Parkinson's disease Flashcards
1st line treatment for parkinson’s ?
if motor symptoms affect QOL - Levodopa
if motor symptoms don’t affect QOL either
- levodopa
- dopamine agonist
- MAO-B inhibitor
2nd line treatment for parkinson’s ?
if symptoms aren’t controlled by single therapy and/or develop dyskinesia, add one of the following;
- MAO-B inhibitor
- COMT inhibitor
- dopamine agonist
what is the diagnostic criteria for parkinson’s?
bradykinesia + 1 of the following
- postural instability
- tremor (> 4-6Hz)
- rigidity
exclude all other diagnsoses
3 supporting criteria i.e; - unilateral rest tremor progressive excellent response to levodopa - asymmetrical - etc
a patient with parkinsons has severe nausea and vomiting. what advice would you give with regards to his medication and why ?
continue to take medication, give dopamine patch as rescue medication if unable to take levodopa orally
risk of acute akinesia and/or neuroepileptic malignant syndrome if medication is missed
how would you manage postural hypotension in a patient with parkinson’s ?
midodrine
acts on peripheral alpha adrenergic receptors to increase arterial resistance
management of excessive daytime sleepiness in parkinson’s ?
modafinil if alternative strategies fail
side effects of levodopa.
dyskinesia 'on-off' effect dry mouth anorexia palpitations postural hypotension psychosis drowsiness
side effects of dopamine agonists.
high risk of excessive day time sleepiness and impulse control disorder
associated with pulmonary, retroperitoneal and cardiac fibrosis
nasal congestion
postural hypotension
hallucination
medication used in the management of drug-induced parkinsonism ?
anti-muscarinics
what drugs can cause parkinsonism ?
typical antipsychotics metoclopramide CCB's lithium tetrabenazine (huntingtons) reserpine (alkaloid used for HTN)
differentials of parkinsons?
multiple system atrophy
- parkinsons, atonic bladder, postural hypotension, cerebellar signs
levy body dementia
- parkinsonism, cognitive impairment, visual hallucinations
drug-induced
vascular parkinsons
- step wise progression, lower extremity, symmetrical
toxins
- acute onset
- exposure to MPTP, CO, manganese
why is levodopa given with carbapodpa?
to prevent the peripheral metabolism of levodopa into dopamine (therefore unable to cross BBB)
1st line investigation to confirm suspicion of parkinsons ?
dopaminergic agent trial
- positive result = rapid response to levodopa
how would you differentiate between an essential tremor and Parkinsons tremor ?
essential is improved with rest and alcohol
parkinsons is improved with voluntary movement
parkinsons is typically ‘pill rolling’ - thumb and index finger
if there is difficulty:
I-FP- CIT SPECT
what are the 4 parkinson plus syndromes ?
levy body dementia
- fluctuations in cognitive impairment and visual hallucinations
multiple system atrophy
- autonomic dysfunction i.e. atonic bladder, postural hypotension
corticobasal degeneration
- spontaneous activity by an affected linb or akinetic rigidity
progressive supranuclear palsy
- vertical gaze palsy
