesia or motor fluctuations while being on optimal levodopa, next step?
Add either:
- Non ergot derived dopamine receptor
- MAO-B
- COMT inhibitors
Entacapone common symptom??
Red-brown urine
Tolcapone common side effect?
Hepatotoxic
Why should you avoid COMT inhibitors in CVD?
Increases sympathetic side effects eg tachycardia
Ergot derived dopamine receptor agonists?
Bromocriptine
Cabergoline
Bromocriptine / Cabergoline side effects?
Pulmonary effects ( SOB, cough, chest pain)
Pericardial Reactions: Chest pain
Why should you not withdraw meds abruptly in Parkinson’s?
Patient deteriorating
(Use mr preps before)
Nocturnal Akinesia treatment? (Loss of movement in limbs affecting sleep)
1st line : Levodopa or oral dopamine receptor agonist
2nd line: Rotigine
Hypotension in Parkinson’s treatment?
Midodrine
