parkinson's disease Flashcards
Parkinson’s disease
a progressive, degenerative disorder of basal ganglia function
characterized by tremor, rigidity, and bradykinesia
basal ganglia function
function with cerebellum to make smooth, coordinated movement
the substantia nigra in the basil ganglia has cells that produce dopamine
primary and secondary parkinson’s
primary
- idiopathic
- genetic or sporadic
secondary
- infection
- intoxication
- trauma
- drug-induced (antiemetics, antidepressants) - usually reversible
Parkinson’s disease risk factors
Age: after 40, peak in the 70s gender: men > women 3:2 genetics: both dominant and recessive Other risk factors in can develop earlier with: - anxiety/depression - head trauma - hysterectomy -coffee consumption (protective)
dopamine
inhibitory neurotransmitter
controls movement and balance
helps muscles work smoothly, controllably, & w/o unwanted movements
acetylcholine
excitatory neurotransmitter
works in conjunction with dopamine - balance is crucial
Primary parkinson’s
damage to dopamine producing cells
secondary parkinson’s
something has altered production of dopamine
clinical manifestations
bradykinesia cogwheel rigidity resting tremor (pill rolling) shuffling gait mask-like expression postural instability
classic triad of manifestations
tremor
rigidity
bradykinesia
gradual onset and progression
may only involve one side of body at first
tremor with parkinson’s
often the first sign handwriting affected more prominent at rest (improve with movement) aggravated by stress of concentration pill roll
bradykinesia
loss of automatic movements no blinking no swinging of arm while walking no swallowing of saliva (drooling) flat affect (lose ability to use facial muscles) overall lack of spontaneous movement
parkinson’s disease complications
dementia (Lewy bodies) depression/anxiety (lose independence) decreased mobility - malnutrition - aspiration - PNA - UTI's (urinary retention) - skin breakdown drug related complications
goal of pharmacotherapy
help pts maintain motor fx as long as possible and maintain independence
drugs either enhance dopamine or block ACh
levodopa/carbidopa
Sinemet
MOA: levodopa - converts to dopamine in the brain and activates dopamine receptors
carbidopa - blocks destruction of levodopa
most effective drug for PD
takes several months to see improvements
does not work long-term
adverse effects
Sinemet loss of effect
gradual loss of drug effect, varies with individual
dose wears off
may need shorter dose intervals
abrupt loss of effect on-off phenom can occur anytime during dosing interval when it's off, all sxs return "off" periods increase over time can be reduced with drugs and avoiding high PRO meals
levodopa adverse effects
N/V
- give low doses with food (not pro rich food)
Dyskinesias (80%)
- range from annoying to disabling (may have to switch meds)
Postural hypotension
Dysrhythmias
Psychosis (20%)
- hallucinations
- nightmares
- paranoia
Darken sweat and urine
Activate malignant melanoma
Sinemet interactions
decrease effects of levodopa
- B6 (pyridoxine)
- antipsychotics
- protein
increase effects of levodopa
- carbidopa
- anticholinergics
- MAOIs (can cause toxicity)
duopa
carbidopa-levodopa infusion (J tube)
continuous infusion for constant blood level (up to 16 hrs a day, can stop while sleeping)
used for pts who respond to drug but response fluctuates
- on-off phenom
- decreased effects
keeps more consistent levels of drug in body
duopa SEs
falling asleep without warning orthostatic hypotension hallucinations unusual urges depression dyskinesia r/t placement of tube
do not start this drug within 2 weeks of taking MAOI
pramipexole
Mirapex
dopamine receptor agonist
MOA: stimulates dopamine receptors
Uses:
monotherapy in early PD and younger pts
combined with Sinemet in advanced PD
restless leg syndrome
pramipexole
AEs
Nausea
sleep attacks
pathologic gambling and other compulsive behaviors
with levodopa:
profound orthostatic hypotension
dyskinesias
hallucination risk doubles
ropinirole
dopamine receptor agonist
idiopathic/primary PD
AEs similar to other PD drugs
with long term use may be an increased risk of DM and acromegaly
other dopamine agonists
rotigotine (Neupro)
- once daily patch
apomorphine (Apokyn)
- short acting subcut inj
- fast relief of sxs
- used in off phases of PD
