Parkinsons Flashcards by Carter Berg

Pathophysiology of parkinsons?

progressive death of dopamine neurone in substantial nigra (basal ganglia)

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Role of dopamine in parkinsons?

important for smooth, controlled movements

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Protective factors for parkinsons?

smoking, high coffee use
intense exercise

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Hallmark movement sx of parkinsons?

Tremor
Rigidity
Akinesia
Postural instability

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What do you need for diagnosis of parkinsons?

bradykinesia, tremor or rigidity, dopamine helps

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What patients usually get tremors?

younger and more slow progression

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What patients get the rigid subtype?

older and much more rapid progression

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What can cause sx similar to parkinsons?

dopamine blocking agents such as AP and metoclopramide

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When is parkisnons atypical?

if no response to levodopa

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Other types of parkinsons?

Vascular and secondary due to other substances

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Medications that can cause Parkinsonism?

antipsychotics
metoclopramide
lithium
VA

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What antinauseant has less affects on dopamine?

domperidone

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What AP has less risk for Parkinsonism?

quetiapine, clozapine

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Sx of Parkinson’s in early stage?

loss of smell
constipation
depression
fatigue
act out dreams
flat affect
soft speech, dry eyes

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What are later parkinsons sx?

hallucinations
drooling
sex dysfunction
urinary incontinence
orthostatic hypotension
dementia

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Treatment to reduce progression of PD?

NONE

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Non pharm for PD?

Physical/occupational therapy
speech therapy
psych support
hearing/vision/ dental care

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Why use carbidopa/benserazide?

prevents conversion of levodopa to dopamine outside the brain= better efficacy and a/e

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What is levodopa best for?

bradykinesia and rigidity
benefit in 2 weeks

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What sx is levodopa not good for?

tremor, balance and non motor sx

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Why do you need to taper off parkinsons meds if needed?

neurolep[tic malignant syndorme

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Why titrate slow of levodopa?

nausea and gi sx

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What to avoid congesting with levodopa?

protein, iron, antacids

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S/e of levodopa?

gi
dizzy
fatigue
vivid dreams

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What happens after around 5 years of levocarb treatment?

doesn't last as long inability to move dyskinesias

When is dyskinesia the worst on levocarb?

after a dose

Other formulations of Levocarb?

enteral PEG J tube-continuous intestinal gel subcut infusion-continuous

Dopamine agonist drugs?

bromocriptine and carbergoline, pramipexole, ropinirol rotigotine

Why do we never use bromocriptine and carbergoline?

ergot= pulmonary and cardio toxicity

Place in therapy for dopamine agonists?

usually younger due to tolerability in older 'save' levodopa

S/e of Dopamine agonists?

gi, ortho hypo, hallucination, confusion= WORSE than levodopa drowsy impulse control disorders!!!!!!

HUGE s/e of dopamine agonists/

impulse control issues= gambling, sexual, compulsive buys

Where is place for apomorphine?

VERY potent dopamine agonist for rescue of freezing bad nausea though

What causes dose changes for pramipexole?

renal issues

Are dopamine agonists better than levocarb?

Which MAO for parkinsons?

MAO-B drugs?

selegiline and rasagiline

Do we need to worry about diet with MAO-B?

No as long as at PD doses

PLace in therapy for MAO-B?

only for mild fewer s/e and less frequent dosing may be used later to manage motor complications of levodopa

When to take MAO-B?

morning to prevent insomnia/ vivid dreams

Important DI of MAO-B?

SSRI- serotonin syndrome but is rare, DONT freak out

Bad OTC to use with MAO-B?

DM in cough suppresants= serotonin syndrome

How does entacapone work?

COMT inhibitor= stops breakdown of levocarb in periphery

What other drug must you be on if on entacapone?

levocarb duhhhh

S/e of entacapone?

gi turn urine and sweat orange

Dose adjustment if adding entacapone?

about 30 percent

Purpose of amantadine?

for bothersome dyskinesias later in disease course

S/e of amantadine?

nausea, confusion, hallucinations

What treatment for tremor in parkinsons?

anticholinergics

Why don't we generally use anticholinergics in parkinsons?

bad in older people

What anticholinergics for PD?

benztropine, trihexylphenidyl, procyclidine

What can we do if issues of dyskinesia on levocarb?

smaller more frequent dosing, add MAO or amantadine

What can we do to help constipation in PD?

PEG or domperidone

What can we do for depression in PD?

NO bupropion give citalopram, sertraline, venlafaxine, duloxetine

If we do need drugs for orthostatic hypotension what can we do?

fludricortisone, domperidone midodrine

If ED is an issue what can we do?

PDE5i- not if on ergot

What can we do for sialorrhea (less swallowing)

chew/suck on something ipratropium

What can we do for better sleep?

melatonin, dose-in, trazadone

If sleep moving disorder what should we do for that?

NO hs AD dosing give melatonin or benzo

How can we improve restless leg syndrome?

hs dopamine therapy, gabapentin or pregabalin

If hallucinations what can we do?

clozapine but bad s/e quetiapine