Parkinsons disease Flashcards
What are the two types of symptoms in parkinsons disease?
Motor and non motor
If parkinsons is affecting daily life what is the first line treatment?
Levadopa
What is the alternative treatment in parkinsons disease if it is not affecting daily life
Levodopa
Non ergot derived dopamine receptor antagonist
MAOB inhibitor
Add on treatments in Parkinsons
Non ergot derived dopamine receptor antagonist
MAOB inhibitor
COMT inhibitor
When can Apomorphine SC be used
During “off periods” with levodopa/ cannot swallow wtc
What antiemetic cannot be used in Parkinsons and why
Metaclopramide cannot be used because it crosses BBB and causes parkinsonism symptoms
Domperidone and Apomorphine used together
Risk of QT prolongation when the two are given together so monitor ECG for signs of arrhythmias
How does Levodopa work
By replenishing dopamine in the brain
What are levodopa side effects?
End dose deterioration/ off periods
Impulse control disorders
Sudden sleep onset
Motor complications during off periods
Dopamine receptor antagonists- What are the non ergot derived?
Pramipexole
Ropinerole
Ritogitine
WHat are some other DRA
Apomorphine and Amantadine
WHat are the side effects of ergot derived DRA
FIbrotic reactions
Retroperitoneal-
Pericardial
Pulmonary
Side effects of DRA
Cardiovascular events Sudden sleep onset Impulse control disorders Psychosis Hypotensive
MAOB- Inhibits MAOB what are the two MAOB
Selegline
Rasageiline
Interactions of MAOB
Hypertensive crisis- Adrenaline, noradrenaline, corticosteroids, pseudoephedrine, phenyl-ephedrine
COM-T inhibitors what are they?
Entacapone
Tolcapone
What is the use for COMT inhibitors?
Never used alone, always with levodopa as they inhbit the enzyme catechol-o- methyltransfarase to stop the breakdown of levodopa so it can enter BBB
Entacapone colours urine what colour
red/brown
What is the patient counselling for COMT-I
Hepatotoxicity look our for signs of jaundice, N&V, abdo pain
Interactions of COMT-I
increased cardiovascular effects
Daytime sleepiness/ sudden onset of sleep treatment
have Parkinson’s meds adjusted/
Modafanil
Postural hypo in Parkinsons 1st line treatment
Midodrine
Psychotic symptoms do you always treat?
No. do not need treatment if well controlled.
If severe then treat
If no cognitive impairment give quetiapine
clozapine if ineffective
rapid eye movement treatment
Clonazepam
Drooling
Botulinum or glycopyronium
