CNS: parkinsons and dementia Flashcards
What is 1st line in motor symptomsthat affect quality of life in PD?
Levodopa (+ carbidopa or benserezide)
What DA agonists should be not be used now and why?
Ergot derived DA agonists e.g. cabergoline, bromocriptine, pergolide- risk of fibrotic reactions (heart, lung, retroperitoneal) - MHRA warning
Name 5 s/e of levodopa
excessive sleepiness end of dose deterioration movement issues e.g. dyskinesa impulse control disorders red/brown urine
What is the advantage of using peripheral dopa-decarboxylase inhibitors with levodopa
no breakdown of l,dopa, can use lower doses
less CV and GI side effects
what is the risk if a patient misses levodopa?
Lack of control of symptoms
Neuroleptic malignant syndrome - fever, rigidity, consciousness reduced, creatine kinase incrased
Which PD drugs have higher risk of impulse disorders, sleepiness and hallucinations?
Non ergot derived DA agonists eg. .ropinirole, rotigtine, pamiprexole
what is the risk of using MOAB inhibitors
hypertensive crisis e.g. using tyramine rich foods, sympathomimetics incl otc decongestants
what is a risk of using selegiline (MAOB) in parkinsons
metabolised to amfetamine - risk - driving offence under drugs and driving legislation if caught under influence
What is a side effect of tolcapone in PD
Hepatotoxicity
Which anti-emetics are preferred in PD
Domperidone
ondansetron
Which medication is licensed for PD-associated dementia
Rivastigmine - caps and oral solution
Do you have to notify DVLA/car insurer when diagnosed with parkinsons
Yes
what drug is first line in mild to moderate dementia
donepezil
then galantamine and rivastigmine
What are side effects of acetylcholineserase inhibitors
cholinergic s/e - DUMB BELS diarrhoea urination muscle problems bronchospasm bradycardia emesis lacrimatiton salivation
What is a waning symptom of galantamine ?
RASH. - risk of SJS
