Parkinson's Disease Flashcards
Which neurotransmitter is deficient in Parksinson’s Disease?
Dopamine
What are the symptoms of Parkinson’s Disease
Motor Sx - hypokinesia, bradykinesia, rigidity, rest tremor and postural instability
Non-motor Sx - dementia, depression, sleep disturbances, bladder and bowel dysfunction, speech and language change, swallowing problems and weight loss
Name the drug classes that can be used to treat Parkinson’s Disease
Levodopa - + carbidopa (Sinemet) or + benserazide (Madopar)
Dopamine Receptor Agonists
- Non ergot dervied -> Pramipexole, ropinorole, rotigotine, amantadine (weak) and apomorphine
- Ergot dervied - bromocriptine, carbergoline and pergolide
MAO-B Inhibitors - selegiline and rasaligine
COMT Inhibitors - Entacapone and tolcapone
Which Parkinson’s med can colour urine reddish/brown
Which Parkinson’s med can stain urine orange
Entacopone - reddish/brown
Levodopa - Orange
Which drug is used to treat advanced PD - how is it given?
Apomorphine (SC intermettient or infusion)
- administer domperidone 2 days before and then discountinue ASAP as both can cause QT prolongation - arrhthymias (MHRA advice assessment and ECG monitoring, weigh up pros/cons)
- Levodopa intenstinal gel - severe Parkinson’s Sx
- Deep brain stimulation
What class of PD has a MHRA alert and what is it
Ergot-dervied dopamine agonists - fibrrotic reactions (retroperitoneal, pulmonary and pericardial)
Counselling for entacpone
- Can colour urine red/brown
- Avoid iron preps 2 hours before/after
Side effects of Levodopa
- Impulse control disorders
- Excessive sleeping, sudden onset of sleep
- Motor complications - dyskinseia and response fluctuations
- End of dose deterioation w shorter length of benefit (switch to MR)
DRA are associated with more X symptoms compared to levodopa
Motor
Side effects of DRA
- Impulse control disorders
- Excessive sleepiness and sudden onset of sleep
- Psychotic Sx
- Hypotensive reaction in first few days
Important intereactions of MAO-B Inhibitors
Hypertensive crisis
Pseudoephredine, phenylrphrine, xylometazoline, oxymetalozine (OTC preps: nose decongestants)
Adrenaline, NA, methylphenidate, amphetamines, b2 agonists - sympathomimetics (increase BP)
Interactions of COMT inhibitors
sympathomimetics - adrenaline, NA, MAOIs (tranlcypromapine)
What is used to treat day-time sleepiness - how often reviewed
(which group of people to avoid this drug in)
Modanifil - yearly
Pregnancy
Drug to treat rapid eye movement sleep behaviour disorder (RBD)
Clonazepam or melatonin
Drug to treat postural hypotension
Midodrine, fludrocortisone
Drug to treat dementia in PD
Rotigotine
Drooling of saliva PD
Glycopyrronium
specialis - botulinum toxin A
Dopamine agonists cause more what compared with levodopa?
Psychiatric side effects
Which antimuscarinic drug can be used to treat parkinson side effects of antipsychotics?
Procyclidine
If a patient who drives develops Parkinsons who do they need to inform?
DVLA
First line treatment for Parkinsons patients who’s motor symptoms affect their quality of life
Levodopa
First line treatment for Parkinsons patients who’s motor symptoms do NOT affect their quality of life
levodopa, non-ergot dervived dopamine agonists (e.g. Ropinorole, Pramipexole, Rotigotine) or MAOBi (rasagiline or Selegilline)
Why should abrupt withdrawal of Levodopa be avoided?
Neuroleptic malginant syndrome
