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Clinical Neuro - MS,AD,HD,PD > Medical Management of PD > Flashcards

Medical Management of PD Flashcards

1
Q

Medical Management Strategies for PD

A

Replace Dopamine

Block Acetylcholine

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2
Q

Dopamine Replacement Therapy

A

Sinemet: L-Dopa/Carbidopa
Amantadine
Dopamine agonists
Enzyme inhibitors

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3
Q

Anticholinergics and what does it affect

A

Block Ach

Effective for tremor only
S/E: confusion, ↓ memory, halluncinations, dry mouth, constipation, urinary retention, orthostasis

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4
Q

What do we have to be aware of with dopamine medication and working with our pts

A

their on and off times - they can make a chart

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5
Q

Dopamine is given with

A

carbidopa
Inhibits the release of L-Dopa in the peripheral tissue and ↑ its release into the brain
↓ the total amount of L-Dopa needed, cutting down on side effects
The combination is called Sinemet

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6
Q

Sinemet function

A

Limits bradykinesia, rigidity & tremor
Does not treat motor planning deficits, postural instability, or non-motor sx
Over time therapeutic window gets smaller and toxic window gets bigger
S/E: Dyskinesia, dystonia, on/off motor fluctuations
50-60% of pts on L-Dopa will have motor complications w/in 5 years

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7
Q

Dopamine agonists

A

Bromocriptine (Parlodel) and Pergolide (Permax)

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8
Q

When Dopamine agonists are added to Sinemet

A

it can ↓ clinical fluctuations

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9
Q

Dopaminergic Drugs work by

A

Boosting output of remaining substantia nigra cells

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10
Q

Neuroprotective Drugs:

A

MAOs

PD

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11
Q

MAOs work by

A

Monoamine Oxidase Inhibitors (MAOs)

Neuronal degradation can be controlled w/ anti-oxidants which control the synthesis & elimination of free radicals
Free radicals damage cells by stealing an electron from another cell to stabilize itself, thereby damaging the other cells

Hypothesis:
In PD, there is ↑ production or ↓ defense against free radicals in the SN, accelerating cell death

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12
Q

Selegiline (Eldepryl) is a type of and does

A

MAO

Inhibits the enzyme that breaks down dopamine
Limits free radical production during dopamine metabolism
May rescue damaged but viable dopaminergic neurons
Early use may ↓ the need for Sinemet early in the course of the disease

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13
Q

Anticholinergic Drugs work by, and drug ex

A

Improves sx of PD by restoring the balance of acetylcholine and dopamine
Parsidol, Cogentin, Akinetin, Artane

Used less frequently than others

More useful early in the disease when tremor is the most prominent problem

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14
Q

4 types of anticholinergic drugs

A

Parsidol, Cogentin, Akinetin, Artane

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15
Q

Amantadine is what type of drug and what does it do

A

Has dopaminergic and anticholinergic properties

Stimulates the release of dopamine from surviving presynaptic terminals in the striatum

Affects rigidity and bradykinesia, but not tremor

(for movement dependent)

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16
Q

Problems with Medical Management: Sinemet can cause

A 
Dyskinesia
Orthostatic hypotension
Behavioral signs
Confusion
Hallucinations
Paranoia
Psychosis
17
Q

Problems with Medical Management: On/Off phenomenon

A

Short duration therapeutic response followed by rapid decline in symptomatic relief
Due in fact that PD medications are toxic to the receptor site
Grows more dramatic over time
“On” time becomes shorter, with “off” time having dyskinesia or severe bradykinesia
“Narrowing therapeutic window”
“Wearing Off” Phenomenon
PT attempted ideally during “on” times

18
Q

Do all patients respond to Sinemet

A

Not all patients respond to Sinemet
1/3 respond for a lifetime
1/3 for 3-5 years
1/3 for 5-7 years

19
Q

What can help treat Hypertonia

A

Botox injections
Have been used in cases where the PD & dystonia have led to severe equinovarus or claw deformities

Effects are temporary!

20
Q

What is done if the medications are not very effective

A

Surgical Approaches

  • Ventrolateral thalamotomy
  • Pallidotomy
  • Intracranial Electrical Stimulation
21
Q

What is a Ventrolateral thalamotomy

A

Ventrolateral thalamotomy
Used for patients that have severe unilateral tremor which is refractory to medical treatment

(B) thalamotomy has been tried for patients with (B) tremor, but this resulted in severe speech deficits

22
Q

What is a Pallidotomy

A

Scarring of the globus pallidus

Has been useful against bradykinesia and tremor

23
Q

Intracranial Electrical Stimulation is

A

Experimental use of low level stimulators with promising results
More and more positive results are being published about Deep Brain Stimulation (DBS)

24
Q

What is Deep Brain Stimulation

A

Surgical placement of electrode into brain regions that control movement
Allows electrical stimulation to the area of altered brain activity
Normalizes pattern of electrical activity w/in specific brain motor circuits
Specific brain sites chose for specific problems
DBS on one side of brain mainly affects symptoms on the opposite side of the body – can have bilateral DBS if sx on both sides

25
Q

DBS Inclusion Criteria

A 
Dx of IPD
Response to L-Dopa
Medical therapy optimized or limited
Disabling tremor, dyskinesia, or motor fluctuations
No dementia or unstable co-morbid medical problems
Appropriate patient expectations
Adequate support & compliance
Tremor is the 10 symptom
26
Q

DBS Exclusion Criteria: absolute and relative

A 
Absolute:
Atypical parkinsonism
Lack of response to L-Dopa
Dementia
Unstable co-morbid conditions including behavioral problems
Relative:
Presence of other CNS dz or brain atrophy
Cognitive dysfn
Coagulapathies
Unrealistic expectations for outcome
27
Q

DBS Management

A

First programming is typically 1 month post implantation
Programming occurs every month until optimized
Annual maintenance checks required
Any magnetic field can switch off the DBS generator
MRI & diathermy are contraindicated post implantation

28
Q

Outcomes from having PD

A

PD is progressive, with death usually occurring due to secondary complications
Can be divided into:
Postural Instability/Gait Disturbed
Tremor Pre-dominant
Has a better prognosis, reflecting a slower progression of the destruction of the substantia nigra cells

29
Q

Recent Theories in Management

A

Fetal nigral or adult adrenal medulla transplants
Inconsistent and unpredictable success

Stem cells from umbilical cord blood or fetal cells – under research

30
Q

PT Interventions for PD

A 
Strengthening exercises
Stretching/ROM exercises
Breathing & relaxation exercises
Aerobic exercise
Motor learning
Gait Training
Balance Training
Functional Training
Adaptive & supportive devices
HEP
Patient/Caregiver education & training
31
Q

Patient Education and PD

A

Three things to tell your PD patients
PD is predictably unpredictable
Never say never
You are only as good as your general health
Don’t single out the PD and neglect other health problems

Three things to focus on
Physical well-being
Social & emotional well-being
Nutrition

Clinical Neuro - MS,AD,HD,PD (18 decks)

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