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Pre-reg Exam 2021 > Movement Disorders > Flashcards

Movement Disorders Flashcards

1
Q

What is Parkinson’s disease?

A

Progressive loss of dopaminergic neurones = dopamine deficiency in nigrostriatal pathway - regulates body movement

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2
Q

What are the symptoms of Parkinson’s disease?

A

Motor symptoms - hypokinesia, bradykinesia, rigidity, rest, tremor, postural instability

Non-motor symptoms - dementia, depression, sleep disturbances, speech and language changes swallowing problems, weight loss

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3
Q

Why should you never abruptly withdraw treatment for Parkinson’s?

A

Acute akinesia

Neuroleptic malignant syndrome

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4
Q

What do you treat nausea and vomiting with in Parkinson’s?

A

Domperidone

NOT metoclopramide

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5
Q

What are the levodopa drugs?

A

Co-beneldopa
Co-careldopa

Associated with more motor complications

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6
Q

What are the dopamine receptor agonists?

A

Bromocriptine
Carbergoline
Pergolide

Pramipexole
Ropinirole
Rotigotine

Amantadine
Apomorphine

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7
Q

What are the MAO-B inhibitors used in Parkinson’s to prevent degradation of dopamine?

A

Selegiline

Rasagiline

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8
Q

What are the COMT inhibitors that are used in Parkinson’s to prevent degradation of dopamine?

A

Entacapone

Tolcapone

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9
Q

What is the first line treatment for motor symptoms in Parkinson’s that decrease the quality of life?

A

Levodopa with carbidopa/benserazide

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10
Q

What is the first line treatment for motor symptoms in Parkinson’s that do not decrease the quality of life?

A

Levodopa
Non-ergot derived dopamine receptor agonists - pramipexole, ropinirole, rotigotine
MAO-B inhibitors

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11
Q

What is used in advanced Parkinson’s disease?

A

Apomorphine

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12
Q

What is apomorphine used for?

A

Advanced Parkinson’s disease

Refractory motor fluctuations episodes

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13
Q

What are the side effects of apomorphine?

A

Nausea and vomiting - start domperidone two days before treatment

QT interval prolongation - domperidone and apomorphine cause QT interval prolongation - risk of arrhythmias

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14
Q

What is the MHRA advice for apomorphine?

A

Assess cardiac risk factors, monitor ECG and ensure benefits outweigh risks when initiating treatment

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15
Q

What is the mechanism of action of levodopa?

A

Amino acid precursor of dopamine and acts by replenishing depleted dopamine levels in the brain

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16
Q

Do Parkinson’s medicines need to be taken at the same time of day?

A

Yes, I’m order to avoid off periods

17
Q

What are the side effects of levodopa?

A

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

18
Q

What is the mechanism of action of dopamine receptor agonists?

A

Direct action on dopamine D2 receptors in striatum

19
Q

What are the non-ergot derived DRAs?

A

Pramipexole
Ropinirole
Rotigotine

20
Q

What are the ergot derived DRAs?

A

Bromocriptine
Cabergoline
Pergolide

21
Q

What are the side effects of ergot derived DRAs?

A

Fibrotic reactions
Pulmonary
Retroperitoneal
Pericardial

22
Q

What are the other DRAs?

A

Apomorphine

Amantadine

23
Q

What are the side effects of DRAs?

A

Impulse control disorders
Excessive sleepiness and sudden onset of sleep
Psychotic symptoms
Hypotension reaction in first few days

24
Q

What is the mechanism of action of the MAO-B inhibitors?

A

Inhibits monoamine oxidase B enzymes which are responsible for the breakdown of monoamines, dopamine

25
Q

What are the MAO-B inhibitors?

A

Rasagiline

Selegiline - metabolised to amfetamine, driving offences

26
Q

What are the interactions with the MAO-B inhibitors that cause hypertensive crises?

A 
Pseudoephedrine
Phenylephrine
Xylometazoline
Oxymetazoline
Adrenaline
Noradrenaline
Methylphenidate 
Amohetamines
B2 agonists
27
Q

What is the mechanism of action of the COMT inhibitors?

A

Prevents the peripheral breakdown of levodopa, by inhibiting catechol-o-methyltransferase, allowing more levodopa to reach the brain

Use as an adjunct to levodopa

28
Q

What are the COMT inhibitors?

A

Entacapone - urine red/brown

Tolcapone - hepatotoxicity

29
Q

What are the counselling points for COMT inhibitors?

A

Report signs of liver toxicity

30
Q

What are the interactions with the COMT inhibitors that increase the cardiovascular effects?

A

Adrenaline
Noradrenaline
MAOIs

Pre-reg Exam 2021 (79 decks)

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