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body, function and pharmacology > Parkinson's disease > Flashcards

Parkinson's disease Flashcards

1
Q

Define Parkinson’s disease

A

Progressive neurological affect the motor functions

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2
Q

What are the motor symptoms of PD?

A

Tremor: resting tremors
Rigidity: initial stiffness, slowing of gait
Akinesia/bradykinesia: begins on one side
Postural instability: stooped posture

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3
Q

What are some of the non-motor symptoms of PD

A 
Depression
Dementia
Psychosis
Sleep disorder
Urinary dysfunction 
Dysphasia or sialorrhea 
Orthostatic hypotension
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4
Q

How would the diagnosis of PD happen?

A

Clinical criteria of primarily motor symptoms. Exclude neurological damage, hx of provoking drugs, toxins, infections and other similar diseases

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5
Q

What are the first-line drugs used to treat PD? Explain the mechanism

A
  • Levodopa: a dopamine precursor that can bypass BBB
  • Carbidopa: Dopa-decarboxylase inhibitor
  • Entacapone: COMT inhibitor
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6
Q

What are the first-line drugs used to treat PD? Explain the mechanism

A
  • Levodopa: a dopamine precursor that can bypass BBB, increasing lack of dopamine
  • Carbidopa: Dopa-decarboxylase (DDC) inhibitor, blocks Levodopa from being used in periphery
  • Entacapone: COMT inhibitor, blocks Levodopa from being metabolised in periphery
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7
Q

Why would you use a combination to treat PD?

A

synergistic effect

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8
Q

What are the combination drug therapies used in PD Tx?

A

Levodopa + carbidopa
levodopa + entacapone
levodopa + carbidopa + entacapone

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9
Q

What are some of the non-pharmacological management techniques used in treatment of PD?

A
  • exercise: balance training, physiotherapy
  • balanced nutrition
  • education, counselling, social support
  • carer support
  • speech and language therapy, PT
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10
Q

What signs can be used for a differential diagnosis?

A
  • essential tremor (affect 3% of population) producing bilateral moving tremor
  • drug induced parkinsonism
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11
Q

SINEMET and KINSON are combinations of which drugs?

A

Carbidopa and Levodopa

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12
Q

Levodopa can slow progression of PD symptoms, reduces mortality and is well tolerated. What are the drawbacks of the drug?

A
  • limited impact on gait and postural instability
  • long-term tx complicated by developing motor complications
  • risk of aggravating hallucinations, cognitive impairment and orthostatic hypotension
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13
Q

What is the optimal dose for levodopa initially? How many formulations are there for levodopa?

A
  • 3x per day intially - will increase later on

- 4 formulations (immediate release, controlled release, dispersible tablets, intestinal gel)

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14
Q

What are some side effects of Levodopa

A
  • nausea
  • vomiting
  • postural hypotension
  • sedation
  • vivid dreams/hallucinations
  • psychosis
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15
Q

What motor complications are associated with Levodopa?

A
  • wearing off
  • delayed on
  • fluctuations with on/off periods
  • dyskinesia (excessive movements from excess dopamine)
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16
Q

Dopamine agonists are another group of drugs that could be used in PD treatment. What is the mode of action?

A

Directly stimulate dopaminergic receptors in the brain providing a modest effect (compared to Levodopa)

17
Q

What are the advantages to using dopamine agonists? What

A
  • significant reduction in motor complications
  • longer half-life and duration of effect than Levodopa
  • ## less frequent administration
18
Q

What are the advantages to using dopamine agonists? What

A
  • significant reduction in motor complications
  • longer half-life and duration of effect than Levodopa
  • less frequent administration
  • alt. first-line for younger sufferers
19
Q

Non-ergot dopamine agonists are safer than ergot derivatives. Give examples of DA durgs

A
  • Pramipexole(O, OMR)
  • Ropinirole (O)
  • Rotigotine (TD patch)
  • Apomorphine (parenteral)
20
Q

What are some of the side effects of DA drugs?

A

fatigue, nausea, leg oedema, constipation. Others: dizziness, drowsiness, hallucinations. sudden sleep attacks, impulse control disorder.

21
Q

MAO-B inhibitors are less commonly used to treat PD. Explain the MOA and provide an example drug

A
  • Blocks monoamine oxidase enzymes that degrade dopamine in basal ganglia
  • Rasagiline and Selegiline
22
Q

Explain the rationale of Anticholinergics for PD thx and provide examples

A

Rationale: dopamine depletion results in overactivity of cholinergic activity so use anti-Ach to combat over excitation

  • Benzhexol
  • Benztropine
23
Q

What are some of the side effects of DA drugs? What AEs are specific to ergot derivatives?

A

impulse control disorders, fatigue, nausea, leg oedema, constipation. Others: dizziness, drowsiness, hallucinations, sudden sleep attacks,
Ergot: Fibrotic reactions and cardiac valve disease

24
Q

COMT inhibitors may be used in adjunct thx. with levodopa. What is the benefit of the COMT inhibitor? what are the downsides of increasing dosage down the line?

A
  • used mostly in advanced PD and motor complications
  • increased “on” times by 1-2 hrs
  • reduced “off” time
  • selective and reversible
  • well tolerated
  • Increase freq/severity of dyskinesia, hallucinations, Vs
25
Q

What are some of the other ways to aid in PD management of symptoms?

A
  • speech thx
  • music thx
  • counselling
  • anti-depressants
  • dance thx

body, function and pharmacology (7 decks)

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