General info Flashcards
Pathophysiology
Progressive loss of dopaminergic neurones = dopamine deficiency in nigrostriatal pathway (which regulates body movements)
Motor symptoms
Hypokinesia
Bradykinesia
Rigidity
Rest tremor
Postural instability
Non-motor symptoms
Dementia
Depression
Sleep disturbances
Speech & language change
Swallowing problems
Weight loss
DVLA/insurance
Must notify the DVLA + car insurer
Withdrawal
Never abruptly withdraw
Can cause acute akinesia + neuroleptic malignant syndrome
Nausea + vomiting
Low dose domperidone
DO NOT give metoclopramide or prochlorperazine
Motor symptoms that decrease QoL
1st line = Levodopa (with carbidopa/benserazide)
Motor symptoms that do not affect QoL
Non-ergot derived dopamine receptor agonists
Levodopa (with carbidopa/benserazide)
MAO-B inhibitors
Adjuvant therapy for patients who have developed dyskinesia & motor fluctuations with levodopa
Non-ergot derived dopamine agonists
MAO-B inhibitors
COMT inhibitors
Amantadine
If dyskinesia not adequately managed by modifying therapy
Ergot-derived dopamine agonists
Inadequate response with non-ergot derived dopamine receptor agonists
Advanced parkinsons disease
- Apomorphine (SC intermittent injections/continuous infusion)
- Levodopa-carbidopa (intestinal gel)
- Deep brain stimulation
Apomorphine
Use - refractory motor fluctuations “OFF” episodes
SE:
- N + V (start domperidone 2 days before injection and stop ASAP)
- QT interval prolongation (apomorphine + domperidone both cause this = serious risk of arrhythmias).
MHRA advice = asses cardiac risk factors, monitor ECG + ensure benefits outweigh risk.
Levodopa-carbidopa (intestinal gel)
Advanced levodopa-responsive PD with severe motor fluctuations, hyperkinesia or dyskinesia)
Deep brain simulation
Symptoms are not adequately controlled with best drug treatment
