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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
Q

Which COMT inhibitor is hepatotoxic?

A

Tolcapone

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24
Q

Which COMT inhibitor colours urine brown red?

A

Entacapone

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25
Q

What type of medicines may help with ‘end-of-dose’ deterioration or nocturnal immobility in PD patients?

A

MR tabs

26
Q

What drug is overall improvement in performance more noticeable in with for PD?

A

Levodopa

27
Q

Which PD drug has less motor complications in long term use?

A

dopamine-receptor agonists

28
Q

3 SE of dopamine receptor agonist compared to levodopa?

A

excessive sleepiness, hallucinations, and impulse control

29
Q

How to avoid potential acute akinesia or neuroleptic malignant syndrome in PD patients?

A

Ensure drug concentrations should NOT drop suddenly due to poor absorption or abrupt withdrawal.

30
Q

What to give is PD patient develops dyskinesia/ motor fluctuations even if on optimal levodopa?

A

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
Q

What is there a risk of for dopamine related medicines in the treatment of PD?

A

risk of addiction like symptoms due to - Dopamine dysregulation syndrome

32
Q

What is 1st line for treating nocturnal akinesia in patients with PD?

A

Levodopa or oral dopamine-receptor agonists

33
Q

What is 2ND line for treating nocturnal akinesia in patients with PD?

A

Rotigotine

34
Q

What drug is a potent dopamine receptor agonist which can cause QT prolongation

A

Apomorphine

35
Q

What is MOA of levodopa?

A

Increases dopa levels

Given with DDC inhibitor to ensure low dose given so less SE.

36
Q

What is 1st line indication of levodopa?

A

Parkinson’s disease (only if Quality of life effected)

37
Q

What are 3 SEs of co- careldopa? (MIS)

A

Motor complications

Impulse control disorders e.g. gambling, binge eating, hyper sexuality

Sudden sleep - cannot drive. (rare)

38
Q

What are the 2 motor complications linked to levodopa use?

A

Dyskinesia

Motor fluctuations - ONE- OFF + End of dose deterioration

39
Q

What 2 counselling points with levodopa?

A

Take meds at specific time -on an empty stomach so medicine gets absorbed more. (2 hours after eating).

40
Q

What is MOA of dopamine receptor agonist?

A

Stimulates post-synaptic D2 receptors.

41
Q

What is 1st line indication of dopamine receptor agonist?

A

Parkinson’s (if Quality of life is NOT affected)

42
Q

What are the 4 SEs of dopamine receptor agonists?

A

Impulse control disorders

Sudden onset of sleep

Psychotic symptoms e.g. hallucinations*

Hypotensive reaction*

42
Q

What is the MOA of MAO-B inhibitors?

A

Blocks monoamine oxidase B - prevents dopamine breakdown.

43
Q

What drugs interact with MAO-B inhibitors to cause increased hypertensive crisis?

A

Sympathomimetics- pseudoephedrine, phenylephrine, xylometazoline -OTC decongestants

B2 agonists, adrenaline, amphetamines + methylphenidate

44
Q

What drugs interact with MAO-B inhibitors to increase serotonin syndrome?

A

Anti-depressants, amphetamines, lithium, methadone, sumatriptan, Ondansetron

45
Q

What is MOA of COMT inhibitors?

A

Blocks catechol- O- methyltransferase- prevents levodopa + peripheral dopamine breakdown.

46
Q

What is indication of COMT inhibitors?

A

PD- adjunct to levodopa

47
Q

What are the 2 SE linked to COMT inhibitors?

A

Red urine

Hepatotoxicity

48
Q

What to give as 1st line in PD patients who develop Postural hypotension?

A

Midodrine hydrochloride

Alt- Fludrocortisone acetate

49
Q

What 3 drugs interacts with COMT inhibitors to increase CVD effects?

A

Adrenaline, noradrenaline, dopamine

50
Q

Drug for rapid eye movement sleep behaviour disorder in PD patients?

A

Clonazepam or melatonin (unlicensed)

51
Q

1st line drug tx for drooling of saliva in PD patients?

A

Glycopyrronium bromide

52
Q

2nd line drug tx for drooling of saliva in PD patients?

A

Botulinum Type A

53
Q

When is levodopa - carbidopa intestinal gel used in PD?

A

Tx of advanced levodopa-responsive PD with severe motor fluctuations + hyperkinesia or dyskinesia

54
Q

What drug can be considered in PD patients experiencing sudden sleepiness when taking meds?

A

Modafinil

55
Q

What is dystonia + causes?

A

Muscle spasm + abnormal posture due to abnormal muscle tone.

Can happen due to Cerebral palsy, neurotransmitter deficiency

56
Q

What is Segawa syndrome?

A

Deficiency in NT dopamine

57
Q

What DDC inhibitor is most commonly used in children?

A

Carbidopa - co-careldopa

58
Q

What 2 metabolic disorder can levodopa treat?

A

tetrahydrobiopterin synthesis + dihydrobiopterin reductase deficiency

59
Q

What 2 antimuscarinic drugs help reduce symptoms of dystonia?

A

procyclidine hydrochloride + trihexyphenidyl hydrochloride

60
Q

What anti-muscarinic drug can be given via IV and effective emergency treatment for acute drug- induced dystonic reactions?

A

Procyclidine Hydrochloride

61
Q

What benzo is given for life threatening drug-induced dystonic reactions?

A

IV diazepam

62
Q

What drug can improve motor tics + symptoms of Tourette’s syndrome?

A

haloperidol

63
Q

what beta blocker can be useful in treating tremor or tremor related anxiety?

A

Propranolol

64
Q

What 2 drugs to avoid in PD Patients?

A

Metoclopramide

Prochloraperazine

Both are antipsychotics

PRE-REG-Thuri (44 decks)

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