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
