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3RD YEAR - Long Term Conditions/FOCP > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

How is Parkinson’s diagnosed?

A

Bradykinesia +1 of: - 4-6 Hz tremor - Mucular rigidity - Postural instability ASSYMETRICAL

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2
Q

If these symptoms are bilateral, how does this change the diagnosis?

A

More likely to be SECONDARY PARKINSONISM caused by drugs (e.g. neuroleptics, antiemetics), CVD, infections etc

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3
Q

Name some non-motor symptoms of parkinson

A
  • REM behaviour disorder (acting out dreams) and other sleep disorders - Reduction in olfactory function (ANOSMIA IN 90%!!!!) - Depression/anxiety/hallucinations - Parasthesia - Fatigue - Sexual dysfunction - Bladder dysfunction
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4
Q

If you see a patient with rapid onset parkinsonism and dementia, what is the most likely diagnosis?

A

Lewy Body Dementia

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5
Q

What is Parkinson’s Disease?

A

A progressive neurodegenerative disease with two main features: 1. Loss of pigmented dopaminergic neurons in the substantia nigra 2. Increase in Lewy Bodies

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6
Q

Name some other relevant motor features of PD

A

Dysphagia Dysarthria Hypersalivation Blurred vision Micrographia Dystonia Stooped posture Shuffling gate Freezing Festinant FALLS

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7
Q

What does festinant mean?

A

Having short stride and quickened gait

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8
Q

What is a parkinson plus syndrome?

A

A group of syndromes that exhibit the same symptoms as parkinsons but with additional features: - Multiple system atrophy - Corticobasal degeneration - Progressive supranuclear palsy

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9
Q

What are the typical pre-motor symptoms?

A
  • Impaired olfaction - REM behaviour disorder - Depression - Constipation
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10
Q

What imaging technique is used in parkinson diagnosis?

A

SPECT - measures loflupane (DaTSCAN) uptake in presynaptic dopamine transporters

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11
Q

What does a DaTSCAN look like in a PD patient?

A

More like .. than the usual “

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12
Q

What are the pros and cons of DaTSCANS?

A

PRO - high sensitivity and specificity CON - expensive

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13
Q

Describe the onset and progression of PD

A

Insidious onset (latent period can be up to 3 decades) Long clinical course (10-30 years) Incurable, decreased life expectancy

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14
Q

What are the four stages in the McMahon model of PD?

A

Diagnosis (1.6 years) Maintenance (5.9 years) Complex (4.9 years) Palliative (2.2 years)

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15
Q

Name the 7 classes of drugs used to treat PD?

A
  • L-dopa - Dopamine agonists - MAOB inhibitors - COMPT inhibitors - Amantadine - Anticholinergics - Oestrogen
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16
Q

Name two examples of L-Dopa with decarboxylase inhibitor

A

Madopar, Sinemet

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17
Q

Name two examples of MAOB inhibitors

A

Selegiline, Rasagiline

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18
Q

Name three examples of dopamine agonists

A

Ropinirole, Pramipexole, Rotigotine

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19
Q

How do L-Dopa and decarboxylase inhibitors work?

A

L-dopa is converted to dopamine in the brain

20
Q

How do COMT inhibitors work, and what is an example?

A

Entacapone They stop L-dopa from being converted to 3-0 methydopa (must be used alongside)

21
Q

How do MAOB inhibitors work?

A

They stop dopamine from being converted to its inactive metabolite

22
Q

Which of the drug treatments is best for symptom control?

A

L-dopa, however it has motor complications, unlike the others

23
Q

Why is L-Dopa used in older patients and dopamine agonists used in younger ones?

A

L-dopa is the best for symptomatic treatment but DAs are best in delaying onset of motor complications

24
Q

Which members of the MDT are involved in Parkinsons care?

A

PD nurse specialist, physiotherapy, occupational therapy, SALT, support groups

25
Q

What drug is primarily used in early PD?

A

MAOB inhibitors (best at stopping progression of disease, but not that good at symptom control)

26
Q

What medications should be stopped when prescribing for PD?

A

Dopamine-blocking agents: - Neuroleptics - Antiemetics - Sodium valproate - CCBs

27
Q

If a PD patient starts experiencing hallucinations from their meds, what can be given to them?

A

Quetiapine

28
Q

How does Amantadine work?

A

Stimulates release of dopamine

29
Q

What is the pharmacology of L-Dopa?

A
  • Absorbed from small bowel - Motor symptoms improve 20-70%
30
Q

What are the short term side effects of L-Dopa?

A

GI - nausea, vomiting, decreased appetite Psychiatric - confusion, hallucinations, delusions Cardiovascular - postural hypotension Sleep disorders - somnolence, insomnia, vivid drea nightmares

31
Q

What are the long term side effects of L-Dopa?

A

DYSKINESIAS - Abnormal involuntary movements RESPONSE FLUCTUATIONS - end-of-dose deterioration and unpredictable on/off switching PSYCHIATRIC - confusion, hallucinations

32
Q

What is the pharmacology of Dopamine agonists?

A
  • Act directly on D1/D2 postsynaptic receptors in the striatum
33
Q

Which dopamine agonists are administered by which routes?

A

Ropinirole - oral Rotigotine - transdermal Subcutaneous - apomorphine

34
Q

What are the side effects of dopamine agonists?

A
  • Nausea, vomiting, loss of appetite - Postural hypotension - Confusion, hallucinations - Somnolence - Impulse control disorders (hypersexuality, gambling etc)
35
Q

What is the pharmacology of MOAB inhibitors?

A
  • Irreversible inhibitors - Decrease dopamine breakdown so that there is more in the synaptic cleft NB - in practice these are rarely used alone as they have a weak clinical effect
36
Q

What are the side effects of MOAB inhibitors?

A

Nausea, vomiting, confusion

37
Q

What is an important drug interaction to be aware of in reference to MOAB inhibitors?

A

Interact with anti-depressants –> SEROTONIN SYNDROME

38
Q

What is the pharmacology of COMT inhibitors?

A

Inhibit COMT so that more levodopa is available to cross the BBB

39
Q

What are the side effects of COMT inhibitors?

A

Nausea, vomiting, confusion DIARRHOEA AND DISCOLOURATION OF BODY FLUIDS Increased dyskinesias

40
Q

What is the pharmacology of amantadine?

A

Antiviral, NMDA receptor antagonist causing increased release of dopamine

41
Q

When is amantadine used?

A

In the later stages of disease to treat dyskinesias (however do not use in the elderly as it causes confusion)

42
Q

What are the side effects of amantadine?

A
  • Confusion - Halluciantions, pscyhosis - Livedo reticularis (skin condition) - Ankle oedema
43
Q

What is the pharmacology of anticholinergics?

A

Decrease the effects of relative ACh excess, that occurs due to dopaminergic deficiency

44
Q

What are the side effects of anticholinergics?

A

Cognitive impairment Dry mouth, blurred vision, constipation, urinary retention, dizziness

45
Q

When are anticholinergics used?

A

In the young, to combat tremor

3RD YEAR - Long Term Conditions/FOCP (39 decks)

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