Drug management of non-motor symptoms in Parkinson's disease Flashcards
How should daytime sleepiness and sudden onset of sleep be managed in PD?
1) Parkinson’s drug treatment should be adjusted under specialist to see if this helps
2) Modafinil should be considered to treat excessive daytime sleepiness- Reviewed at least every 12 months.
what advice should be given to patients who have have daytime sleepiness or sudden onset of sleep as a result of PD?
1) Do not drive and inform DVLA about their symptoms
2) Think about any occupational hazards
How is nocturnal akinesia treated in PD?
inability to turn in bed and difficulty in rising to pass urine during the night
1) First-line: Levodopa or oral dopamine-receptor agonists 2) Rotigotine as second-line (if both of the above fail)
how should patients with PD who develop postural hypotension be managed?
1) Review treatment to address any pharmacological cause
2) If therapy is required: Midodrine is first line and fludrocortisone is as an alternative.
How should psychotic symptoms such as hallucinations and delusions be managed in those with PD?
1) Need not be treat if symptoms are well tolerated Otherwise review dosage of any antiparkinsonism drugs that might have triggered these side effects
2) In patients with no cognitive impairment, quetiapine can be considered to treat hallucinations and delusions
3) If quetiapine ineffective consider clozapine
what drugs should be used to manage rapid eye movement sleep behaviour disorder in PD?
Clonazepam or melatonin
Drug treatment for drooling of saliva in PD should only be considered if non-drug options e.g. SALT are not available or ineffective. What drugs can be considered if this is the case?
1) First line: Glycopyrronium bromide
2) Second line: Botulinum toxin type A
Outline the treatment options for those with mild-to-moderate Parkinson’s disease dementia
1) An acetylcholinesterase inhibitor- Rivastigmine is licenced for mild-to-moderate dementia in PD
2) If acetylcholinesterase inhibitors are not tolerated or C/I consider Memantine
what treatment can patients with advanced PD be offered?
Apomorphine as intermittent injections or continuous subcutaneous infusions
what should be administered to control nausea and vomiting associated with apomorphine?
domperidone is usually started two days before apomorphine therapy, and then discontinued as soon as possible.
When used together, domperidone and apomorphine can increase the risk of serious arrhythmia due to QT prolongation. How does the MHRA advise this should be managed?
Assessment of cardiac risk factors and ECG monitoring
Impulse control disorders can develop in a person with Parkinson’s disease who is on any dopaminergic therapy at any stage in the disease. which patients are especially at risk?
1) History of previous impulsive behaviours
2) Alcohol consumption
3) Smoking
How should problematic impulse control disorders be
managed in PD?
Dopamine-receptor agonist therapy may be reduced or stopped. Doses should be reduced gradually and patients should be monitored for symptoms of dopamine agonist withdrawal.
