parkinson's disease Flashcards
what is parkinson’s disease
progressive neurodegenerative condition caused by degeneration of dopaminergic neurons in the substantia nigra
triad of features in parkinson’s
bradykinesia
tremor
rigidity
features of the tremor seen in parkinson
most marked at rest, 3-5Hz
worse when stressed, improves with voluntary movement
pill rolling
other characteristic features of parkinson’s disease
mask like facies
flexed posture
micrographia
drooling saliva
psych: depression, dementia, psychosis
impaired olfaction
REM sleep disorder
fatigue
postural hypotension
different features seen in drug-induced parkinsonism
motor symptoms generally rapid onset and bilateral
rigidity and rest tremor uncommon
first line treatment of parkinson’s disease
motor symptoms affecting quality of life: levodopa
if motor symptoms not affecting quality of life: dopamine agonist, levodopa or monoamine oxidase B inhibitor
what parkinson drug has the most specified adverse events
dopamine agonists
- excessive sleepiness, hallucinations, impulse control
second line management of parkinson’s disease if patients symptoms not managed or has developed dyskinesia
ADD
dopamine agonist
MAO-B inhibitor
catechol-O-methyl transferase inhibitor (COMT)
risk if medication is not taken/absorbed (gastroenteritis)
acute akinesia
neuroleptic malignant syndrome
important note with levodopa
combine with decarboxylase inhibitor (carbidopa or benserazide)
to prevent peripheral metabolism of levodopa to dopamine outside of the brain
adverse effects of levodopa
dry mouth
anorexia
palpitations
postural hypotension
psychosis
management of parkinson’s patient cannot take levodopa orally
dopamine agonist patch as rescue medication
examples of dopamine receptor agonists
bromocriptine
ropinirole
cabergoline
apomorphine
