Parkinsons Flashcards
What is Parkinson’s defined by?
Parkinson’s disease is a progressive neurodegenerative condition resulting from the death of dopaminergic cells
Patients with Parkinson’s disease classically present with motor-symptoms including
hypokinesia, bradykinesia, rigidity, rest tremor, and postural instability
Non-motor symptoms include
dementia, depression, sleep disturbances, bladder and bowel dysfunction, speech and language changes, swallowing problems and weight loss.
Patients with suspected Parkinson’s disease should be referred every how often? Do they tell the DVLA?
to a specialist and reviewed every 6 to 12 months. When Parkinson’s disease diagnosis is confirmed, patients should be advised to inform the DVLA and their car insurer
Aim of Parkinson’s treatment?
Parkinson’s disease is an incurable progressive condition, and the aim of treatment is to control the symptoms and to improve the patient’s quality of life
First-line treatment
In early stages of Parkinson’s disease, patients whose motor symptoms decrease their quality of life should be offered levodopa combined with carbidopa (co-careldopa) or benserazide (co-beneldopa).
Parkinson’s disease patients whose motor symptoms do not affect their quality of life, could be prescribed a choice of
levodopa, non-ergot-derived dopamine-receptor agonists (pramipexole, ropinirole or rotigotine) or monoamine-oxidase-B inhibitors (rasagiline or selegiline hydrochloride).
Daytime sleepiness
Modafinil
Nocturnal Akinesia- what is it defined by??
Loss of movement
Postural Hypotension- what do they have reviewed? What is given first line of drug therapy is needed, what is the second option?
Patients who develop postural hypotension should have their drug treatment reviewed to address pharmacological cause. If drug therapy is required - midodrine hydrochloride as the fist option and fludrocortisone as an alternative
Psychotic symptoms:
What would be the first thing to do? What would we give to patients with non cognitive impairment - what happens if treatment is ineffective??
What can worsen motor Parkinson’s???
Hallucinations and delusions can be treated but don’t have to if they are well tolerated, dosage of any antiparkinson drug may have triggered hallucinations
Patients with non cognitive impairment- quetiapine considered to treat hallucinations and delusions, if standard treatment not effective- clozapine. Phenothiazines and butyrophenones can worsen motor features of Parkinson’s
Rapid eye movement/ drooling treatment only if speech therapy not effective
Clonazepam or melatonin should be considered to treat rapid eye movement
Drooling- Only if speech therapy and language therapy not effective - Glycoprronium bromide 1st line, Botulunum toxin type A 2nd line.
Dementia- is treated using what??
Rivastigmine,memantine
Deep brain stimulation - should be considered with which patients???
should only be considered with patients with advanced Parkinson’s disease whose symptoms aren’t adequately controlled
Intestinal gel contains what? What can it treat?
containing co-carledopa or continuous subcutaneous infusion of foslevodopa with foscarbidopa may be used to treat advances levadopa - responsive Parkinson’s disease with motor fluctuations and hyperkinesis or dyskinesia
Non ergot derived dopamine receptor:
Pramipexole,ropinirole, rotigotine
Can cause what (3)
Non ergot cause what more than what???
- Impulse disorders
- Sudden onset of sleep
- Hypotension
Non ergot= more impulse disorders than levadopa
Patients who develop dyskinesia or motor fluctuations despite optimal levadopa therapy should add an adjuvant to levadopa:
-ergot-derived dopamine receptor agonist
Ergot derived dopamine receptor agonist (bromocriptine,cabergoline)
What is bromocriptins used in???
Bromocriptine rescue drug for neuroleptic malignant syndrome
Ergot derived dopamine receptor agonist (bromocriptine,cabergoline)
Bromocriptine rescue drug for neuroleptic malignant syndrome
Pulmonary reactions:
report SOB
Pericardial reactions:
chest pain
If a person has off periods, due to end of dose deterioration?
Use MR preps
Gambling
The dopamine agonists pramipexole and ropinirole, and the dopamine modulator aripiprazole, are associated with an increased risk of developing problematic gambling.
Levodopa and oral dopamine receptor agonists should be considered as first line? What is second line? When would we opt for that?
Levodopa or oral dopamine receptor agonists should be considered as a first lien option and rotigotine as second line (if levadopa and oral dopamine- receptor agonists are ineffective)
Advanced Parkinson’s which intermittent injections do we use?
Advanced Parkinson’s -apomorphine as intermittent injections or continuous subcutaneous infusions
- Nausea and vomiting unlicensed under what kg? Need to start when? What issues are associated with concomitant use??
Domperidone (unlicensed in less than 35kg)need to start two days before apomorphine therapy and then discontinued as soon as possible to reduce risk of arrhythmias due to QT prolongation associated with concomitant use of Domperidone,apomorphine hydrochloride - assessment if cardiac risk and ECG monitoring to ensure that the befits outweigh the risks
