Movement Disorders Flashcards
What is Parkinson’s disease?
Progressive loss of dopaminergic neurones = dopamine deficiency in nigrostriatal pathway - regulates body movement
What are the symptoms of Parkinson’s disease?
Motor symptoms - hypokinesia, bradykinesia, rigidity, rest, tremor, postural instability
Non-motor symptoms - dementia, depression, sleep disturbances, speech and language changes swallowing problems, weight loss
Why should you never abruptly withdraw treatment for Parkinson’s?
Acute akinesia
Neuroleptic malignant syndrome
What do you treat nausea and vomiting with in Parkinson’s?
Domperidone
NOT metoclopramide
What are the levodopa drugs?
Co-beneldopa
Co-careldopa
Associated with more motor complications
What are the dopamine receptor agonists?
Bromocriptine
Carbergoline
Pergolide
Pramipexole
Ropinirole
Rotigotine
Amantadine
Apomorphine
What are the MAO-B inhibitors used in Parkinson’s to prevent degradation of dopamine?
Selegiline
Rasagiline
What are the COMT inhibitors that are used in Parkinson’s to prevent degradation of dopamine?
Entacapone
Tolcapone
What is the first line treatment for motor symptoms in Parkinson’s that decrease the quality of life?
Levodopa with carbidopa/benserazide
What is the first line treatment for motor symptoms in Parkinson’s that do not decrease the quality of life?
Levodopa
Non-ergot derived dopamine receptor agonists - pramipexole, ropinirole, rotigotine
MAO-B inhibitors
What is used in advanced Parkinson’s disease?
Apomorphine
What is apomorphine used for?
Advanced Parkinson’s disease
Refractory motor fluctuations episodes
What are the side effects of apomorphine?
Nausea and vomiting - start domperidone two days before treatment
QT interval prolongation - domperidone and apomorphine cause QT interval prolongation - risk of arrhythmias
What is the MHRA advice for apomorphine?
Assess cardiac risk factors, monitor ECG and ensure benefits outweigh risks when initiating treatment
What is the mechanism of action of levodopa?
Amino acid precursor of dopamine and acts by replenishing depleted dopamine levels in the brain
Do Parkinson’s medicines need to be taken at the same time of day?
Yes, I’m order to avoid off periods
What are the side effects of levodopa?
Impulse control disorders
Excessive sleepiness and sudden onset of sleep
Motor complications - dyskinesia, response fluctuation = large variations in motor performance
End of dose deterioration with shorter length of benefit
What is the mechanism of action of dopamine receptor agonists?
Direct action on dopamine D2 receptors in striatum
What are the non-ergot derived DRAs?
Pramipexole
Ropinirole
Rotigotine
What are the ergot derived DRAs?
Bromocriptine
Cabergoline
Pergolide
What are the side effects of ergot derived DRAs?
Fibrotic reactions
Pulmonary
Retroperitoneal
Pericardial
What are the other DRAs?
Apomorphine
Amantadine
What are the side effects of DRAs?
Impulse control disorders
Excessive sleepiness and sudden onset of sleep
Psychotic symptoms
Hypotension reaction in first few days
What is the mechanism of action of the MAO-B inhibitors?
Inhibits monoamine oxidase B enzymes which are responsible for the breakdown of monoamines, dopamine
What are the MAO-B inhibitors?
Rasagiline
Selegiline - metabolised to amfetamine, driving offences
What are the interactions with the MAO-B inhibitors that cause hypertensive crises?
Pseudoephedrine Phenylephrine Xylometazoline Oxymetazoline Adrenaline Noradrenaline Methylphenidate Amohetamines B2 agonists
What is the mechanism of action of the COMT inhibitors?
Prevents the peripheral breakdown of levodopa, by inhibiting catechol-o-methyltransferase, allowing more levodopa to reach the brain
Use as an adjunct to levodopa
What are the COMT inhibitors?
Entacapone - urine red/brown
Tolcapone - hepatotoxicity
What are the counselling points for COMT inhibitors?
Report signs of liver toxicity
What are the interactions with the COMT inhibitors that increase the cardiovascular effects?
Adrenaline
Noradrenaline
MAOIs
