Parkinsons Flashcards
What symptoms have to be present for a diagnosis of Parkinsons?
Bradykinesia PLUS one of the following:
- 4-6Hz resting tremor
- muscle ridgidity
- postural instability
Which other neurodegenerative disorder most mimics parkinson’s symptoms?
progressive supranuclear palsy
Why is carbidopa or benserazide combined with levodopa in the treatment of parkinsons?
Prevents peripheral breakdown of levodopa- prolonging it’s effect.
Name the two contra-indications to levodopa.
history of melanoma/ suspicious undiagnosed lesions and angle-closure glaucoma
Name 3 main side effects of levodopa
postural hypotension, impulse control disorders, and dyskinesia
Which drug used in parkinson’s disease is most associated with motor fluctuations?
Levodopa
What can be done if a patient is experiecing nocturnal akinesia or end-of-dose detioration whilst taking levodopa?
Can be changed to MR preparation
What is 1st line therapy in patients whose motor symptoms ARE affecting their quality of life? (Early disease)
Levodopa
What is 1st line therapy in patients whose motor symptoms AREN’T affecting their quality of life? (Early disease)
Levodopa OR non-ergot derived dopamine agonists OR monoamine-oxidase inhibitors
Name the 2 contra-indications of non-ergot derived dopamine agonists.
severe cardiovascular disease and psychotic disorders
Name 3 main side effects of non-ergot derived agonists
sudden onset of sleep, hypotension, and impulse control disorders
Which drug class used in parkinson’s disease can cause erythema to lower legs?
non-ergot derived dopamine agonists
What can occur if parkinson’s meds are abruptly withdrawn?
neuroleptic malignant syndrome and acute akinesia
What gastrointestinal conditions are monoamine-oxidase-B inhibitors contra-indicated in?
active duodenal and gastric ulceration
What other condition are monoamine-oxidase-B inhibitors contra-indicated in other than ulceration?
postural hypotension
What is an uncommin cardiovascular side effect of COMT inhibitors?
Myocardial infarction
Describe ergot-derived dopamine agonists place in therapy in parkinson’s disease?
Only to be used as an adjunct to Levodopa if non-ergot derived dopamine agonists do not adeqautely control symptoms
What is last-line in early parkinson’s disease if still experiencing dyskinesia?
Amantadine
Which anti-emetic is administered 2 days before apopmorphine infusion?
Domperidone
What is 1st line in advanced parkinson’s disease where other therapy has failed?
Apomorphine S/C infusion
What treatment is recommended when symptoms of Parkinson’s disease are not adequately controlled on drug therapy?
Deep Brain Stimulation
What drug treatment is indicated in advanced levodopa-responsive parkinson’s disease with dyskinesia/hyperkinesia?
Intestinal Levodopa gel or continuous subcutaneous infusion of foslevodopa with foscarbidopa
What drug therapy can be used in excessive daytime sleepiness associated with Parkinson’s disease?
Modafinil
First-line therapy in nocturnal akinesia?
levodopa or non-ergot derived dopamine agonists
Second-line therapy in nocturnal akinesia?
Rotigotine
Which drug therapy can be used for psychotic symptoms in parkinson’s disease where no congitive impairment is present?
Quetiapine and Clozapine
Which drug therapy is unlicensed for postural hypotension in parkinson’s disease but may still be used?
Fludrocortisone
Which drug therapies are recommended to treat REM sleep disorders in parkinson’s disease?
Clonazepam and melatonin
First-line for drooling associated with parkinson’s disease?
Glycopyrronium
