parkinson's Flashcards
`what drugs are used as neuroprotective therapies for parkinson’s
[2]
selegiline
coenzyme Q-10
which drugs are used for early symptomatic treatment of PD [3]
amantadine
benzhexol
selegiline
what drug is used for main symptomatic therapy
levodopa
levodopa MOA
dopamine precursor –> increase dopamine synthesis
levodopa is prepared with what class of drugs to prevent side effects d/t excess dopamine in PNS
peripheral decarboxylase inhibitors
what is sinemet
levodopa + carbidopa
what is madopar
levodopa + beserazide
levodopa S/E
short term: n&v, postural hypotension
long-term: motor fluctuation, dyskinesia
what drug is given to counter levodopa side effect of nausea & vomiting
domperidone
levodopa cautions
- most efficacious but dose should be kept to minimum
- wearing-off effect – beneficial effects wear off after few hours
1. take on empty stomach
2. adjust dose, increase frequency
3. ER formulation, additional PD meds
what drugs are given with levodopa to treat dyskinesia
amantadine (antiviral)
memantine
anticholinergics
side effects of amantadine / memantine [3]
ankle swelling
skin rashes
hallucinations
which drug is a COMT inhibitor
selegiline (Jumex)
COMT inhibitor MOA
inhibit monoamine oxidase B –> inhibit dopamine breakdown
COMT inhibitor uses
mild antiparkinson activity
delay nigral brain degeneration
efficacious as symptomatic monotherapy for early parkinsons
which drug delays nigral brain degeneration
selegiline
what is coenzyme Q-10
antioxidant, decrease rate of progression
what anticholinergics are given for PD
trihexyphenidyl (onset 60min)
benzhexol (onset 60min)
why are anticholinergics given for PD
- symptomatic monotherapy
- adjunct to levodopa to treat tremors & stiffness
anticholinergics side effects
dry mouth, urinary retention, constipation
sedation, confusion, hallucination, delirium, memory problems
dopamine agonists MOA
act on dopamine receptors in brain to reduce symptoms
dopamine agonists use
delay/prevent onset of motor complications
which has stronger antiparkinson effects, levodopa or dopamine agonists?
levodopa
which drugs are dopamine agonists? [4
bromocriptine (parlodel)
ropinirole (requip)
pramipexole (sifrol)
pergolide (celance, permax)
piribedil (trivastal retard)
are dopamine agonists used as monotherapy or adjunct to levodopa
both
side effects of dopamine agonists 7
n&v, postural hypotension, dyskinesia (same as levodopa)
hallucinations (esp elderly)
cardiac fibrosis (bromo, pergolide)
pedal edema
arrhythmia
restrictive valvular heart disease (pergolide)
ropinirole, pramipexole > somnolence
is levodopa or dopamine agonists preferred for younger patients?
dopamine agonists
what are the cardinal features of parkinson’s
resting tremor
rigidity
bradykinesia
gait abnormality
does parkinson’s usually present unilaterally or bilaterally?
unilateral progressing to bilateral
what is the main concern for patients with late parkinson’s
worsning postural instability leading to falls
what is an indicator that a patient does not have idiopathic parkinson’s
failure to respond clinically to large doses of levodopa
risk factors of parkinson’s (5)
old age
early onset dementia
fam hx
herbicide/pesticide, heavy metal exposure
repeated head trauma
diagnostic tests for parkinson’s
MRI brain/spine
PET (positron emission tomography)
SPECT (single photon emission computerised tomography)
hx, neurological assessment
rigidity most commonly affects flexors or extensors?
flexors
