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PRE-REG-Thuri > NERVOUS SYSTEM- PARKINSON'S DISEASE > Flashcards

NERVOUS SYSTEM- PARKINSON'S DISEASE Flashcards

1
Q

What is Parkinson’s disease?

A

Loss of dopaminergic neurones in nigrostriatal pathway.

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2
Q

What 2 categories are PD symptoms split into?

A

Motor

Non-motor

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3
Q

What are 5 Motor symptoms of PD?

A

Tremors

Hypokinesia (reduced motor activity)

Bradykinesia (slow movements)

Rigidity

Postural instability

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4
Q

List 7 non-motor symptoms associated with PD?

A

Dementia

Depression

Sleep problems

Speech + language changes

Swallowing problems

Weight loss

Bladder + bowel dysfunction

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5
Q

What is 1st line drug treatment for PD if motor symptoms affects QOL?

A

Levodopa with carbidopa/ benserazide

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6
Q

What is 1st line drug treatment for PD if motor symptoms DON’T affect QOL?

A

A choice of levodopa

OR

non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine)

OR

MAO-B inhibitors

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7
Q

List 2 examples of MAO-B inhibitors

A

(rasagiline

selegiline hydrochloride).

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8
Q

3 examples of non-ergot-derived dopamine-receptor agonists?

A

pramipexole, ropinirole or rotigotine

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9
Q

Which drug is linked to motor complications?

A

Levodopa

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10
Q

What 3 drugs are better in treating motor complications in PD?

A

MAO-B inhibitor

COMT inhibitor

Dopamine receptor agonist.

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11
Q

What is used for N + V in PD patients?

A

Domperidone - does not cross BBB + block dopamine receptors

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12
Q

What are 2 risks of abrupt withdrawal of PD drugs?

A

Neuroleptic malignant syndrome

Acute akinesia (freezing mid-action)

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13
Q

What are the 4 classes of dopaminergic drugs?

A

Levodopa

Dopamine receptor agonist

MAO-B inhibitor

COMT inhibitor

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14
Q

What are the 2 forms of levodopa?

A

Co-beneldopa (levodopa + benserazide)

Co-careldopa (levodopa + carbidopa)

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14
Q

what is levodopa given with + why?

A

Dopa- decarboxylase inhibitor

Prevents levodopa being broke down before it reaches brain.

Can allow us to use lower dose so less SE/ N+ V

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15
Q

What are benserazide + carbidopa?

A

DDC inhibitors - stops the levodopa breaking down before it gets to reach the brain.

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16
Q

What 2 categories are dopamine- receptor agonists?

A

ergot derived

non-ergot derived

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16
Q

List 3 ergot derived dopamine receptor agonists?

A

Bromocriptine

Cabergoline

Pergolide

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17
Q

What does Selegiline metabolise into + why is it bad?

A

metabolises into amphetamine (affects concentration when driving.

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18
Q

What SE is seen in ergot derived dopamine receptor agonists?

A

Cardio- fibrotic reactions

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19
Q

When should ergot-derived dopamine-receptor agonist be considered in PD?

A

In combo with levodopa if symptoms NOT controlled with non-ergot derived dopamine agonist.

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20
Q

List 1 weak dopamine-receptor agonist?

A

Amantadine

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21
Q

List 3 non-ergot-derived dopamine receptor agonists?

A

Pramipexole

Ropinirole

Rotigotine

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22
Q

List 3 COMT inhibitors?

A

Entacapone

Opicapone

Tolcapone

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23
Which COMT inhibitor is hepatotoxic?
Tolcapone
24
Which COMT inhibitor colours urine brown red?
Entacapone
25
What type of medicines may help with ‘end-of-dose’ deterioration or nocturnal immobility in PD patients?
MR tabs
26
What drug is overall improvement in performance more noticeable in with for PD?
Levodopa
27
Which PD drug has less motor complications in long term use?
dopamine-receptor agonists
28
3 SE of dopamine receptor agonist compared to levodopa?
excessive sleepiness, hallucinations, and impulse control
29
How to avoid potential acute akinesia or neuroleptic malignant syndrome in PD patients?
Ensure drug concentrations should NOT drop suddenly due to poor absorption or abrupt withdrawal.
30
What to give is PD patient develops dyskinesia/ motor fluctuations even if on optimal levodopa?
offered a choice of non-ergotic dopamine-receptor agonists (pramipexole, ropinirole, rotigotine), monoamine oxidase B inhibitors (rasagiline or selegiline hydrochloride) COMT inhibitors (entacapone or tolcapone) as an adjunct to levodopa.
31
What is there a risk of for dopamine related medicines in the treatment of PD?
risk of addiction like symptoms due to - Dopamine dysregulation syndrome
32
What is 1st line for treating nocturnal akinesia in patients with PD?
Levodopa or oral dopamine-receptor agonists
33
What is 2ND line for treating nocturnal akinesia in patients with PD?
Rotigotine
34
What drug is a potent dopamine receptor agonist which can cause QT prolongation
Apomorphine
35
What is MOA of levodopa?
Increases dopa levels Given with DDC inhibitor to ensure low dose given so less SE.
36
What is 1st line indication of levodopa?
Parkinson's disease (only if Quality of life effected)
37
What are 3 SEs of co- careldopa? (MIS)
Motor complications Impulse control disorders e.g. gambling, binge eating, hyper sexuality Sudden sleep - cannot drive. (rare)
38
What are the 2 motor complications linked to levodopa use?
Dyskinesia Motor fluctuations - ONE- OFF + End of dose deterioration
39
What 2 counselling points with levodopa?
Take meds at specific time -on an empty stomach so medicine gets absorbed more. (2 hours after eating).
40
What is MOA of dopamine receptor agonist?
Stimulates post-synaptic D2 receptors.
41
What is 1st line indication of dopamine receptor agonist?
Parkinson's (if Quality of life is NOT affected)
42
What are the 4 SEs of dopamine receptor agonists?
Impulse control disorders Sudden onset of sleep Psychotic symptoms e.g. hallucinations* Hypotensive reaction*
42
What is the MOA of MAO-B inhibitors?
Blocks monoamine oxidase B - prevents dopamine breakdown.
43
What drugs interact with MAO-B inhibitors to cause increased hypertensive crisis?
Sympathomimetics- pseudoephedrine, phenylephrine, xylometazoline -OTC decongestants B2 agonists, adrenaline, amphetamines + methylphenidate
44
What drugs interact with MAO-B inhibitors to increase serotonin syndrome?
Anti-depressants, amphetamines, lithium, methadone, sumatriptan, Ondansetron
45
What is MOA of COMT inhibitors?
Blocks catechol- O- methyltransferase- prevents levodopa + peripheral dopamine breakdown.
46
What is indication of COMT inhibitors?
PD- adjunct to levodopa
47
What are the 2 SE linked to COMT inhibitors?
Red urine Hepatotoxicity
48
What to give as 1st line in PD patients who develop Postural hypotension?
Midodrine hydrochloride Alt- Fludrocortisone acetate
49
What 3 drugs interacts with COMT inhibitors to increase CVD effects?
Adrenaline, noradrenaline, dopamine
50
Drug for rapid eye movement sleep behaviour disorder in PD patients?
Clonazepam or melatonin (unlicensed)
51
1st line drug tx for drooling of saliva in PD patients?
Glycopyrronium bromide
52
2nd line drug tx for drooling of saliva in PD patients?
Botulinum Type A
53
When is levodopa - carbidopa intestinal gel used in PD?
Tx of advanced levodopa-responsive PD with severe motor fluctuations + hyperkinesia or dyskinesia
54
What drug can be considered in PD patients experiencing sudden sleepiness when taking meds?
Modafinil
55
What is dystonia + causes?
Muscle spasm + abnormal posture due to abnormal muscle tone. Can happen due to Cerebral palsy, neurotransmitter deficiency
56
What is Segawa syndrome?
Deficiency in NT dopamine
57
What DDC inhibitor is most commonly used in children?
Carbidopa - co-careldopa
58
What 2 metabolic disorder can levodopa treat?
tetrahydrobiopterin synthesis + dihydrobiopterin reductase deficiency
59
What 2 antimuscarinic drugs help reduce symptoms of dystonia?
procyclidine hydrochloride + trihexyphenidyl hydrochloride
60
What anti-muscarinic drug can be given via IV and effective emergency treatment for acute drug- induced dystonic reactions?
Procyclidine Hydrochloride
61
What benzo is given for life threatening drug-induced dystonic reactions?
IV diazepam
62
What drug can improve motor tics + symptoms of Tourette's syndrome?
haloperidol
63
what beta blocker can be useful in treating tremor or tremor related anxiety?
Propranolol
64
What 2 drugs to avoid in PD Patients?
Metoclopramide Prochloraperazine Both are antipsychotics

PRE-REG-Thuri (44 decks)

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