Parkinson's Disease Flashcards
1
Q
Signs & Symptoms of Parkinson’s Disease
A
- Resting Tremor
- Rigidity
- Bradykinesia
- Postural instability
2
Q
Staging of Parkinson’s Disease- Hoehn & Yahr Scale
A
- Stage 0: No signs evident
- Stage 1: Unilateral involvement
- Stage 2: Bilateral involvement
- Stage 3: Bilateral involvement with mild postural imbalance, history of falls, patient lives independently
- Stage 4: Bilateral involvement, history of falls, needs help with ADLs
- Stage 5: Fully developed, end stage disease, bed or wheelchair confined
3
Q
Pathophysiology of Parkinson’s Disease (PD)
A
- Decrease in dopamine receptors
- Greater than 80% loss in DA receptors = PD
4
Q
Treatment of PD in absence of functional impairment
A
-Rasagiline monotherapy
5
Q
Treatment of mild PD
A
- Amatadine
- MAO B inhibitor
ex. Rasagiline or Selegiline
6
Q
Treatment of moderate to advanced PD
A
- Dopamine agonist
ex. Mirapex (Pramipexole), Requip (Ropinirole) - Carbidoa/levodopa
7
Q
How to work around “Wearing off” associated with Carbidopa/Levodopa use
A
- Increase dose/ frequency
- Add on Dopamine agonist
- Add on MAO B inhibitor
- Add on COMT
8
Q
Stalevo
A
-Carbidopa/ Levodopa
PLUS
-Entacapone
-Increases bioavailability of Levodopa
9
Q
Can you use Entacapone as monotherapy?
A
- No it is a COMT
- Only role is in conjunction with Carbidopa/Levodopa
10
Q
How to treat pts with PD and depression?
A
- Atypical antipsychotic
ex. quetiapine (seroquel) - Can use SSRI for significant depression
11
Q
Selegiline
A
- MAO B inhibitor
- 10mg/day
- Cut L dopa dose in half if using these medications together
12
Q
Rasagiline
A
- MAO B inhibitor
- 5x more potent than selegiline
- Approved by FDA for first time treatment in early parkinson’s disease
13
Q
Carbidopa/Levodopa
A
- Almost all PD pts end up on this med
- But after a few years in becomes less effective
14
Q
Pramipexole (Mirapex)
A
- Dopamine agonist
- Indicated in treatment of moderate to advanced PD
- Adjust for renal insufficiency
15
Q
Ropinirole (Requip)
A
- Dopamine agonist
- Indicated in treatment of moderate to advanced PD
- Max dose: 24mg/day
