Parkinsons Flashcards
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Clinical manifestations of Parkinson disease?
The symptoms of Parkinson’s disease are characteristically asymmetrical.
Triad
1) rigidity - cogwheel: due to superimposed tremor
flexed posture,drooling of saliva, postural hypotension,
2) bradykinesia
3) tremor - most marked at rest , typically ‘pill-rolling’,
gait - shuffling walk
psychiatric features: depression is the most common feature (affects about 40%)
mask face
Drug-induced parkinsonism has slightly different features to Parkinson’s disease such as ?
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor are uncommon
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treatment of parkinson disease first line if motor symptoms are not affecting patients quality of life ?
dopamine agonist (NON-ergot derived),
levodopa
or monoamine oxidase B (MAO‑B) inhibitor
treatment of parkinson disease first line if motor symptoms are affecting patients quality of life ?
levodopa
dopamine agonist (non-ergot derived),monoamine oxidase B (MAO‑B) inhibitor effects on motor skills compared to levodopa ?
Less improvement in motor symptoms
Less improvement in activities of daily living
If a patient continues to have symptoms despite optimal levodopa treatment or has developed dyskinesia then NICE recommend the addition of ?
dopamine agonist,
MAO‑B inhibitor
or catechol‑O‑methyl transferase (COMT) inhibitor
if alternative strategies fail from dopamine agonist , MOA inhibitors and (COMT) inhibitor , what can be considered ?
Modafinil - called wakefulness promoting agents
to manage drooling of saliva in people ?
glycopyrronium bromide (used for bowel colic in pliative too !)
Levodopa
nearly always combined with a decarboxylase inhibitor why ?
carbidopa or benserazide
prevents the peripheral metabolism of levodopa to dopamine outside of the brain
levodopa adverse effects ?
common adverse effects:
dry mouth
anorexia
palpitations
postural hypotension
psychosis
NICE recommends not to have a ‘drug holiday’ from Parkinson medication because ?
risk of acute dyskinesia /akinesia or neuroleptic malignant syndrome if medication is not taken/absorbed (for example due to gastroenteritis)
= fever,
muscle rigidity,
encephalopathy,
myoglobinuria,
unstable vital signs and
raised creatine kinase
autonomic lability: typical features include hypertension, tachycardia and tachypnoea
agitated delirium with confusion
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dopamine agonist - impulse control diroders
clinicians may limit levodopa doses due to ?
dyskinesias at peak dose: dystonia, chorea and athetosis (involuntary writhing movements)
what should be given for a patient with Parkinson’s disease cannot take levodopa orally, they can be given
dopamine agonist patch as rescue medication to prevent acute dystonia
what are the dopamine receptor agonist ?
bromocriptine, ropinirole, cabergoline, apomorphine
ergot-derived dopamine receptor agonists ?
bromocriptine, cabergoline
side effects of ergot-derived dopamine receptor agonists ?
pulmonary, retroperitoneal and cardiac fibrosis.
The Committee on Safety of Medicines advice that an echocardiogram, ESR, creatinine and chest x-ray should be obtained prior to treatment and patients should be closely monitored
MAO-B (Monoamine Oxidase-B) inhibitors
selegiline
function of mao b inhibitors ?
inhibits the breakdown of dopamine secreted by the dopaminergic neurons
COMT inhibitor example ?
entacapone, tolcapone
how to treat drug induced parkinisoms ?
Antimuscarinics
help tremor and rigidity
. procyclidine, benzotropine, trihexyphenidyl (benzhexol)
dopamine agonist for tremor ?
Pramipexole is a dopamine agonist (used in also restless leg syndrome)
What is seen on blood results for neuroleptic malignant syndrome is given what ?
raised creatine kinase is present in most cases.
Acute kidney injury (secondary to rhabdomyolysis)
A leukocytosis may also be seen
Max of neuroleptic malignant syndrome ?
stop any antipsychotic
IV fluids to prevent renal failure
dantrolene may be useful in selected cases
thought to work by decreasing excitation-contraction coupling in skeletal muscle by binding to the ryanodine receptor, and decreasing the release of calcium from the sarcoplasmic reticulum
bromocriptine, dopamine agonist, may also be used
MOI inhibited side effects ?
Serotonin syndrome
Clinical creatures of serotonin syndrome
Abrupt onset
Hypereflexia
Dilated pupils
CLONUS
MX of severe serotonin reuptake syndrome ?
Cyproheptadine
Chlorpromazine
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Drug induced Parkinson differing in
motor symptoms are generally rapid onset and bilateral
rigidity and rest tremor-UNCOMMON
