CNS Parkinsons Flashcards
Parkinsons alleviated by what?
Increasing amounts of dopamine
what are the 2 types of pts in parkinsons
- whose motor symptoms decrease QoL
- whose motor symptoms dont affect QoL
PARKINSONS DISEASE- FIRST-LINE TREATMENT
Motor symptoms decrease quality of life?
Levodopa + Carbidopa/Benserazide
eg co-careldopa / co-beneldopa
PARKINSONS DISEASE- FIRST-LINE TREATMENT
Motor symptoms do NOT decrease quality of life?
- Levodopa
- Non-ergot-derived dopamine-receptor (pramipexole, rotigotine)
- Monoamine-oxidase-B-inhibitors (rasagilin/selegiline)
examples of Non-ergot-derived dopamine-receptor agonists PR^2
pramipexole, rotigotine, ropinirole
examples of Monoamine-oxidase-B-inhibitors
rasagiline/selegiline
adverse reactions from antiparkinsonian drugs include what
psychotic symptoms, excessive sleepiness and sudden onset of sleep with dopamine-receptor agonists, and impulse control disorders with all dopaminergic therapy (especially dopamine-receptor agonists)
LEVODOPA
Whys is carbidopa/benserazide added?
Prevents breakdown of levodopa before it crosses into the brain
if levo given on its own, only 1% is used by body!
LEVODOPA- SIDE-EFFECTS?
Impulse disorders:
- gambling
- binge eating
- hypersexuality
Sudden onset of sleep (treat w/ modafinil)
Red urine
NON-ERGOT-DERIVED DOPAMINE RECEPTORS- PR^2
SIDE-EFFECTS?
Impulse disorders
Sudden onset of sleep
( same as levodopa but GREATER impulse control disorders)
Hypotension (postural-
treat w/ Midodrine->Fludrocortisone)
MONOAMINE-OXIDASE-B INHIBITORS
SIDE-EFFECTS?
Hypertensive crisis if given w/ phenylephrine/pseudoephedrine OTC
do not give these OTC with MAO-i. can cause hypertnesive crisis
MAO-i interact with which type of foods?
Tyramine-rich foods:
Mature cheese
Salami
Marmite
Yeast
Tofu
/Meat
Yeast Extract
Some beers/wines
mao-i interact with tyramine rich foods to cause a hypertensive crisis! why?
tyramine naturally increases BP and is broken down by the enzyme MAO.
so inhibitors will cause htn crisis
If patient develops dyskinesia (involuntary erratic writhing movements of face arms legs trunk) /motor fluctuations w/ optimal levodopa, WHAT DO YOU DO?
Add an adjuvant:
- Non-ergotic dopamine receptor agonist (NEDR-A)
- monoamine oxidase B inhibitor
- COMT inhibitor
name 2 COMT INHIBITORS
ET
ENTACAPONE/TOLCAPONE
SEs of COMT inhibitors
Entacapone- red-brown urine
Tolcapone- hepatotoxic
Increases sympathetic SE- increase in CVD events
(tachycardia, fast breathing..)
COMT inhibitors should be avoided in which pts
w CVD due to increased sympathetic SEs
What do you do if symptoms are not controlled with a NEDR-A as adjunct to levodopa?
Add EDR-A instead, w/ levodopa
ergot derived dopamine receptor agonist
ERGOT-DERIVED DOPAMINE RECEPTOR AGONISTS- 2 EXAMPLES?
BC
BROMOCRIPTINE/CABERGOLINE
ERGOT-DERIVED DOPAMINE RECEPTOR AGONISTS SEs
FIBROTIC REACTIONS!!!
Pulmonary reactions: SOB, chest pain, cough
Pericardial reactions: Chest pain
ANTI-PARKINSONS MEDS
Withdrawal associated?
yes, Do not withdraw medications abruptly
what are ‘off periods’ associated w anti-parkinsons meds and how to handle
Person has ‘off periods’ (med wearing off, no longer optimal) due to end of dose deterioration -> use MR prep. more consistent conc of drug in blood
ANTI-PARKINSONS MEDS
Nocturnal Akinesia-
1st line?
2nd line?
Nocturnal akinesia- treat with
1st line: levodopa/oral dopamine receptor agonist, i.e bromocriptine, cabergoline
2nd line: rotigotine
ANTI-PARKINSONS MEDS
How is hypotension treated? and how why does it work
Midodrine
sympathomimetic causes vasoconstriction, increasing arterial resistance thus increasing BP
ANTI-PARKINSONS MEDS
How is sudden onset of sleep treated?
Modafinil
more on bnf…