Dementia and Parkinson's disease Flashcards
First line drug class in mild to moderate Alzheimer’s disease is _______
AChE inhibitors - donepezil, galantamine and rivastigmine
True or false: AChE inhibitors can cause syncope
TRUE - they may also cause GI discomfort, arrhythmias and urinary incontinence.
Serious skin reactions like Stevens-Johnson’s syndrome can occur with which Alzheimer’s drug ?
Galantamine
Mechanism of action of Memantine
Glutamate receptor antagonist
2nd line treatment
True or false: Benzodiazepines should be avoided in dementia patients
FALSE - they can be used to treat aggression and agitation
Why are dopamine decarboxylase inhibitors combined with L-dopa in Parkinson’s treatment ?
Peripheral decarboxylation of dopamine causes side effects e.g. postural hypotension, tachycardia and nausea
True or false: Dopamine antagonists are better at controlling motor symptoms than levodopa
FALSE
Ldopa is better at controlling motor symptoms in Parkinson’s.
Pramipexole, ropinirole and rotigotine are examples of ________ DA agonists
Non-ergot derivative
Ergot-derivatives e.g. bromocriptine are not recommended by NICE
Impulse control disorders can be a side effect of ______
Dopamine agonists
Includes binge eating, hypersexuality, pathological gambling etc
When is apomorphine indicated in Parkinson’s disease?
In advanced disease for unpredictable “off periods”
Selegeline and rasagiline are examples of which type of antiparkinsonian drug?
Monoamine oxidase B inhibitor (MAOB-i)
Entacapone is a COMT inhibitor. How does it work
Prevents the peripheral breakdown of L-dopa. Allows more to enter the brain
True or false: antimuscarinic drugs are safe to use in dementia patients
FALSE
They should be avoided as they may increase cognitive impairment
True or false: vascular dementia can be managed with AChE inhibitors or Memantine
FALSE
These drugs should only be used if the patient has co-morbid Alzheimer’s, Parkinson’s dementia or Lewy body dementia
Which AChE inhibitors are first line (unlicensed) for Dementia with Lewy Bodies ?
Donepezil or Rivastigmine
Galantamine only if the above are not tolerated
Memantine only if all AChE inhibitors are contraindicated or not tolerated
Drug used to manage daytime sleepiness in Parkinson’s disease
Modafinil
Drug used to treat postural hypotension associated with Parkinson’s disease ?
Midodrine
Fludrocortisone as an alternative but this us unlicensed
Which AChE inhibitor is licensed for the treatment of dementia associated with Parkinson’s disease
Rivastigmine
What class of drug is apomorphine
A DA receptor agonist. Specialist use only
What are the non-ergot derived DA agonists
4 points
Pramipexole
Rotigotine
Ropinirole
Apomorphine
Bromocriptine and Cabergoline are examples of what class of drug
(ergot derived) DA agonists
Which antipsychotic is used 1st line for psychosis in Parkinson’s disease
Quetiapine
2nd line clozapine
Why are ergot derived DA agonists not used very often
They are associated with fibrotic reactions eg in the lungs and heart
Levodopa preparations colour the urine what colour
Red/brown
