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Pharmacotherapeutics Theory 2 > Parkinson's Disease > Flashcards

Parkinson's Disease Flashcards

1
Q

What are the 5 Cardinal Symptoms of Parkinson’s Disease?

A
  • Tremor at rest
  • Bradykinesia
  • Muscle rigidity
  • Postural instability
  • Gait freezing
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2
Q

What are other symptoms of Parkinson’s Disease?

A
  • Anxiety
  • Constipation
  • Akinesia
  • Fatigue
  • Stuttering
  • Anosmia
  • Drooling
  • Postural hypertension
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3
Q

When can a diagnosis of Parkinson’s be Made?

A
  • If three of the cardinal symptoms are present, a provisional diagnosis of PD can be made
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4
Q

What tool can be used in assessing Parkinson’s Disease?

A
  • Hoehn and Yahr scale
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5
Q

What is the Difference between Parkinsonism vs Parkinson’s Disease?

A
  • Parkinsonism refers to any condition that involves a combination of the types of changes in movement seen in Parkinson’s disease
    • Idiopathic Parkinson’s Disease
    • Drug or Toxin Induced Parkinsonism
    • Parkinsonism associated with other neurological diseases
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6
Q

What are the Principles of Management in the Treatment of Early and Advanced PD?

A
  • Attempt to keep the patient functioning for as long as possible with the minimum amount of medication
    • Although, may need to use multiple drugs at some stage
  • Individualise therapy
    • Clinical and lifestyle preferences
    • Patient preference
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7
Q

What is the Ultimate Goal of treating PD?

A
  • Ultimately treating PD is about trying to balance the benefit of relieving tremor/rigidity without causing the risk of dyskinesias
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8
Q

What is Non-Pharmacological Management of PD?

When is Non-pharm management used?

A
  • Used if there’s no functional impairment
  • Group support
  • Education
  • Exercise
  • Nutrition
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9
Q

What are 5 Advantages of Dopamine Agonists?

A
  • They act directly on dopamine receptors
  • Absorption and transport into the brain (levodopa is affected by circulating acids)
  • Longer half-life than levodopa formulations
  • Adequate control of symptoms
  • Good choice for initial treatment in many patients, especially young-onset
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10
Q

What is Adjuvant Therapy Recommended for?

A
  • At some stage, whatever treatment you give initially will become insufficient to control movement
  • Will need options to add on
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11
Q

What Adjuvant Therapy Options are Recommended?

A
  • Anticholinergic drugs
  • COMT inhibitor
  • Dopamine agonists
  • MAO-B inhibitor
  • Other
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12
Q

What are some non-motor symptoms of PD?

A
  • Mental Health Problems
    • Depression
    • Psychotic Symptoms
    • Dementia
  • Sleep Disturbances
  • Falls
  • Autonomic Disturbances
    • Bladder dysfunction
    • Constipation
    • Sexual dysfunction
    • Orthostatic hypotension
    • Sialorrhea
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13
Q

Non-motor symptoms of PD: How is Sleep Disturbance Managed?

A
  • Advise good sleep hygiene
    • Restrict day time napping
    • Avoid stimulants at night
    • Regular sleeping pattern
    • Comfortable bedding
  • Review medications and avoid drugs that may affect sleep or alertness, or may interact with other medication
  • Advise patients with sudden onset of sleep not to drive and consider any occupational hazards
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14
Q

Non-motor symptoms of PD: How are Autonomic Disturbances Managed?

  • Bladder dysfunction
  • Constipation
  • Sexual Dysfunction
  • Orthostatic Hypotension
A
  • Bladder dysfunction
    • Bladder training
    • Drugs for urinary incontinence (oxybutynin)
  • Constipation
    • Dietary modification and exercise
    • Laxatives
  • Sexual dysfunction
    • Urological evaluation
    • Drugs or devices for erectile dysfunction
  • Orthostatic hypotension
    • Non-pharmacological measures
    • Domperidone
    • Reduce meal frequency
    • Night time head-up tilt
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15
Q

Non-motor symptoms of PD: How is Sialorrhea Managed?

A
  • Intraparotid botulinum toxin Type A
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16
Q

How is Nausea Managed?

A
  • Slow titration and administration w/ food
  • Additional dose of carbidopa 30 mins before regular levodopa
  • Domperidone (other anti-emetics such as metoclopramide, prochlorperazine and promethazine should be avoided)
17
Q

How is Somnolence Managed?

A
  • Dose of dopamine agonist should be reduced or discontinued and levodopa should substitute
  • Other drugs such as MAO-B inhibitors and caffeine could help
18
Q

How are Hallucinations Managed?

A
  • Timing of hallucinations relative to dosing time, therefore can modify when they take dopamine agonists if hallcuinations happen at a particular time
  • Reduce or eliminate in the following order: anticholinergics, selegiline, dopamine agonists, amantadine, COMT inhibitors, levodopa
  • Antipsychotics: low doses of clozapine and quetiapine (1st gen antipsychotics would worsen PD)
19
Q

How is Compulsive Behaviour Managed?

A
  • Excessive gambling, hypersexuality and shopping or eating
    • Carers need to be aware if they start
  • Gradual reduction or elimination of dopamine agonist and switch to levodopa
20
Q

How is Nocturnal Akinesia Managed?

A
  • MR levodopa preparations may be used
  • Consider rotigotine if levodopa and/or dopamine agonists aren’t effective
21
Q

Issues with regards to conversion of standard release formulations to controlled release formulations?

A
  • CR levodopa have reduced bioavailability as compared to the standard tablets and therefore require dose adjustment if converting between products
  • Specific recommendation varies according to the particular product but the aim is to as quickly as possible correct for the reduced bioavailability without causing any troublesome dyskinesias by increasing the dose too much
  • As a result, some patients may experience an increase in rigidity during the initial phase of the swap until the dose is stabilised
22
Q

What is the Role of New Formulations in PD?

A
  • Can be used in the treatment of advanced PD which try to correct levels of dopamine in the brain in a more physiological way
23
Q

What may Neuroleptic Malignant Syndrome occur with?

A
  • May occur with antiemetic drugs, antidepressants and lithium or after the cessation of dopamine agonist drugs
24
Q

What are the symptoms of Neuroleptic Malignant Syndrome?

A
  • Fever
  • Increase in WBC
  • Muscular rigidity
  • Altered level of consciousness
25
Q

What is the Treatment of Neuroleptic Malignant Syndrome?

A
  • Treatment depends on severity of symptoms
    • At onset, discontinue drug and monitor vital signs
    • Bromocriptine reduces rigidity and fever
26
Q

What shouldn’t be used as a neuroprotective therapy in PD?

A
  • Vitamin E
  • Co-enzyme Q10
  • Dopamine agonists
  • MAO-B inhibitors

Pharmacotherapeutics Theory 2 (17 decks)

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