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Neurology > Parkinson disease > Flashcards

Parkinson disease Flashcards

1
Q

What are the side effects of MAOi?

A

Common: headache, nausea
Depression in some
Rare: hallucinations, confusion
Interactions with other serotinergic medications can be severe

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2
Q

Name 3 MAOi used in PD and their doses

A

Selegeline 5mg OD or BD
Rasagiline 1mg mane
Safinamide 50mg daily for 14 days then 100mg daily

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3
Q

Do medications improve:

  1. Motor symptoms?
  2. Balance?
A
  1. yes

2. no

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4
Q

What is the role of amantadine in PD?

What is the dose?

A

Used in mild PD as mono-therapy or adjunct where tremor is prominent symptom or dyskinesia
100mg BD or TDS

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5
Q

What are the drug classes used in PD?

A
  1. MAOi (type b)
  2. amantadine
  3. anticholinergics
  4. dopamine agonists
  5. dopamine replacement
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6
Q

What are the side effects of anticholinergics?

A
  1. Cognitive impairment
  2. Blurred vision
  3. Dry mouth
  4. Red itchy eyes
  5. Constipation
  6. Urinary retention
    Use with caution >65
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7
Q

Side-effects of amantadine (3)

A

livedo reticularis
confusion
nightmares

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8
Q

What are the dopamine agonists used and their dose? (4)

A

Cabergoline 5mg daily
Pramipexole up to 4.5 daily
Rotigitine up to 16mg (patch)
Ropinirole up to 1.5mg per day

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9
Q

What is punding? When does it occur?

A

Stereotyped, often purposeless behaviours
Such as assembling and disassembling
Occurs with short acting dopaminergics

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10
Q

What are risk factors for developing PD?

A

Age >60
M > F
Genetics
Pesticide and heavy metal exposure

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11
Q

What is the role for anticholinergics in PD?

What are 2 anticholinergics used?

A

For treatment of tremor as monotherapy or add-on

Trihexyphenydil, benztropine

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12
Q

What proportion of PD are over 65 years of age?

A

> 80%

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13
Q

What are the typical features of PD?

A
  1. tremor
  2. bradykinesia
  3. postural instability
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14
Q

What are the side effects of dopamine agonists?

A
  1. Nausea and vomiting
  2. Drowsiness
  3. Hallucinations
  4. Sedation
  5. Confusion
  6. Pedal oedema
  7. Orthostatic hypotension
  8. Compulsive behaviours
    Start low and slowly uptitrate
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15
Q

What is dopamine withdrawal syndrome?

A
  • Anxiety, panic attacks, depression, drug craving, fatigue, dizziness
    Occurs in the context of abrupt cessation of dopamine agonists or replacement
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16
Q

What therapeutics are used for moderate PD? (young vs old)

A

Young: dopamine agonists
Old: dopamine replacement

17
Q

Do treatments of PD slow the progression of disease?

A

No

18
Q

What is the classification system used to determine the severity of PD?

A

Heohn and Yahr

19
Q

What proportion of patients will have levodopa-related complications?

A

50%

20
Q

What are the diagnostic criteira for PD?

A

There are none, requires diagnosis by history, examination and response to medication

21
Q

What is dopamine dysregulation syndrome? How often does it occur?

A

Compulsive use of short active dopaminergics resulting in physical, social or occupational dysfunction.
4%

22
Q

How often does punding occur?

A

15%

23
Q

What are dyskinesias related to treatment in PD?

A

Involuntary movements of limbs or torso or head or neck
Dystonic or choreiform
Related to levodopa therapy

24
Q

Do dyskinesias occur with dopamine agonists?

A

No

25
Q

What are “biphasic” and “peak” dyskinesias?

A

Biphasic - when levodopa levels are rising or falling, causes dyskinesia in arms or legs
Peak - when levodopa at peak concentration and involves head and neck

26
Q

Where are DBS probes placed for PD? What are the indications?

A

Deep subthalamic neuclei or internal globus pallidus

Should have refractory symptoms and PD >5 years duration

Neurology (10 decks)

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