PARKINSON'S: ADVANCED + OTHER SYMPTOMS Flashcards
Treatment of Advanced PD
- Apomorphine hydrochloride
- Given as an intermittent injection or Subcutaneous infusion
Or - Levodopa-carbidopa intestinal gel (DuoDopa)
- Administered with a portable pump directly into the duodenum
Apomorphine side effects
- N&V
- QT prolongation
- Hallucinations
- Yawning
What is given to help with the N&V side-
effect of
apomorphine?
Domperidone
Restricted in those weighing less than 35kg
What is the risk of using domperidone and apomorphine together?
Risk of QT prolongation
- assessment of cardiac risk factors,
- ECG monitoring to ensure that the benefits outweighs the risks when starting treatment
What other drugs may be helpful for tremor?
Antimuscarinics e.g.
procyclidine, orphenadrine, trihexyphenidyl
How do you reduce dyskinesia?
Decrease levodopa dose (as it is a side-effect of it)
- Add another adjuvant drug
How do you treat daytime sleepiness and sudden onset of sleep?
Review treatment
- Can give Modafinil (CNS stimulant)
- Patients should also inform DVLA
How do you treat depression as a symptom of Parkinson’s?
as normal
CBT
SSRI
How would you treat hallucinations as a result of side-effect of
Parkinson’s treatment?
Review Parkinson’s treatment, may need dose reduction
- Give Quetiapine (OR
Clozapine if standard therapy not effective)
- AVOID TYPICAL
ANTIPSYCHOTICS (can worsen motor features)
How would you treat rapid eye movement
(REM) sleep behaviour disorder in Parkinson’s?
- Clonazepam
- Melatonin
How would you treat drooling of saliva in Parkinson’s?
- SLT-
1. Glycopyrronium
2. Botulinum toxin type A
3. Other antimuscarnins e.g. hyoscine
How do you treat dementia associated with Parkinson’s?
- AChE
- Memantine, if AChE not tolerated ineffective
How would you treat postural hypotension in Parkinson’s?
Review current therapy
- Midodrine or Fludrocortisone to treat hypotension
How would you treat impulse control disorders in Parkinson’s?
More likely to occur with Dopamine agonists
- May need slow dose reduction
- Specialist CBT may be required if dose reduction not sufficient
N+V in PD
N&V not necessarily caused by parkinson’s
- If patient needs antiemetic, than AVOID
Metoclopramid
- Use Domperidone instead
