PARKINSON'S DISEASE Flashcards
What is Parkinson’s Disease?
Chronic, progressive neurodegenerative condition due to the loss of dopaminergic neurons in the substantia nigra.
Dopamine deficiency in the basal ganglia leads to a movement disorder with parkinsonian motor symptoms
Motor symptoms of Parkinson’s Disease
o Hypokinesia
o Bradykinesia
o Rigidity
o Rest tremor
o Postural instability
Non-motor symptoms of Parkinson’s Disease
o Dementia
o Depression
o Sleep disturbances
o Bladder and bowel dysfunction
o Speech and language changes
o Swallowing problems
o Weight loss
Treatment of Parkinson’s disease for patients whose motor symptoms DECREASE their quality of life
- Levodopa + carbidopa/ benserazide
Treatment of Parkinson’s disease for patients whose motor symptoms DON’T AFFECT their quality of life
- Levodopa + adjunct
- Non-ergot derived dopamine-receptor
o Pramipexole
o Ropinirole
o Rotigotine - Monoamine-oxidase B inhibitors
o Seligiline
o Rasagiline
o Safinamide
Non-ergot derived dopamine-receptor agonist
o Pramipexole
o Ropinirole
o Rotigotine
Side effects of Non-ergot derived dopamine-receptor
Impulse disorders
Sudden onset of sleep
Hypotension (treated with midrodine or fludrocortisone)
Which PD medication is most likely to cause impulse disorders?
Non-ergot derived dopamine-receptor
What is hypotension in PD treated with?
midrodine or fludrocortisone
Monoamine-oxidase B inhibitors
o Seligiline
o Rasagiline
o Safinamide
o Seligiline
o Rasagiline
o Safinamide
Phenylephrine, pseudoephedrine = hypertensive crisis
What foods do Monoamine-oxidase B inhibitors interact with?
Interacts with tyramine rich food
* Mature cheese, salami, marmite, yeast, tofu
Treatment of Parkinson’s disease for patients who develop dyskinesia or motor fluctuations despite optimal levodopa therapy
- COMT inhibitors
Entacapone
Tolcapone
COMT inhibitors
Entacapone
Tolcapone
Side effects of entacapone
red brown urine
Side effects of tolcapone
hepatotoxic
increases sympathetic SFx increase in CD events
Treatment of Parkinson’s disease for patients
if symptoms are not adequately controlled with non-ergot derived dopamine receptor agonists as an adjunct
- Ergot-derived dopamine receptor agonist
o Bromocriptine
o Cabergoline
Ergot-derived dopamine receptor agonist
o Bromocriptine
o Cabergoline
Side effects of Ergot-derived dopamine receptor agonist
pulmonary reactions: report SOB, chest pain cough.
pericardial reactions: chest pain
Withdrawing medication in Parkinson’s Disease
- Do not withdraw medication abruptly
- If person has off periods due to end of dose deterioration – use MR preparations
- Treat nocturnal akinesia with levodopa or oral dopamine receptor agonists as first line option
Dopamine pathway
- Dopamine is unable to cross the BBB
- It is important to note that levodopa can be metabolised on either side of the BBB
- 90% of levodopa gets converted into dopamine in the intestinal wall by DDC
o So it is administered with a DDCI - SUCH AS carbidopa or benserazide in order to prevent metabolism until after it has crossed BBB
- 5% of levodopa is metabolised by plasma COMT
o COMT inhibitor
o Entacapone may be used as an adjunct
Levodopa side effects
- Impulse disorders
- Sudden onset of sleep
- Red urine
- Motor complication
- Dyskinesia
- Response fluctuation
Impulse disorders
o Pathological gambling
o Binge eating
o Hypersexuality
How is sudden onset of sleep treated?
modafinil - review every 12 months
o DVLA needs to be informed, pt advised not to drive
