Parkinsons Flashcards
Day time sleepiness/sudden onset of sleep in PD
Adjust drug treatment
Modafinil (rv every 12 months)
Rapid eye movement sleep behaviour disorder in PD
Clonazepam or melatonin once pharmacological causes have been addressed
Sailva drooling
Speech and language first line
Glycopyrronium bromide
Botox
Parkinsons disease dementia
Mild-to-moderate PDD: Offer acetylcholinesterase inhibitor (e.g. rivastigmine – licensed for this use).
Severe PDD: Consider acetylcholinesterase inhibitor (unlicensed use).
If not tolerated/contraindicated: Consider memantine hydrochloride (unlicensed).
Antipsychotic use in PD
First decrease any dosage that may be causing these symptoms
1st - If no cognitive impairment use quetiapine
2nd - Clozapine
Postural hypotension
Rv drug treatment to address any pharmacological cause
Midodrine is first line
Fludrocortisone is an alternative
Motor symptoms treatment
If decreasing QOL= Levodopa+ carbidopa or beneserazide
If no effect on QOL= Levodopa or non ergot derived dopamine receptor agonist (pramipexole, ropinirole, rotigotine) or MAOB (rasagiline, selegiline)
Patient counselling for antiparkinsonian drugs
Psychotic symptoms
excessive sleepiness
sudden onset of sleep
impulse control disorders
Q: What adjuncts can be offered to patients with Parkinson’s who develop motor fluctuations despite optimal levodopa therapy?
A: Non-ergotic dopamine-receptor agonists (pramipexole, ropinirole, rotigotine), MAO-B inhibitors (rasagiline, selegiline), or COMT inhibitors (entacapone, tolcapone).
Q: When should ergot-derived dopamine-receptor agonists be considered in Parkinson’s management?
A: Only if symptoms are not adequately controlled with non-ergot-derived dopamine agonists
Advanced Parkinson disease treatment
Apomorphine as intermittent injections/continous SC infusion
Can cause n+V - Domperidone
Nocturnal akinesia in PD
impaired ability to move in bed during sleep, especially in individuals with Parkinson’s disease (PD) treatment
1st- Levodopa or dopamine receptor agonists
When would you give domperidone with apomorphine treatment
Start 2 days before starting apomorphine and discontinue ASAP to reduce N+V
Domperidone risks
Need to assess cardiac risk factors and monitor ECG before initiating domperidone due to risk of arrhythmia due to QT prolongation associated with concomitant use of domperidone and apomorphine
Key SE of levodopa
Arrythmias
Impulse control
On and off symptoms
Dyskinesia
Sudden onset of sleep
Psychosis
Levodopa in preg and BF
Contraindicated
Levodopa Interactions
With antihypertensives as can cause hypotensive effect
COMT inhibitors + Levodopa interaction
Reduce COMT inhibitor dose by 10-30%
