Parkinson's medications Flashcards
What is given for nausea?
domperidone 10-20mg tds
po or 30mg tds pr. Cyclizine and ondansetron are acceptable
alternatives (do not use metoclopramide or prochlorperazine)
What should a patients be given if they’re unable to swallow their medication and are on a dopamine agonis?
Dopamine Agonist (ropinerole, pramipexole, cabergoline, pergolide) this should be swapped to an equivalent dose of the rotigotine transdermal patch
In which order should medications be reduced or stopped when the medical causes of confusion have already been addressed?
Anticholinergics Amantadine Selegiline /rasagiline Ropinerole/Pramipexole/rotigotine Levodopa
Which drugs should not be given when patients are experiencing hallucinations or confusion?
Conventional antipsychotic drugs (eg haloperidol, chlorpromazine
Which drugs should be used for sedation?
lorazepam 1 mg po or im (risk of falls, respiratory depression)
Quetiapine 12.5mg –25mg od or bd. Discuss with pharmacist before
prescribing. Do not use if ECG shows prolonged QT interval.
Which medications are contraindicated in Parkinson’s?
Antipsychotics: Haloperidol (Serenace, Haldol) Chlorpromazine (Largactil) Promazine Sulpiride Anti-emetics: Metoclopramide (Maxalon) Proclorperazine (Stemetil)
Which medications are best avoided in patients with Parkinson’s disease dementia?
Oxybutynin
Tolterodine
Trihexyphenidyl
tricyclic antidepressants
What needs to be done to enable apomorphine therapy after surgery?
Domperidone should be commenced for 3 days prior to the
apomorphine challenge.
A pre-operative apomorphine challenge should be done by the PDNS
to establish tolerance and dose.
The apomorphine pump should be commenced on the day prior to
operation.
The apomorphine therapy can be discontinued once oral or nasogastric medication can be recommenced
What should be considered before switching dopamine agonists?
The stage of PD the patient is at
- How the patient has previously tolerated medication changes
- Side effects previously experienced eg. postural hypotension,
somnolence, impulse control problems.
- The patient’s neuro-psychiatric health (hallucinations, psychosis,
cognition).
- The rationale for switching and the potential side effects should be discussed with the patient
Which medications are used for Parkinson’s?
Levo-dopa: co-beneldopa & sinemet. Replace dopamine using peripheral decarboxylase inhibitor to prevent peripheral breakdown
First line in elderly
Can cause nausea, dramatic improvement in stiffness and may improve tremor, but less so
Dopamine agonist: rotigotine and ropinorole
Active post synaptic receptors
Impulse control disorder or hallucinations
Others:
MAO-B inhibitors: selegiline & rasagaline
Amantadine
Entacapone
What dose of Levodopa is used?
Usually max dose = 600-1000mg/day, with plasma half-life of 60-90mins
most effective treatment and well tolerated by the elderly
its duration of action may be longer as it is taken up by neurones and slowly released
What are the side effects of L-dopa?
Nausea & vomiting Postural hypotension Hallucinations & confusion Motor side effects common in prolonged use -Wearing off -Dyskinesia -Motor fluctuations- on/off effect
What are examples of dopamine agonists?
Ropinerole
Pramipexole
Rotigotine (patch)
Apomorphine (subcut)
What are the side effects of dopamine agonists?
o Nausea
o Postural dizziness
o Hallucinations
o Ankle swelling
o Somnolence
Impulse control disorder (<13%, young men > older women)
Gambling, hypersexuality, binge eating, compulsive shopping, punding
Compulsion to perform repetitive mechanical tasks: collecting, assembling & tak
What are motor problems associated with dopamine agonists?
Inadequate treatment effect Wearing off “on-off” Dose failures Freezing Dyskinesia: peak dose, diphasic Early morning foot dystonia
