Parkinson's disease Flashcards
What is parkinsons disease?
= degenerative brain disorder affecting movement
- leading to gradual loss of muscle control
- Involves loss of dopaminergic neurons in the substantiar Niagara part of the brain
= abnormally low dopamine levels
Risk factors of PD
- Older age - due to acceleration of normal age related deterioration
- Oxidative damage –>
- environemntal factors
- genetic predisposition
- medications
What are the clinical characteristics of PD ?
Motor
- Tremor - shaking usually starts on one side of the body - Rigidity - Stiffness where the limbs feel like lead - Akinesia/bradykinesia - difficulty initiating movement and slowness - Postural instability - balance issues
Non motor
- mental/behavioural issues - Sense of smell - sweating and melanoma - gastrointestinal issues
What are the three types of parkinsons disease?
- Vascular parkinsonism
- Dementia with lew bodies
- drug induced parkinsonism
Pharmacogical treatment of PD?
Treatment is to provide symptomatic relief
- Levodopa/dopa decarboxylase inhibitors - Dopamine Agonists - monoamineoxidase type B Inhibitors - Anticholinergics `
non-pharmacological treatment of PD?
- Counselling and education
- information on drugs
- physical activity
- Physiotherapy
- Supportive care
Practice points of PD
- many medications interact with Parkinson’s medicines or may worsen Parkinson’s symptoms
- reduce dose gradually - abrupt withdrawal may lead to symptoms resembling the neuroleptic malignant symptoms
- supportive care vital in advanced PD
- avoid anti nausea and antipsychotics
MOA of Levodopa/dopa Decarboxylase inhibitors
= replace missing dopamine in brain
Adverse reactions of Levodopa/dopa Decarboxylase inhibitors
- nausea and vomiting
- postural hypotension
- cardiac arrhythmias
- constipation
- sudden sleep episodes
MOA of Dopamine agonists and examples
= stimulates dopamine receptors
- inhibit proflactin secretion
- mimic dopamine to increase dopamine levels
e. g. apomorphine
- pramipexole
Adverse reactions of dopamine agonists
- N & V
- Constipation
- Orthostatic hypotension
- Drowsiness
- fainting
- hallucinations/confusions
Interactions with dopamine agonists?
- sedatives
- metroclopramide
- antipsychotics
practice points of dopamine agonists
- effective first line drug
- improve bradykinesia and rigidity
- monitoring essential
MOA And examples of monoamine oxidase type B inhibitors (MOA-B)
= conserve dopamine by blocking MOA-B enzyme
- decrease breakdown of dopamine
- block dopamine reuptake
e.g. selegintine
Adverse reactions of MOA-B ?
- orthostatic hypotension
- dyskinesia
- insomnia
- nausea
