Parkinsons Flashcards
what are the cardinal features of Parkinsons Disease (PD)?
resting tremor
rigidity
bradykinesia
postural instability
what is the aetiology of PD?
loss of dopaminergic neurons in the substantia nigra and associated alpha synuclein lewy body deposition in the basal ganglia, brainstem and cortex
aside from the cardinal features mentioned before, what are other symptoms of PD?
autonomic dysfunction - OH, constipation, urinary frequency and urgency
sleep disturbance
loss of sense of smell
depression and dementia
hypophonia
mask face
how is PD investigated?
dopaminergic agent trial
MRI brain if suspicion of other pathology
what drugs are used in the treatment of PD?
levodopa dopamine agonists MOA-B inhibitors COMT inhibitors anti-cholinergics
what is the initial drug of choice in people <70 with PD?
dopamine agonists
what is the initial drug of choice in people >70 with PD
levodopa
- can give carbadopa alongside which inhibits peripheral conversion of levodopa to dopamine, reducing the side effects. Cannot cross BBB so doesnt effect neuronal actions of L-dopa
what are SE’s of levodopa?
Early
- Nausea and vomiting
- sleep wake cycle disturbance and nightmares
- hallucinations
- postural hypotension
Late
- dykinesia: higher incidence in younger patients thats why they recieve dopamine agonists first
- dystonia
- hallucinations
what are examples and SE’s of dopamine agonists?
ropinirole, pramiprexole, rotigotine, apomorphine
Drowsiness, N&V, hallucinations, compulsive behaviour
what are examples of MOA-B inhibitors and some side effects?
rasagiline and selegiline
postural hypotension and AF
cheese HTN crisis
what are examples and SE’s of COMT inhibitors?
entacapone and tolacapone
hepatotoxic, derranged LFTs
what else can be helpful in PD treatment?
anticholinergics for symptoms relief (tremor)
- trihexyphenidyl
deep brain stimulation
