Medical Management - Parkinson's Flashcards
medical management
primary importance in PD
PD is
dynamic dz
not a static presentation
what must we do w/ medical management
must constantly re-evaluate and change dosing and timing of meds
as the sxs change and the dx progresses
what does the pt experience w/ meds
changing response to meds and dz’s progression
medical management strategies
block acetylcholine
replace dopamine
block acetylcholine
anticholinergics
effective for tremor only
block acetylcholine –> S/E
confusion
decrease memory
hallucinations
dry mouth
constipation
urinary retention
orthostasis
replace dopamine
sinemet
amantadine
dopamine agonists
enzyme inhibitors
sinemet –> replace dopamine
L-dopa carbidopa
what are some sxs caused by
decreased dopamine
dopamine replacement therapy aimed at
replacing the deficient NT
does dopamine cross the BBB
no
but L-Dopa (its precursor) does
what is L-dopa delivered w/
carbidopa = sinemet
what does sinemet inhibit
the release of L-dopa in the peripheral tissue
what does sinemet do
increases its release into the brain
decreases the amount of L-dopa needed (cutting down the side effects)
sinemet (levadopa/carbidopa)limits
limits bradykinesia, rigidity and tremor
what doesnt levadopa/carbidopa treat
motor planning deficits
postural instability
non-motor sxs
what happens overtime –> levadopa/carbidopa
therapeutic windown gets smaller and toxic window gets bigger
S/E levadopa/carbidopa
dyskinesia
dystonia
on/off motor fluctuations
50-60% of pts on L-dopa
will have motor complications w/in 5 yrs
dopamine agonists
bromocriptine (parlodel)
pergolide (permax)
what happens when dopamine agonists and added to sinemet
decrease clinical fluctuations
what do dopamine agonists do
boosts output of remaining substantia nigra cells
neuroprotective drugs
MAOs
MAOs
monoamine oxidase inhibitors (MAOs)
what do MAOs control
neuronal degradation can be controlled w/ anti-oxidase
which controls the synthesis and elimination of free radicals
hypothesis –> MAOs
in PD –> there is increased production or decrease defense against free radicals in the SN
accelerating cell death
type of MAO
selegiline
selegiline
inhibits the enzyme that breaks down dopamine
what does selegiline limit
free radical production during dopamine metabolism
what must selegiline rescue
damaged but viable dopaminergic neurons
what may early use of selegiline do
decrease the need for sinemet
early in the course of the dz
what do anticholinergic drugs do
restore the balance of acetylcholine and dopamine
anticholinergic drugs
parsidol
cogentin
akinetin
artane
when are anticholinergic drugs used
less frequently than others
when is the use of anticholinergic drugs more useful
early in the dz
when tremor is the most prominent problem
amantadine has
dopaminergic and anticholinergic properties
what dos amantadine do
stimulates the release of dopamine
from surviving presynaptic terminals in the striatum
what does amantine affect
rigidity and bradykinesia
but not tremor
