Parkinsons Flashcards
What happens if you withdraw parkinson’s medication suddenly?
acute akinesia, neuroleptic malignant syndrome
Be aware of situations where malabsorption could also have this eff ect (eg abdominal surgery, gastroenteritis).
what drug do you give levodopa with?
dopa-decarboxylase inhibitor
in co-beneldopa or co-careldopa
levodopa SEs?
dyskinesia, painful dystonia. Non-motor
SES: psychosis; visual hallucinations, nausea and vomiting (give domperidone).
When should modified release levodopa be used?
in late disease
Why is it important to start levodopa later in disease?
Effi cacy of this therapy reduces with time, requiring larger and more frequent dosing, with worsening SEs and response fluctuations
How are dopamine antagonists used in parkinsons disease? Examples?
to delay starting levodopa therapy in early stages of PD and allow for lower doses of levodopa as PD
progresses.
ropinirole and pramipexole monotherapy
Rotigotine transdermal patches are available as mono- or additive
Apomorpine MOA? route? use? SEs?
potent dopamine agonist continuous SC injection to even out end-of- dose effects, or as a rescue-pen for sudden ‘off ’ freezing. SE: injection-site ulcers
What classes of Pharmacological therapy in Parkinson’s disease are thaere?
levodopa dopamine agonist apomorphine anticholinergics MAO-B inhibitors COMT inhibitors
Anticholinergic for parkinsons examples? usage?
benzhexol
orphenadrine
usage limited to younger patients (confusion and muliple SEs in elderly)
MAO-B inhibitors examples? usage? SEs?
rasagiline, selegiline
alternative to dopamine agonists
in early PD.
SEs include postural hypotension and atrial fi brillation.
COMT inhibitors examples? effect?
entacapone, tolcapone
May help motor complications in
late disease
Tolcapone SEs? class?
COMT inhibitor
severe hepatic complications and requires close
monitoring of LFT.
