Parkinson's Disease Flashcards
Do you have to refer to neurologist before starting medication?
YES
Levodopa common preparations?
Madopar (co-beneldopa)
Sinemet (co-careldopa)
Modified release vs. dispersible tablet levodopa?
Dispersable tables have rapid bioavailability and may help jump-start patients in the morning, or during sudden off-freezing, and is more beneficial than modified release versions
Side effects of levodopa
Mnemonic= DOPAMINE Dyskinesia On-off effect Psychosis Reduced ABP Mouth dryness Insomina N/V EDS
Dopamine agonists examples
Ropinirole
Pramipexole
Bromocriptine
Pergolide
Apomorphine
Potent DA agonist used with continuous SC infusion to even out end-of-dose effects or rescue-pen for sudden off-freezing
Anticholinergic examples
Orphrenadine
Can help to reduce tremor but may cause confusion in elderly
MAO-B inhibitors
Selegiline, rasagiline
Alternative to dopamine agonists in early stages
Side effects of MAO-B inhibitors?
Postural hypotension
Atrial fibrillation
COMT inhibitors
Entecapone, tolcapone
May lessen off-time in those with end-of-dose wearing off
What is deep brain stimulation?
Surgery to implant a device that sends electrical signals to brain areas responsible for body movement. Electrodes are placed deep in the brain and are connected to a stimulator device.
What is involved in surgical ablation?
Removal of overactive basal ganglia circuits (e.g. subthalamic nuclei)
What drugs typically given for young-onset and biologically fit PD patients?
Dopamine agonists
MAO-B inhibitors
L-DOPA
What drugs typically given for biologically frail patients with co-morbidities?
L-DOPA
MAO-B inhibitors
Typically how long will levodopa be effective for?
2-5 years
