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CNS > Movement Disorders and Parkinson's Disease > Flashcards

Movement Disorders and Parkinson's Disease Flashcards

1
Q

What’s Motor neurone disease?

A

Neurodegenerative condition which affects brain & spinal cord.

Degeneration of motor neurones

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2
Q

What are the symptoms of the degeneration of motor neurones - motor neurone disease?

A
  • Muscle weakness
  • Muscle cramps
  • Stiffness
  • Loss of dexterity
  • Reduced respiratory
  • Cognitive function

Refer all patients to neurologist without delay

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3
Q

What are some non drug treatments for Motor Neurone disease?

A
  • Nutrition
  • Psychosocial support
  • Physio
  • Exercise programmes
  • Use of mobility aids & special equipment
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4
Q

What drugs are used to manage the Muscular symptoms of Motor Neurone Disease?

A
  • Quinine
    It is the first line treatment for muscle cramps
  • Baclofen is 2nd line

Tizanidine, dantrolene sodium or gabapentin can be used as well but they are unlicensed for it.

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5
Q

What drugs are used to manage Muscular stiffness of Motor Neurone Disease?

A
  • Baclofen
  • Tizanidine
  • Dantrolene
    = Gabapentin

All unlicensed

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6
Q

What drugs are used to manage Saliva problems of Motor Neurone Disease?

A
  • Antimuscarinic drug (unlicensed)
  • Glycopyrronium bromide (for pts with cognitive impairment)

If ineffective, refer to specialist for botulinum toxin type A

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7
Q

What drugs are used to manage Thick tenacious salvia of Motor Neurone Disease?

A
  • Humidification (moisture)
  • Nebulisers
  • Carbocisteine
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8
Q

What drugs are used to manage respiratory symptoms of Motor Neurone Disease?

A

Breathlessness should be treated with opioids (unlicensed)
OR
If symptoms exacerbated by anxiety Benzodiazepines (unlicensed)

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9
Q

What drugs are used to manage Amyotrophic lateral sclerosis (motor nuerone disease)?

A

Riluzole - used to extend life.

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10
Q

What is Parkinson’s Disease?

A

A progressive neurodegenerative condition

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11
Q

What are examples of motor symptoms of Parkinsons?

A

Motor:
- Hypokinesia (small movements)
- Bradykinesia (slow movements)
- Rigidity
- Rest tremor
- Postural instability

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12
Q

What are examples of non-motor symptoms of Parkinsons?

A
  • Dementia
  • Depression
  • Sleep disturbances
  • Bladder & bowel dysfunction
  • Speech and language changes
  • Swallowing problems
  • Weight loss
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13
Q

Who must be alerted once Parkinson’s is diagnosed?

A

DVLA and Car insurer

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14
Q

How often must Parkinson’s be reviewed?

A

Every 6-12 months

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15
Q

What drugs are used to treat Parkinson’s disease?

A
  • Co-beneldopa
  • Co-carelodopa
  • Entacapone
  • Opicapone
  • Tolcapone
  • Amantadine
  • Rasagiline
  • Selegiline
  • Trihexyphenidyl
  • Pramipexole
  • Ropinirole
  • Rotigotine
  • Apomorphine
  • Bromocriptine
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16
Q

What are the two drug classes of Anti-parkinsons?

A
  1. Antimuscarinics
  2. Dopaminergic
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17
Q

Give examples of Antimuscarinics drugs?

A
  • Orphenadrine
  • Procyclidine
  • Trihexyphenidyl
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18
Q

What are the various groups of Dopaminergic drugs? With examples of each one?

A
  • Catechol-o-methyltransferase inhibitor
    (Entacapone, Opicapone, Tolcapone)
  • Dopamine precursors-Lovodopa
    (Co-beneldopa, co-careldopa)

Dopamine receptor agonists - mimic action of dopamine
(Amantadine, Apomorphine, Bromocriptine, Cabergoline, pergolide, pramipexole, Ropinirole, rotigotine)

Monoamine-oxidase B inhibitors
(Rasagiline, selegiline, safinamide)

19
Q

What is the drug treatment of Parkinsons?

A

1st Line - management of motor symptoms which decrease quality of life
- Co-careldopa
- Co-beneldopa

2nd Line - Management of motor symptoms which do not affect quality of life
-Levodopa
- Non ergot derived dopamine receptor agonists (pramipexole, ropinirole, rotigotine)
- Monoamine oxidase B inhibitors (rasagiline or selegiline)

20
Q

How is Parkinsons treatment stopped?

A

Gradually - to prevent side effects

21
Q

What patient & carer advice must be given with Parkinsons drug?

A

Inform patients on risk of adverse reactions including:
- Psychotic symptoms
- Sudden onset of sleep with dopamine agonists (pramipexole, ropinirole or rotigotine) - so caution with driving n operating machinery.

  • Impluse control disorders with dopaminergic therapy
    (pramipexole, ropinirole, rotigotine)
  • Hypotensive reactions (dizziness, headache etc). Esp in first few days of treatment.
  • Coloured urine but is harmless.

All these symptoms are less likely with levodopa but Levopda is associated with more motor complications like dyskinesia.

22
Q

What drugs make Co-careldopa and Co-beneldopa?

A

Co-careldopa = Levopoda + Carbidopa

Co-beneldopa = Levopda + Benserazide

23
Q

When should non-ergotic dopamine agonists be used?

A

When patients develop dyskinesia or motor fluctuations.

They should be given non-ergotic dopamine agonists along with levodopa.

24
Q

Examples of non-ergotic dopamine agonists?

A
  • Pramipexole
  • Ropinirole
  • Rotigotine
  • Monoamine oxidase B inhibitors (rasaligine or selegiline)
  • COMT inhibiotrs (entacapone or tolcapone)
25
Q

When can an ergot derived dopamine agonist be used? What are examples?

A

They should ONLY be considered as adjunct to levodopa if non-ergot is not adequate.

Ergot derived dopamine includes:
- Bromocriptine
- Cabergoline
- Pergolide

26
Q

When is Amantadine used?

A

Used if dyskinesia is still not adequately managed by modifying existing therapy

27
Q

What are the non-motor symptoms of Parkinsons?

A
  1. Excessive daytime sleepiness & sudden onset of sleep
  2. Nocturnal akinesia (inability to turn in bed or rise to pass urine at night
  3. Postural hypotension
  4. Depression
  5. Psychotic symptoms
  6. Rapid eye movement sleep behavior disorder
  7. Drooling saliva
  8. Parkinsons disease dementia
  9. Advanced parkinsons disease
  10. Impulse control disorders
28
Q

What drug should be given to manage excessive daytime sleepiness and sudden onset of sleep in Parkinsons disease?
How often should it be reviewed and what advice should be given?

A
  • Give modafinil
  • Review every 12 months
  • Advice pt not to drive, inform DVLA
29
Q

What drugs should be given to manage nocturnal akinesia in Parkinsons disease?

A

1st line:
- Levodopa or oral dopamine receptor agonist

2nd line:
- Rotigotine

30
Q

What drug should be given to manage postural hypotension in Parkinsons disease?

A
  • Midodrine hydrochloride (1st line)
  • Fludrocortisone (alternative)
31
Q

What should be done to manage depression in Parkinsons disease?

A
  • Refer to anti-depressant lecture
32
Q

What should be done to manage Psychotic symptoms in Parkinsons disease?

A
  • For hallucinations & delusions - if tolerated no treatment is needed but consider reducing the dose, but seek specialist advice first
  • Quetiapine can be used
  • Clozapine as an alternative
    BUT ONLY IN THOSE WITH NO COGNITIVE IMPAIRMENT
  • Other antipsychotics (phenothiazines & butylphenones) will worsen the motor symptoms of Parkinson’s
33
Q

What should be done to manage Rapid eye movement sleep behaviour disorder in Parkinsons disease?

A
  • Clonazepam
  • Melatonin
34
Q

What should be done to manage drooling saliva in Parkinsons disease?

A

Drug treatment should only be considered if non-drug treatment such as speech or language therapy is not available or ineffective

  • Glycopyrronium (1st line)
  • Botuliunum toxin type A (2nd line)
35
Q

What should be done to manage Parkinsons disease dementia in Parkinsons disease?

A
  • Offer a cholinesterase inhibitor (C.I) to patients with mild-to-moderate parkinsons
  • Offer memantine if C.I is contraindicated.
36
Q

What should be done to manage advanced parkinsons disease?

A
  • Offer apomorphine hydrochloride injections or infusions
  • Give domperidone to counter N&V side effects from apomorphine
37
Q

What should be done to manage Impulse control disorders in Parkinsons disease?
What are some examples of this?

A

Examples - compulsive gambling, binge eating, obbessive shopping

Can develop in patients doing dopaminergic therapy. Esp in those with a history of impulsive behaviours, alcohol consumption or smoking.

Reduce the dose of the dopamine receptor agonist gradually & monitor for any withdrawal symptoms.

If dose reduction is ineffective, offer CBT (Cognitive behavioural therapy)

38
Q

What is a side effect of anti-parkinsons drugs?

A
  • Fibrotic reactions.

Watch out for:
- Dysponea (laboured breathing)
- Persistent cough
- Chest pain
- Cardiac failure
- Abdo pain

39
Q

Which drugs cause abdominal pain?

A
  • Bromocriptine
  • Cabergoline
  • Pergolide
40
Q

Which drugs are dopaminergic therapy and cause impulse control disorders?

A
  • Levodopa
  • Apomorphine
  • Bromocriptine
  • Cabergoline
  • Pergolide
  • Pramipexole
  • Ropinirole
  • Rotigotine
41
Q

What are the rules for the stopping of Anti-parkinsons drugs?

A
  • Never stop abruptly or decrease dose suddenly as increases risk of Neuroleptic Malignant Syndrome (NMS).

If Nausea & Vomiting occurs, give DOMPERIDONE.
NEVER give metoclopramide as it causes EPSEs and it worsen the disease and reduce the effects of anti-parkinsons drugs.

42
Q

What are examples of Neuroleptic Malignant Syndrome (NMS) symptoms?

A
  • High fever
  • Confusion
  • Rigid muscles
  • Sweating
  • Fast HR
43
Q

What is the interaction and rule between Apomorphine and Domperidone?

A

Domperidone increases risk of QT prolongation when given with apomorphine - causes serious arrythmia.

But Apomorphine causes N&V and Domperidone treats it.

SO start domperidone 2 days before apomorphine treatment and discontinue asap.

44
Q

What are examples of COMT inhibitors and what advice must be given with them?

A

Tolcapone
- Causes liver toxicity.
- Advise pt to recognise signs (n&v, fatigue, anorexia, abdo pain, dark urine & pruritus)

Entacapone
- Advise may colour urine a reddish brown colour.

CNS (14 decks)

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